1
|
Sanabria A, Pinillos P, Chiesa-Estomba C, Guntinas-Lichius O, Kowalski LP, Mäkitie AA, Rao KN, Ferlito A. Comparing Mohs micrographic surgery and wide local excision in the management of head and neck dermatofibrosarcoma protuberans: a scoping review. J DERMATOL TREAT 2024; 35:2295816. [PMID: 38146660 DOI: 10.1080/09546634.2023.2295816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia-Biodonostia Research Institute, San Sebastian, Spain
| | | | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Karthik N Rao
- Department of Head Neck Surgical Oncology, All India Institute of Medical Sciences, Raipur, India
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
2
|
Asarkar AA, Chang BA, de Bree R, Kowalski LP, Guntinas-Lichius O, Bradley PJ, de Graaf P, Strojan P, Rao KN, Mäkitie AA, López F, Rinaldo A, Palme C, Genden EM, Sanabria A, Rodrigo JP, Ferlito A. Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies. Adv Ther 2024:10.1007/s12325-024-02861-6. [PMID: 38642199 DOI: 10.1007/s12325-024-02861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. METHODS A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. RESULTS Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. CONCLUSION The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.
Collapse
Affiliation(s)
- Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Brent A Chang
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Patrick J Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Pim de Graaf
- Amsterdam UMC Location Vrije Universiteit, Radiology and Nuclear Medicine, de Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000, Ljubljana, Slovenia
| | - Karthik N Rao
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, India
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fernando López
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Carsten Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY, 10029, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Universidad de Antioquia, Medellin, Colombia
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, 33011, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35030, Padua, Italy
| |
Collapse
|
3
|
Brunet A, Rovira A, Quer M, Sanabria A, Guntinas-Lichius O, Zafereo M, Hartl DM, Coca-Pelaz A, Shaha AR, Marie JP, Vander Poorten V, Piazza C, Kowalski LP, Randolph GW, Shah JP, Rinaldo A, Simo R. Recurrent Laryngeal Nerve Intraoperative Neuromonitoring Indications in Non-Thyroid and Non-Parathyroid Surgery. J Clin Med 2024; 13:2221. [PMID: 38673494 DOI: 10.3390/jcm13082221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term "recurrent laryngeal nerve monitoring". IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured.
Collapse
Affiliation(s)
- Aina Brunet
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitari Bellvitge, Universitat de Barcelona, 08907 Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Aleix Rovira
- Department of Otorhinolaryngology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Miquel Quer
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin 1226, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Head and Neck Surgery, Jena University Hospital, 07747 Jena, Germany
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dana M Hartl
- Thyroid Surgery Unit, Department of Otorhinolaryngology Head and Neck Surgery, Institute Gustave Roussy, 94805 Paris, France
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain
| | - Ashok R Shaha
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, Medical College, Cornell University, New York, NY 10065, USA
| | - Jean-Paul Marie
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Biomedical Research, University Hospital Rouen, 76000 Rouen, France
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Cesare Piazza
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Spedali Civili of Brescha, School of Medicine, University of Brescia, 25123 Brescia, Italy
| | - Luiz P Kowalski
- Department of Otorhinolaryngology Head and Neck Surgery, A.C. Camargo Cancer Center, Faculty of Medicine, University of Sao Paulo, São Paulo 03828-000, Brazil
| | - Gregory W Randolph
- Department of Otorhinolaryngology, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
| | - Jatin P Shah
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weil Medical College, Cornell University, New York, NY 10065, USA
| | | | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
- King's College London, London SE5 8AF, UK
| |
Collapse
|
4
|
Betancourt C, Sanabria A. Post-thyroidectomy pain relief is enhanced by wound infiltration. A systematic review of randomized controlled trials. Surgeon 2024:S1479-666X(24)00017-9. [PMID: 38360454 DOI: 10.1016/j.surge.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Thyroidectomy is a common surgical procedure. Traditional options for pain management, such as analgesics and nonsteroidal anti-inflammatory medications (NSAIDs), are limited by their side effects. Surgical wound infiltration with local anesthetics has the potential to reduce the need for analgesics in a number of surgical procedures. This systematic review and meta-analysis wanted to resolve these concerns and assess the efficacy of WI in the management of postoperative pain after thyroidectomy. MATERIAL AND METHODS The review adhered to Cochrane Collaboration and PRISMA standards. RCTs comparing WI with no infiltration or placebo were included. Patients with benign or malignant thyroid disease who underwent open thyroidectomy were eligible. Postoperative pain was assessed using a visual analogue scale (VAS) as the primary outcome. Time to first rescue dose, the need for analgesic rescue in the first 24 h, and total opioid analgesic consumption were secondary outcomes. Standardized mean difference (SMD) and odds ratio (OR) were used to analyze the data. RESULTS 16 randomized controlled trials involving 1202 patients were included. At 6 and 8 h postoperatively, WI exhibited a statistically significant impact on pain management. In the WI group, the need for analgesic rescue was significantly reduced. At 4 h postoperatively, non-anesthetic medications demonstrated a significant analgesic effect. CONCLUSIONS This systematic review and meta-analysis support the use of WI with local anesthetics for postoperative pain management after thyroidectomy. These findings have significant implications for improving perioperative care, especially in ambulatory settings where effective pain management is essential.
Collapse
Affiliation(s)
- Carlos Betancourt
- Head and Neck Service, Hospital Alma Mater. Medellín, Colombia. CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater. Medellín, Colombia. CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia; Department of Surgery, School of Medicine, Universidad de Antioquia, Cra. 51d #62-29, Medellin, Colombia.
| |
Collapse
|
5
|
Ledesma-Leon T, Solis-Pazmino P, Lincango EP, Figueroa LA, Ellenhorn J, Nasseri Y, Cohen J, Romero-Arenas M, Garcia C, Sanabria A, Rojas T, Torres-Román J, Camacho E, Vallejo S, Alvarado-Mafla B, Dream S, James BC, Ponce OJ, Sharma A, Brito JP. Ablation techniques or active surveillance compared to surgical resection in patients with low-risk papillary thyroid cancer: a systematic review and meta-analysis. Endocrine 2024; 83:330-341. [PMID: 37658978 DOI: 10.1007/s12020-023-03502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The global prevalence of thyroid cancer is on the rise. About one-third of newly diagnosed thyroid cancer cases comprise low-risk papillary thyroid cancer (1.5 cm or more minor). While surgical removal remains the prevailing approach for managing low-risk papillary thyroid cancer (LPTC) in patients, other options such as active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) are also being considered as viable alternatives. This study evaluated and compared surgical thyroid resection (TSR) versus non-surgical (NS) methods for treating patients with LPTC. METHODS The study encompassed an analysis of comparisons between surgical thyroid resection (TSR) and alternative approaches, including active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), or laser ablation (LA). The focus was on patients with biopsy-confirmed low-risk papillary thyroid cancer (LPTC) of less than 1.5 cm without preoperative indications of local or distant metastasis. The primary outcomes assessed were recurrence rates, disease-specific mortality, and quality of life (QoL). Data were collected from prominent databases, including Cochrane Database, Embase, MEDLINE, and Scopus, from inception to June 3rd, 2020. The CLARITY tool was utilized to evaluate bias risk. The analysis involved odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes, as well as mean differences (MD) and standardized mean differences (SMD) for continuous outcomes. The study is registered on PROSPERO under the identifier CRD42021235657. RESULTS The study incorporated 13 retrospective cohort studies involving 4034 patients. Surgical thyroid resection (TSR), active surveillance (AS), and minimally invasive techniques like radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) were performed in varying proportions of cases. The analysis indicated that specific disease mortality rates were comparable among AS, MWA, and TSR groups. The risk of recurrence, evaluated over different follow-up periods, showed no significant differences when comparing AS, RFA, MWA, or LA against TSR. Patients undergoing AS demonstrated better physical health-related quality of life (QoL) than those undergoing TSR. However, no substantial differences were observed in the overall mental health domain of QoL when comparing AS or RFA with TSR. The risk of bias was moderate in nine studies and high in four. CONCLUSION Low-quality evidence indicates comparable recurrence and disease-specific mortality risks among patients with LPTC who underwent ablation techniques or active surveillance (AS) compared to surgery. Nevertheless, individuals who opted for AS exhibited enhanced physical quality of life (QoL). Subsequent investigations are warranted to validate these findings.
Collapse
Affiliation(s)
- Tannya Ledesma-Leon
- Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Paola Solis-Pazmino
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
- Surgery Group Los Angeles, Los Angeles, CA, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eddy P Lincango
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | - Luis A Figueroa
- Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | | | | | - Jason Cohen
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | - Minerva Romero-Arenas
- Department of Surgery, Weill Cornell Medicine New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Cristhian Garcia
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello, Quito, Ecuador
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia. -Centro de Excelencia en Enfermedades de Cabeza y Cuello. CEXCA, Medellin, Colombia
| | - Tatiana Rojas
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | | | - Emilia Camacho
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Sebastian Vallejo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Sophie Dream
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Benjamin C James
- Beth Israel Deaconess Medical Center Department of Surgery, 484273, Surgery, 185 Pilgrim Road, Palmer 605, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Oscar J Ponce
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | - Arun Sharma
- MultiCare Health System Tacoma General Hospital, Tacoma, WA, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA.
| |
Collapse
|
6
|
Gómez O, Sanabria A. Quality of life of patients with thyroid cancer in Colombia. ENDOCRINOL DIAB NUTR 2024; 71:61-70. [PMID: 38553170 DOI: 10.1016/j.endien.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/29/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Quality of life (QoL) in thyroid cancer patients is comparable to patients with other tumours with worse prognosis. The aim was to evaluate QoL in Colombian patients with thyroid carcinoma and to explore the association of QoL scores with patient features. METHODS This is a cross-sectional study. The present research was carried out from data obtained for the validation study of the Spanish version of the THYCA-QoL. Adult patients with thyroid carcinoma who underwent total or partial thyroidectomy were included and asked to complete the Spanish-validated versions of the THYCA-QoL and EORTC QLQ-C30 questionnaires. The scores of each domain and single items underwent linear transformation to values of 0-100. Comparisons of scale scores with clinical variables were performed. RESULTS We included 293 patients. The global EORTC QLQ-C30 score was 73.2±22.1 and the domains with poorer values were emotional and cognitive and the symptoms with poorer values were insomnia and fatigue. The global THYCA-QOL score was 28.4±17.8. The domains with poorer values were neuromuscular and psychological and the single items with poorer values were headaches and tingling hands/feet. CONCLUSION Colombian patients with thyroid cancer have a good prognosis, but they experience important problems related to QoL. QoL was influenced by demographic and clinical factors such as age, sex functional status and clinical stage.
Collapse
Affiliation(s)
- Oscar Gómez
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia; Head and Neck Service, Fundación Colombiana de Cancerología-Clínica Vida, Medellín, Colombia; Centro de Excelencia en Enfermedades de Cabeza y Cuello, CEXCA, Medellín, Colombia.
| |
Collapse
|
7
|
Eskander A, Dziegielewski PT, Patel MR, Jethwa AR, Pai PS, Silver NL, Sajisevi M, Sanabria A, Doweck I, Khariwala SS, St John M. Oral Cavity Cancer Surgical and Nodal Management: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2024; 150:172-178. [PMID: 38153725 DOI: 10.1001/jamaoto.2023.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Importance Lymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome. Observations The surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended. Conclusions Existing literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.
Collapse
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Mirabelle Sajisevi
- Department of Otolaryngology, The University of Vermont Medical Center, Burlington
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Ilana Doweck
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Maie St John
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
| |
Collapse
|
8
|
Valencia J, Jiménez J, Sanabria A. Early stimulated thyroglobulin after thyroidectomy for thyroid cancer predicts preradioiodine therapy thyroglobulin values. Minerva Endocrinol (Torino) 2023; 48:387-394. [PMID: 35822431 DOI: 10.23736/s2724-6507.22.03813-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Follow-up of patients who undergo a total thyroidectomy is performed with thyroglobulin (Tg), and antithyroglobulin antibodies (AbTg). The objective of RAI adjuvant therapy is to negativize Tg to undetectable levels to ease the follow-up. The objective of this study was to evaluate the correlation of serum Tg values measured 2 weeks after surgery with the Tg value prior to RAI adjuvant therapy in order to define its utility as a reliable predictor of pretherapy Tg and as a potential predictor to avoid RAI adjuvant therapy. METHODS Retrospective analysis of a cohort recruited prospectively. Adult patients with thyroid carcinoma who underwent total thyroidectomy and classified as intermediate or high risk by ATA guidelines. All patients were left without levothyroxine support after surgery and for at least two weeks. We measured biochemical markers two-four weeks after thyroidectomy and before and after RAI. RESULTS We included 75 patients. Thirty-three (44.0%) patients were classified as ATA high risk. In the post-RAI scan, only 1 (1.3%) showed distant metastases. The comparison between early postoperative and pretherapy Tg values showed that Tg decreased or remained stable at postoperative levels in 75 patients (100%). CONCLUSIONS Postoperative Tg measurements are a reliable marker of pretherapy Tg levels in patients with intermediate- and high-risk thyroid carcinoma who are candidates for RAI adjuvant therapy. These results need correlation with outcomes and response to therapy in high-risk patients.
Collapse
Affiliation(s)
- Julio Valencia
- School of Medicine, Department of Surgery, University of Antioquia, Medellin, Colombia
- Head and Neck Service, Pablo Tobón Uribe Hospital, Medellín, Colombia
| | - Jorge Jiménez
- Centro de Excelencia en Enfermedades de Cabeza y Cuello (CEXCA), Medellín, Colombia
| | - Alvaro Sanabria
- School of Medicine, Department of Surgery, University of Antioquia, Medellin, Colombia -
- Centro de Excelencia en Enfermedades de Cabeza y Cuello (CEXCA), Medellín, Colombia
| |
Collapse
|
9
|
Sanabria A, Olivera MP, Chiesa-Estomba C, Hamoir M, Kowalski LP, López F, Mäkitie A, Robbins KT, Rodrigo JP, Piazza C, Shaha A, Sjögren E, Suarez C, Zafereo M, Ferlito A. Correction to: Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review. Adv Ther 2023; 40:4691-4692. [PMID: 37526875 PMCID: PMC10499939 DOI: 10.1007/s12325-023-02626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia.
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
| | - María Paula Olivera
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, and the Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan Pablo Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Elizabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125, Padua, Italy
| |
Collapse
|
10
|
Sanabria A, Olivera MP, Chiesa-Estomba C, Hamoir M, Kowalski LP, López F, Mäkitie A, Robbins KT, Rodrigo JP, Piazza C, Shaha A, Sjögren E, Suarez C, Zafereo M, Ferlito A. Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review. Adv Ther 2023; 40:3681-3696. [PMID: 37436593 PMCID: PMC10427525 DOI: 10.1007/s12325-023-02561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario. METHODS A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case-control, comparative cohort, or randomized controlled trial (RCT) studies were included. RESULTS A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8-20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce. CONCLUSION We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia.
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
| | - María Paula Olivera
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, and the Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan Pablo Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Elizabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Mark Zafereo
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125, Padua, Italy
| |
Collapse
|
11
|
Restrepo S, Rojas S, Sanabria A. Satisfaction With Head and Neck Scar Appearance in Latin American Patients: A Cross-Sectional Study. Eplasty 2023; 23:e56. [PMID: 37743968 PMCID: PMC10517663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Surgical scars have been related to poor quality of life, and this is important for head and neck scars. There is a paucity of data about the effect of scars on appearance in Latin American patients. The objective of this study was to describe the self-assessment of patient scars using the Patient Scar Assessment Questionnaire (PSAQ). Methods This is a cross-sectional study. The validated Spanish version of the PSAQ was used. Adult patients who underwent elective head and neck surgery were included. Demographic and clinical data were obtained from clinical charts. Univariate and multivariate analysis using a forward logistic regression was planned to assess the weight of specific subscale items on the overall subscale score for appearance and satisfaction with appearance. Results 180 patients were recruited. A total of 144 (80%) patients were female, and the most frequent type of surgery was thyroidectomy. The global appearance, the global scar consciousness and the global scar appearance satisfaction was classified as excellent/good in 72.2%, 93.9% and 87.8% of patients, respectively. The multivariate analysis showed that color (OR 5.9, 95% CI 1.7-20.8), width (OR 58.9, [4.3-807.6]), and flatness (OR 5.7, [1.3-23.6]) were the items statistically associated with a regular/bad result in the appearance subscale. Conclusions There is a high level of satisfaction with head and neck scar appearance, and these data should be used to assess the impact of surgical interventions on cosmesis. The intrinsic characteristics of scars are the most relevant for defining scar satisfaction.
Collapse
Affiliation(s)
- Santiago Restrepo
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
| | - Santiago Rojas
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
- Head and Neck Service, Fundación Colombiana de Cancerología- Clínica Vida, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y Cuello, CEXCA, Medellín, Colombia
| |
Collapse
|
12
|
Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright SB, Castells Fusté I, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Doulatram Gamgaram VK, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, François G, Frías-Fernández P, Gamboa-Dominguez A, Genc V, Giordano D, Gómez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JHI, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Košec A, Kovacevic B, Kowalski LP, Králik R, Yadav SK, Kumorová A, Lampridis S, Lasithiotakis K, Leclere JC, Leong EKF, Leow MKS, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, López-Gómez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Muñoz-de-Nova JL, Muradás Girardi F, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Pérez ÒV, Petrovic S, Raffaelli M, Ramacciotti CF, Ratia Gimenez T, Rivo Vázquez Á, Roh JL, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Vázquez Rentería RS, Velázquez-Fernández D, Vithana SMP, Yücel L, Yulian ED, Zahradnikova P, Zarogoulidis P, Ziablitskaia E, Zolotoukho A, Calò PG. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. Lancet Diabetes Endocrinol 2023; 11:402-413. [PMID: 37127041 PMCID: PMC10147315 DOI: 10.1016/s2213-8587(23)00094-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING None.
Collapse
Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Chiara Dobrinja
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Ebtesam Abdullah Al-Suhaimi
- Biology Department, College of Science, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Julia Altmeier
- Endocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Said Anajar
- Department of Otolaryngology-Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Akif Enes Arikan
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Türkiye
| | - Irina Azaryan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Giancarlo Basili
- Azienda USL Toscana Nord-Ovest, UOSD Chirurgia della Tiroide, Toscana, Italy
| | - Hakan Bolukbasi
- General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
| | - Marco Bononi
- Dipartimento di Chirurgia Pietro Valdoni, Policlinico Umberto I Sapienza, Rome, Italy
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK
| | - Mehmet Buğra Bozan
- General Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Türkiye
| | - Gabriela Brenta
- Endocrinology Department, Unidad Asistencial Dr César Milstein, Buenos Aires, Argentina
| | - Laurent Brunaud
- Department of Surgery CVMC, CHU Nancy-Brabois, Université de Lorraine, Nancy, France
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Antoine Buemi
- Department of Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | | | - Beatriz Cavalheiro
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital São Camilo Oncologia-Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | | | - Andres Chala
- Head and Neck Department Oncologos del Occidente, Universidad de Caldas, Manizales, Colombia
| | - Shun Yan Bryant Chan
- Department of Surgery, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China
| | - John Chaplin
- Department of Otolaryngology Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany; Department of Endocrine Surgery, Evangelisches Klinikum Cologne Weyertal, Cologne, Germany
| | - Maria Grazia Chiofalo
- Head and Neck Cancer Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Fondazione G Pascale, Napoli, Italy
| | - Emmanuel Chrysos
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | - Annamaria D'Amore
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael de Cillia
- Department of Surgery, Saint John of God Hospital, Salzburg, Austria
| | - Carmela De Crea
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Nicolò de Manzini
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Leandro Luongo de Matos
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Unit-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Del Rio
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Muthuswamy Dhiwakar
- Department of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Coimbatore, India
| | | | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Valerio D'Orazi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Division of General Surgery-Section of Endocrine and Diabetic Foot Surgery, "Fabia Mater" Hospital, Rome, Italy
| | | | - Vitalijus Eismontas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania; Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Hadj Omar El Malki
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University, Rabat, Morocco
| | | | - Octavian Enciu
- Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Francesco Feroci
- Department of Surgery, General Surgery Unit, S Stefano Hospital, Prato, Italy
| | | | - Dimitrios Filis
- Department of Surgery, Saint Andrew Hospital of Patras, Patras, Greece
| | - Gorostidi François
- Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Armando Gamboa-Dominguez
- Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Volkan Genc
- Department of Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - James Griffin
- Otolaryngology, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - Sofia Cuco Guerreiro
- Endocrine Surgery, University Hospital Center of Central Lisbon, Hospital Curry Cabral, Lisboa, Portugal
| | - Karan Gupta
- Department of Head and Neck Surgery, Medanta, Gurugram, India
| | - Keshav Kumar Gupta
- Department of ENT, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | | | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Wirsma Arif Harahap
- Department of Surgery, Faculty of Medicine, Universitas Andalas, Padang City, Indonesia
| | - Lindsay Hargitai
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Dana Hartl
- Department of Surgery, Anesthesia and Interventional Radiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy, Villejuif, France
| | - Andrzej Hellmann
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jiri Hlozek
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nadia Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "Georgios Papanikolaou", Thessaloniki, Greece
| | - J H Isabelle Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | | | - Milan Jovanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade, Serbia
| | - Reto Martin Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fahmi Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Iraq
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Martin Karamanliev
- Department of Surgical Oncology, University Hospital "Georgi Stranski", Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Japan
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Bozidar Kovacevic
- Institute of Pathology and Forensic Medicine, Medical Military Academy, Belgrade, Serbia
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgry and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Robert Králik
- Department of Surgical Oncology, St Elisabeth Cancer Institute, Medical Faculty of Comenius University, Bratislava, Slovakia
| | | | - Adriána Kumorová
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital Ružomberok, Ružomberok, Slovakia
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
| | - Konstantinos Lasithiotakis
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | | | | | | | - James Y Lim
- Department of Surgery and Otolaryngology, Oregon Health and Science University, Portland, OR, USA
| | | | - Shirley Yuk Wah Liu
- Department of Surgery, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Perucho Llorach
- Unit of Endocrine Surgery Head and Neck Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Javier López-Gómez
- Head and Neck Department, Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Eleonora Lori
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Lourdes Quintanilla-Dieck
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Roberta Lucchini
- Endocrine Surgery Unit, University of Perugia, Santa Maria Hospital, Terni, Italy
| | - Amin Madani
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Manatakis
- Second Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ivan Markovic
- Clinic for Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Julie A Miller
- The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC, Australia
| | - Michele Minuto
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Barbara Mullineris
- Department of General, Emergency and New Technologies, University Hospital of Modena, Baggiovara Civil Hospital, Modena, Italy
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Saki Nader
- Otolaryngology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Chiara Offi
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, ASl Napoli 1 Centro, Naples, Italy
| | - Ohad Ronen
- Galilee Medical Center, Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel
| | | | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Yongqin Pan
- Department of Thyroid Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Emmanouil Panagiotidis
- Department of Nuclear Medicine/PET CT, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Theodosios Papavramidis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Pradipta Kumar Parida
- Department of ENT-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anna Paspala
- Department of Surgery, Eugenideio Hospital, Athens, Greece
| | - Òscar Vidal Pérez
- General Surgery Department, Universitat de Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Tomas Ratia Gimenez
- General Surgery, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
| | - Ángel Rivo Vázquez
- Department of General and Digestive Surgery, Division of Endocrine Surgery, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alena Santeerapharp
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Arseny Semenov
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Altinay Serdar
- Department of Endocrin Pathology Unit, University of Health Sciences, Faculty of Medicine, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sean C Sheppard
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Rachel L Slotcavage
- Department of Surgery and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Soo Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Yigit Turk
- Division of Endocrine Surgery, General Surgery Department, Ege University Hospital, Izmir, Turkey
| | - George Tzikos
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kristina Vabalayte
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Kelly Vargas-Osorio
- Clinical University Hospital Santiago de Compostela University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - David Velázquez-Fernández
- Endocrine Surgery Unit, Department of Surgery, National Institute for Medical Sciences and Nutrition, Mexico City, Mexico
| | | | - Levent Yücel
- Department of Otorhinolaryngology, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey
| | - Erwin Danil Yulian
- Division of Surgical Oncology, Department of Surgery, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Petra Zahradnikova
- Department of Paediatric Surgery, Medical Faculty of Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Paul Zarogoulidis
- Third Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgeniia Ziablitskaia
- Central Research Laboratory, Clinical Medical Multidisciplinary Center of St Luke VI Vernadsky Crimean Federal University, Simferopol, Russia
| | - Anna Zolotoukho
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | |
Collapse
|
13
|
Sanabria A, Betancourt C, Chiesa-Estomba C, Coca-Pelaz A, Florek E, Guntinas-Lichius O, Lopez F, Mäkitie AA, Nixon IJ, Randolph G, Rinaldo A, Rodrigo JP, Shaha AR, Tufano RP, Zafereo M, Ferlito A. Locoregional strategies to decrease postoperative pain and neck discomfort after open thyroidectomy: A scoping review. Head Neck 2023. [PMID: 37163465 DOI: 10.1002/hed.27392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023] Open
Abstract
Adequate pain control enhances patients' quality of life and allows a quick return to normal activities. Current pain management practices may contribute to the crisis of opioid addiction. We summarize the evidence that evaluates locoregional interventions to decrease pain and neck discomfort after thyroidectomy. We designed a scoping review. The search strategy was made in the Pubmed/MEDLINE and EMBASE database. We included only systematic reviews and RCTs that compared two or more strategies. Forty-nine publications including 5045 patients fulfilled criteria. Sore throat frequency is higher for endotracheal intubation and topical administration of anesthetic before intubation decreases this. Pre-incisional infiltration of the surgical wound decreases postoperative pain. Bilateral superficial plexus nerve block decreases analgesic requirements during and after thyroidectomy. Wound massage and neck exercises decrease postoperative discomfort. Locoregional interventions significantly impact postoperative pain and may reduce opioid use and improve patient outcomes.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y cuello, Medellín, Colombia
| | - Carlos Betancourt
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y cuello, Medellín, Colombia
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology - Head & Neck Surgery, Hospital Universitario Donostia-Biodonostia Research Institute, San Sebastian, Spain
| | - Andrés Coca-Pelaz
- Department of Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA)-Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Fernando Lopez
- Department of Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA)-Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Iain J Nixon
- Department of Otorhinolaryngology - Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - Gregory Randolph
- Division of Otolaryngology - Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA
| | | | - Juan Pablo Rodrigo
- Department of Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA)-Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ralph P Tufano
- FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
14
|
Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O, Guntinas-Lichius O, Eisbruch A, Zafereo M, Mäkitie AA, Shaha AR, Coca-Pelaz A, Rinaldo A, Saba NF, Cohen O, Lopez F, Rodrigo JP, Silver CE, Strandberg TE, Kowalski LP, Ferlito A. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 2023; 40:1957-1974. [PMID: 36920746 DOI: 10.1007/s12325-023-02460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.
Collapse
Affiliation(s)
- Leandro L Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - K Thomas Robbins
- Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gyorgy B Halmos
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robert P Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
15
|
Garcia-Lozano CA, Sanabria A. Preliminary Report of Active Surveillance as a Conservative Strategy for Bethesda IV Thyroid Nodules. Thyroid 2023; 33:126-128. [PMID: 36254389 DOI: 10.1089/thy.2022.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Carlos Andres Garcia-Lozano
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| |
Collapse
|
16
|
Antoniou SA, Florez ID, Markar S, Logullo P, López-Cano M, Silecchia G, Antoniou GA, Tsokani S, Mavridis D, Brouwers M, Bertolaccini L, Alonso-Coello P, Akl E, Chand M, Como JJ, de Borst GJ, Di Saverio S, Emile S, Eom BW, Gorter R, Hanna G, Immonen K, Lai Q, Lumen N, Mathew JL, Montendori A, Moya M, Pellino G, Sanabria A, Saratzis A, Smart N, Stefanidis D, Zaninotto G. Author Correction: AGREE-S: AGREE II extension for surgical interventions: appraisal instrument. Surg Endosc 2023; 37:780. [PMID: 36414872 DOI: 10.1007/s00464-022-09770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stavros A Antoniou
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus. .,European University Cyprus, Nicosia, Cyprus.
| | - Ivan D Florez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, University of Antioquia, Medellin, Colombia
| | - Sheraz Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Patricia Logullo
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Val d' Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Coca-Pelaz A, Rodrigo JP, Lopez F, Shah JP, Silver CE, Al Ghuzlan A, Menke-van der Houven van Oordt CW, Smallridge RC, Shaha AR, Angelos P, Mendenhall WM, Piazza C, Olsen KD, Corry J, Tufano RP, Sanabria A, Nuyts S, Nathan CA, Vander Poorten V, Dias FL, Suarez C, Saba NF, de Graaf P, Williams MD, Rinaldo A, Ferlito A. Evaluating new treatments for anaplastic thyroid cancer. Expert Rev Anticancer Ther 2022; 22:1239-1247. [PMID: 36283091 DOI: 10.1080/14737140.2022.2139680] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Anaplastic thyroid cancer (ATC) is one of the most lethal diseases known to humans with a median survival of 5 months. The American Thyroid Association (ATA) recently published guidelines for the treatment of this dreadful thyroid malignancy. AREAS COVERED This review presents the current therapeutic landscape of this challenging disease. We also present the results from trials published over the last five years and summarize currently active clinical trials. EXPERT OPINION Recent attempts to improve the prognosis of these tumors are moving toward personalized medicine, basing the treatment decision on the specific genetic profile of the individual tumor. The positive results of dabrafenib and trametinib for ATC harboring the BRAF V600E mutation have provided a useful treatment option. For the other genetic profiles, different drugs are available and can be used to individualize the treatment, likely using drug combinations. Combinations of drugs act on different molecular pathways and achieve inhibition at separate areas. With new targeted therapies, average survival has improved considerably and death from local disease progression or airway compromise is less likely with improvement in quality of life. Unfortunately, the results remain poor in terms of survival.
Collapse
Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carl E Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Abir Al Ghuzlan
- Department of Medical Biology and Pathology, Institut Gustave Roussy, Villejuif, France
| | - C Willemien Menke-van der Houven van Oordt
- Department of Medical Oncology, Amsterdam Center for Endocrine and Neuro Endocrine Tumors (ACcENT), Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | | | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - William M Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Cesare Piazza
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - June Corry
- Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia
| | - Ralph P Tufano
- FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, FL, USA
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y cuello, Medellín, Colombia
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, University of Leuven, Belgium.,Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Cherie-Ann Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, LA, USA
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.,Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Fernando Luiz Dias
- Head and Neck Surgery Section, Instituto Nacional do Câncer (INCA), Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Pim de Graaf
- Cancer Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michelle D Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - Alfio Ferlito
- Coordinator of the International Head Neck Scientific Group, Padua, Italy
| |
Collapse
|
18
|
Ledesma-Leon T, Solis-Pazmino P, Naranjo EPL, Ponce OJ, Rojas T, Alvarado-Mafla B, Camacho E, Torres-Roman JS, Soto Jacome C, Vallejo S, Sanabria A, Brito JP, Ali N, James BC, Dy B, Sharma A. PSAT377 Minimally Invasive Treatment Modalities or Active Surveillance Compared to Surgery for Patients with Small Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
The incidence of thyroid cancer is increasing worldwide. A third of new thyroid cancer cases are small papillary thyroid cancer (1.5 cm or less in size). Although surgical intervention is the most common management option for patients with small papillary thyroid cancer (SPTC), active surveillance (AS), radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA) are also considered as management alternatives. This study aimed to assess the comparative effectiveness of surgical (TS) vs. non-surgical management options for patients with SPTC.
Methods
We included studies comparing any type of TS versus AS, LA, RFA, or MWA in patients with a biopsy-proven SPTC of less than 1.5 cm without evidence of preoperative local or distant metastasis. The outcomes of interest were risk of recurrence of thyroid cancer, disease-specific mortality, and quality of life (QoL). All outcomes were measured at the longest follow-up. Literature search used Cochrane Database, Embase, and MEDLINE from inception to June 3rd, 2020. The CLARITY tool was used to assess the risk of bias. For dichotomous outcomes, we calculated odds ratios (OR) and their corresponding 95% confidence intervals (CI) using random-effects models. We estimated mean differences (MD) and standardized mean differences (SMD) based on predetermined criteria for continuous outcomes. PROSPERO (CRD42021235657).
Results
We included 14 retrospective cohort studies consisting of 6457 patients. TS, AS, RFA, MWA, and LA therapies were performed in 67.50% (n=4291), 21.03% (n=1337), 7.53% (n=479), 2.49% (n=255), and 1.27% (n=81) of cases, respectively. Disease-specific mortality (mean follow-up ranged from 37.5 to 120.0 months) was not different between patients who underwent TS versus AS. There was no data on mortality for the other noninvasive approaches. The risk of recurrence (mean follow-up ranged from 17.0 to 49.2 months) was not different when comparing LA, RFA, AS, or MWA against TS. The overall physical health domain of QoL (mean follow-up ranged from 10.8 to 29.6 months) was increased in patients who underwent AS (SMD: 0.23 95%CI 0.09; 0.37, k=2, I2=0.00%) compared to TS, but it was no different when comparing MWA or RFA versus TS. In addition, there were no differences in the overall mental health domain of QoL comparing AS or RFA vs TS. The risk of bias was considered moderate in nine studies and high in five studies.
Conclusion
Low evidence quality suggests equal risk of recurrence and mortality between SPTC patients who underwent minimally invasive treatment modalities or active surveillance compared to surgery. However, physical QoL was better in SPTC patients who underwent AS. Further studies are needed to confirm these results and draw robust conclusions.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
Collapse
|
19
|
Cordero-Garate J, Naranjo EPL, Tana ASC, Dominguez CM, Toapanta EA, Quinteros A, Jacome CS, Gomez S, García-Bautista A, Leon-Ledesma T, Solis-Pazmino P, Godoy R, Sanabria A, Villacis OAE, Garcia C. PSAT281 Crico-tracheal Resection with End-to-End Anastomosis for Locally Advanced Thyroid Cancer: A Case Series of Early Postoperative Outcomes of a Low-Income Country from Latin America. J Endocr Soc 2022. [PMCID: PMC9625541 DOI: 10.1210/jendso/bvac150.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Tracheal invasion is a poor prognostic factor in patients with aggressive thyroid cancer. Crico-tracheal resection and primary anastomosis (CTRA) is the preferred surgical technique. Appropriate resection can improve early postoperative outcomes and long-term oncological outcomes. A recent systematic review of eastern literature showed a moderate rate of postoperative complications. However, there is a paucity of data regarding early postoperative complications in Latin America. Therefore, the aim of this report is to describe the early postoperative outcomes of three patients with thyroid cancer invading the trachea who underwent CTRA in two tertiary referral centers (1 public and 1 private) in a low-income country. Clinical Cases There were 2 females (F1: 53 y, F2: 55 y) and 1 male (M1: 53 y) patients from Ecuador. Patient F1 had follicular variant of papillary thyroid cancer (PTC) and was operated on in the public center and patients F2 and M1 had classic variant of PTC. Neck CT and perioperative flexible endoscopy were performed for airway invasion assessment. All patients underwent total thyroidectomy with circumferential CTRA. Patient F1 had a right lobe thyroid tumor with intraluminal invasion of the 5th tracheal ring up to the cricoid cartilage, the recurrent laryngeal nerve (RLN) and common carotid artery, and bilateral central neck lymph node metastasis. She underwent bilateral central neck dissection, carotid shaving, and RLN resection. Patient F2 showed an enlarged, multinodular thyroid invading the 4th up to the 1st tracheal ring, without luminal compromise. There was no invasion to other structures. Patient M1 had a right lobe thyroid tumor, with intraluminal invasion of the 4th tracheal ring up to the cricoid cartilage and invasion of the RLN. He underwent RLN resection. Patient F1 and M1 were classified as Shin IV and patient F2, Shin III. Regarding the 30-day postoperative complications, patient F1 had tracheostomy infection on day 5, tracheal dehiscence and anastomotic dehiscence that caused massive bleeding, cardiorespiratory failure and death on day 8. Patient M1 only presented mild bleeding through the traqueostomy tube on day 1, non-compressive cervical hematoma on day 2, and was discharged on day 5. Patient F2 had no complications and was discharged on day 3. The last 2 patients were decanulated successfully at the 2-week follow-up and received adjuvant radioactive iodine. Conclusions CTRA seems to be a safe procedure with moderate postoperative complications, low mortality, and zero tracheotomy-dependency rates in patients operated in Ecuador. Our results are similar to those described in the international literature. Further studies are needed to confirm these results and draw robust conclusions. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
Collapse
|
20
|
De Diego Soler O, Sanabria A, Morr I, Alamar M, Lorenzatti D, Prat S, Doltra A, Millan I, Sotes S, Lopez T, Ortega-Paz L, Sabate M, Andrea R, Brugaletta S, Ortiz-Perez JT. Analysis of myocardial salvage with cardiac magnetic ressonance and angiography depending on the STEMI revascularization pathway in a PPCI centre. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Reperfusion networks have permitted improvements in reperfusion delays in primary percutaneous coronary intervention (PPCI)-treated ST elevation myocardial infarction (STEMI). However, the impact on myocardial salvage (MS) of direct transfer to the catheterization laboratory (cath-lab) to minimize system delay remains unknown.
Objective
We sought to quantify the myocardial salvage index (MSI) acutely and to assess adverse remodeling at 6 months in PPCI-treated STEMI according to the mode of patient presentation.
Methods
Between 2005 and 2021 we included 493 patients in a single center registry of first PPCI-treated STEMI who were studied with Late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) in the acute phase. Among them, 414 (84.0%) underwent a second LGE-CMR at 6 months. Subjects were classified depending on the mode of presentation: those diagnosed out-of-hospital and directly transferred to the cath-lab by the Emergency Medical Services (EMS group, 29.82%); subjects with first medical contact in a PCI-capable hospital (PCI-H group, 41.75%); and patients presenting to a non-PCI-capable center and transferred for PCI (non-PCI-H group, 28.43%). We computed the angiographic area at risk by BARI score, and combined it with the LGE-CMR derived infarct size to compute a validated MSI, expressed as percentage of area at risk. The change in ejection fraction (EF) and indexed left ventricle end-diastolic volume (iLVEDV) from baseline to 6 months was also computed.
Results
The mean age was 58.9±11.9 years, 84.5% were male and 51.4% had anterior STEMI. Total median ischaemic time was (median (interquartile range)) 126 (105–161) min in the EMS group, 201 (145–321) min in the PCI-H group and 300 (173–592) min in the non-PCI-H group (p<0.01). MSI was 45.28±2.6%, 39.63±2.2% and 35.53±2.7% respectively (p=0.034). In a multiple linear regression model adjusting for relevant covariables, including initial TIMI flow, area at risk, Killip class, age, sex, diabetes, number of vessels and presence of collaterals, a 7.50% (95% CI 0.9 to 14.1%) increase in MSI was observed in the EMS group compared to the PCI-H group, and 11.03% (95% CI 3.9 to 18.2%) compared to the non-PCI-H group (p=0.027 and 0.003 respectively). At 6 months, the mean absolute increase in EF was 5.36±0.6% for the EMS group, 4.03±0.5% for the PCI-H group and 3.52±0.6% for the non-PCI-H group (p<0.05 in the adjusted analysis) and the increase in iLVEDV was 2.37±7.3, 5.51±6.6 and 18.30±7.6 mL/m2 respectively (p=0.28).
Conclusions
Patients with out-of-hospital diagnostis of STEMI by the EMS who were directly transferred to the cath-lab showed shorter total ischaemic times, resulting in increased myocardial salvage and a trend towards improved indexes of left ventricular function at 6 months.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Grant from La Maratό de TV3 and grant from Fundaciό La Caixa
Collapse
Affiliation(s)
| | - A Sanabria
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - I Morr
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - M Alamar
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - D Lorenzatti
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Prat
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - A Doltra
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - I Millan
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Sotes
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - T Lopez
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - L Ortega-Paz
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - M Sabate
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - R Andrea
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Brugaletta
- Hospital Clinic of Barcelona , Barcelona , Spain
| | | |
Collapse
|
21
|
Suárez C, López F, Rodrigo JP, Mendenhall WM, de Bree R, Mäkitie AA, Vander Poorten V, Takes RP, Bondi S, Kowalski LP, Shaha AR, Fernández-Alvarez V, Gutiérrez JC, Zidar N, Chiesa-Estomba C, Strojan P, Sanabria A, Rinaldo A, Ferlito A. Benign Peripheral Non-cranial Nerve Sheath Tumors of the Neck. Adv Ther 2022; 39:3449-3471. [PMID: 35689724 DOI: 10.1007/s12325-022-02191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
Benign peripheral non-cranial nerve sheath tumors are rare lesions, including both schwannomas and neurofibromas. These tumors arise from Schwann cells, and may originate from any peripheral, cranial, or autonomic nerve. Most of them are localized and sporadic but multifocal systemic forms can occur. Cervical sympathetic chain, brachial plexus, cervical plexus and spinal roots and nerves are the major nerve systems commonly affected. Dumbbell-shaped intra- and extradural tumors occur most commonly in the cervical spine, as well as purely extradural and paravertebral tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques and surgical innovations such as endoscopically assisted approaches and robotic surgery. Microsurgical intracapsular excision of the tumor helped by the use of intraoperative fluorescent dyes and intraoperative neurophysiological monitoring minimize postoperative neural deficit, since most schwannomas are encapsulated. Most tumors can be removed with a low rate of complications and recurrence. Radiotherapy should be considered for growing lesions that are not amenable to surgery. In asymptomatic patients, observation and serial scans is an option for elderly infirm patients.
Collapse
Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Avenida de Roma s/n, 33011, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
- Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefano Bondi
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center and University of São Paulo Medical School, São Paulo, Brazil
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Julio C Gutiérrez
- Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastián, Spain
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, 050010, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, 050021, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
22
|
López F, Shah JP, Beitler JJ, Snyderman CH, Lund V, Piazza C, Mäkitie AA, Guntinas-Lichius O, Rodrigo JP, Kowalski LP, Quer M, Shaha A, Homma A, Sanabria A, Ferrarotto R, Lee AWM, Lee VHF, Rinaldo A, Ferlito A. The Selective Role of Open and Endoscopic Approaches for Sinonasal Malignant Tumours. Adv Ther 2022; 39:2379-2397. [PMID: 35352310 PMCID: PMC9122878 DOI: 10.1007/s12325-022-02080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
Endoscopic endonasal surgery has been demonstrated to be effective in the treatment of selected cases of sinonasal cancers. However, in cases of locally advanced neoplasms, as well as recurrences, the most appropriate approach is still debated. The present review aims to summarize the current state of knowledge on the utility of open approaches to resect sinonasal malignant tumours. Published comparative studies and meta-analyses suggest comparable oncological results with lower morbidity for the endoscopic approaches, but selection biases cannot be excluded. After a critical analysis of the available literature, it can be concluded that endoscopic surgery for selected lesions allows for oncologically safe resections with decreased morbidity. However, when endoscopic endonasal surgery is contraindicated and definitive chemoradiotherapy is not appropriate, craniofacial and transfacial approaches remain the best therapeutic option.
Collapse
Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain.
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Maine General Hospital, Augusta, Maine, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Valerie Lund
- The Royal National Throat Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy, Brescia, Italy
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Luiz P Kowalski
- Department of Otorhinolaryngology, Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Akihiro Homma
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Victor H F Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
23
|
Cohen O, Ronen O, Khafif A, Rodrigo JP, Simo R, Pace-Asciak P, Randolph G, Mikkelsen LH, Kowalski LP, Olsen KD, Sanabria A, Tufano RP, Babighian S, Shaha AR, Zafereo M, Ferlito A. Revisiting the role of surgery in the treatment of Graves' disease. Clin Endocrinol (Oxf) 2022; 96:747-757. [PMID: 34954838 DOI: 10.1111/cen.14653] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 01/06/2023]
Abstract
Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.
Collapse
Affiliation(s)
- Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv, Israel
| | - Juan P Rodrigo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, Oviedo, Spain
| | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA
| | - Lauge H Mikkelsen
- Department of Pathology, Eye Pathology Section, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, AC Camargo Cancer Center, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Ips Universitaria, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello-Clínica Las Vegas-Quirón, Medellín, Colombia
| | - Ralph P Tufano
- Multidisciplinary Thyroid and Parathyroid Center, Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Madison, USA
| | - Silvia Babighian
- Department of Ophthalmology, Ospedale Sant'Antonio, Azienda Ospedaliera, Padova, Italy
| | - Ashok R Shaha
- Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mark Zafereo
- Department of Head & Neck Surgery, Anderson Cancer Center, Houston, Texas, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
24
|
Sjogren E, Hendriksma M, Piazza C, Hartl DM, Suarez C, Cohen O, de Bree R, Quer M, Poorten VV, Rodrigo JP, Civantos F, Genden E, Kowalski LP, Makitie A, Shaha A, Takes RP, Sanabria A, Guntinas-Lichius O, Rinaldo A, Ferlito A. Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review. J Voice 2022:S0892-1997(22)00069-8. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
Collapse
Affiliation(s)
- Elisabeth Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dana M Hartl
- Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Oviedo, Spain
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric Genden
- Ear, Nose, Throat / Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolarynglology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School
| | - Antti Makitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
25
|
Dominguez LC, Dolmans D, de Grave W, Donkers J, Sanabria A, Stassen L. Supervisors' transformational leadership style and residents' job crafting in surgical training: the residents' views. Int J Med Educ 2022; 13:74-83. [PMID: 35349982 PMCID: PMC9017501 DOI: 10.5116/ijme.622d.e2f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aims to explore the effects of three supervisors' leadership styles (transformational, transactional, and laissez-faire) on residents' job crafting. METHODS Sequential explanatory mixed-methods. First, a purposive sample of residents rated the leadership style of their supervisors and their own job crafting on the Multifactor Leadership Questionnaire and the Dutch Job Crafting Scale. The effects were tested through linear mixed effects regression analysis. Thereafter we conducted semi-structured interviews with residents and conducted a thematic analysis. RESULTS A total of 116 residents participated. A transformational style had a positive effect on residents' job crafting (b = .19, t(112) =3.76, p=. 009), whereas the transactional and laissez-faire styles did not. This could be explained by the fact that residents felt a positive influence of the supervisors with such style on the atmosphere for training, on the job resources available to them, and on their modelling function for how to handle the demands of the environment. CONCLUSIONS A transformational style of the supervisor has a positive effect on residents' job crafting. Future research should explore the supervisors' perspective, as well as the effectiveness of leadership training for supervisors with a focus on resident outcomes, such as job crafting.
Collapse
Affiliation(s)
| | - Diana Dolmans
- Department of Educational Development and Research, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Willem de Grave
- Department of Educational Development and Research, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Jeroen Donkers
- Department of Educational Development and Research, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Alvaro Sanabria
- Department of Surgery, Universidad de la Sabana, Chía, Colombia
| | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| |
Collapse
|
26
|
Vander Poorten V, Goedseels N, Triantafyllou A, Sanabria A, Clement PM, Cohen O, Golusinski P, Guntinas-Lichius O, Piazza C, Randolph GW, Rinaldo A, Ronen O, Cabanillas ME, Shaha AR, Teng Y, Tufano RP, Williams MD, Zafereo M, Ferlito A. Effectiveness of core needle biopsy in the diagnosis of thyroid lymphoma and anaplastic thyroid carcinoma: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:971249. [PMID: 36204100 PMCID: PMC9532007 DOI: 10.3389/fendo.2022.971249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Both anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any other thyroid swelling, a routine fine-needle aspiration (FNA) cytology is the first and only diagnostic test performed at the initial contact in the average thyroid practice. FNA, however, has a low sensitivity in diagnosing ATC and TL, and by the time the often "inconclusive" result is known, precious time has evolved, before going for core-needle biopsy (CNB) or incisional biopsy (IB) as the natural next diagnostic steps. OBJECTIVES To determine the diagnostic value of CNB in the clinical setting of a rapidly enlarging thyroid mass, via a systematic review and meta-analysis of the available data on CNB reliability in the differential diagnosis of ATC and TL. METHODS A PubMed, Embase and Web of Science database search was performed on June 23th 2021. Population of interest comprised patients who underwent CNB for clinical or ultrasonographical suspicion of ATC or TL, patients with a final diagnosis of ATC or TL after CNB, or after IB following CNB. RESULTS From a total of 17 studies, 166 patients were included. One hundred and thirty-six were diagnosed as TL and 14 as ATC following CNB. CNB, with a sensitivity and positive predictive value of 94,3% and 100% for TL and 80,1% and 100% for ATC respectively, proved to be superior to FNA (reported sensitivity for TL of 48% and for ATC of 61%). Furthermore, the need for additional diagnostic surgery after CNB was only 6.2% for TL and 17.6% for ATC. CONCLUSIONS Immediately performing CNB for a suspected diagnosis of ATC and TL in a rapidly enlarging thyroid mass is more appropriate and straightforward than a stepped diagnostic pathway using FNA first and awaiting the result before doing CNB.
Collapse
Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
- *Correspondence: Vincent Vander Poorten,
| | - Nathan Goedseels
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool, Liverpool, United Kingdom
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Ips Universitaria, Medellín, Colombia
| | - Paul M. Clement
- Department of Oncology, Section General Medical Oncology, KU Leuven, Leuven, Belgium
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, affiliated with Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Zielona Góra, Poland
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Cesare Piazza
- Department of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Gregory W. Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, United States
| | | | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ashok R. Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Yong Teng
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, FL, United States
| | - Michelle D. Williams
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, United States
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
27
|
Carrillo JF, Suarez C, Sanabria A, Onerci TM, Savant D. Editorial: New strategies in treatment of differentiated thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:1004734. [PMID: 36093118 PMCID: PMC9449832 DOI: 10.3389/fendo.2022.1004734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jose Federico Carrillo
- Head and Neck Department, National Institute of Cancerology (INCAN), Mexico City, Mexico
- *Correspondence: Jose Federico Carrillo,
| | - Carlos Suarez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alvaro Sanabria
- Departamento de Cirugía, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - T Metin Onerci
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
28
|
Ramirez A, Sanabria A. Prophylactic central neck dissection for well-differentiated thyroid carcinoma: results and methodological assessment of systematic reviews. JBI Evid Synth 2021; 20:980-1003. [PMID: 34860180 DOI: 10.11124/jbies-21-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim was to assess the methodological quality of systematic reviews evaluating the effectivness of prophylactic central neck dissection plus thyroidectomy to decrease locoregional recurrence in patients with thyroid carcinoma. INTRODUCTION Many systematic reviews have been published concerning prophylactic central neck dissection in well-differentiated thyroid carcinoma, finding inconsistent results regarding the risk of locoregional recurrence. Because systematic reviews are considered the best source on which to base clinical decisions, the assessment of methodological quality is important. INCLUSION CRITERIA This paper included studies that mentioned that a systematic review was performed in adult patients with confirmed diagnosis of well-differentiated thyroid carcinoma without evidence of nodal metastatic disease who underwent total thyroidectomy. Reviews evaluated prophylactic central neck dissection compared with no neck diessection for decreasing locoregional recurrence. METHODS A systematic search was performed using MEDLINE, Embase, the Cochrane Database of Systematic Reviews, LILACS, Web of Science, CNKI, and Google Scholar. PROSPERO was searched for unpublished studies and gray literature. Data regarding the study characteristics, patient types, numbers of patients, and locoregional recurrence by group were extracted. Methodological characteristics, type of statistical analysis and summary estimator, heterogeneity, and publication bias were recorded. The methodological quality was measured using the AMSTAR 2 tool. RESULTS The search identified 12 systematic reviews. Only four systematic reviews reported adherence to methodological guidelines. The AMSTAR 2 critical criteria classified all the studies as critically low quality. The pooled risk difference for locoregional recurrence varied among studies from -5% to 0%. Most of the studies were published in high-impact journals. CONCLUSIONS The published systematic reviews that assessed prophylactic central neck dissection as an intervention to decrease the rate of locoregional recurrence have a critically low methodological quality. The results and recommendations based on these studies should be used with caution. The evaluation of methodological quality by peer reviewers must be improved.
Collapse
Affiliation(s)
- Adonis Ramirez
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia SURCAC, Centro Surcolombiano de Cirugia de Cabeza y Cuello, Neiva, Colombia CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | | |
Collapse
|
29
|
Golusinski P, Corry J, Poorten VV, Simo R, Sjögren E, Mäkitie A, Kowalski LP, Langendijk J, Braakhuis BJM, Takes RP, Coca-Pelaz A, Rodrigo JP, Willems SM, Forastiere AA, De Bree R, Saba NF, Teng Y, Sanabria A, Di Maio P, Szewczyk M, Ferlito A. De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed? Oral Oncol 2021; 123:105620. [PMID: 34798575 DOI: 10.1016/j.oraloncology.2021.105620] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/26/2022]
Abstract
Human papilloma virus (HPV) is a well-established causative factor in a subset of squamous cell carcinomas of the head and neck (HNSCC). Although HPV can be detected in various anatomical subsites, HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is the most common HPV-related malignancy of the head and neck, and its worldwide incidence is constantly rising. Patients with OPSCC are generally younger, have less co-morbidities and generally have better prognosis due to different biological mechanisms of carcinogenesis. These facts have generated hypotheses on potential treatment modifications, aiming to minimize treatment-related toxicities without compromising therapy efficacy. Numerous randomized clinical trials have been designed to verify this strategy and increasingly real-world evidence data from retrospective, observational studies is becoming available. Until now, the data do not support any modification in contemporary treatment protocols. In this narrative review, we outline recent data provided by both randomized controlled trials and real-world evidence of HPV-positive OPSCC in terms of clinical value. We critically analyze the potential value and drawbacks of the available data and highlight future research directions. This article was written by members and invitees of the International Head and Neck Scientific Group.(www.IHNSG.com).
Collapse
Affiliation(s)
- Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora; Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poland.
| | - June Corry
- Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia
| | - Vincent Vander Poorten
- Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ricard Simo
- Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Elisabeth Sjögren
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland; Division of Ear, Nose, Finland
| | - Luis Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Johannes Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology Emory University School of Medicine; Winship Cancer Institute of Emory University, Georgia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, San Remo, Italy
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
30
|
Sanabria A, Pinillos P, Lira RB, Shah JP, Tufano RP, Zafereo ME, Nixon IJ, Randolph GW, Simo R, Vander Poorten V, Rinaldo A, Medina JE, Khafif A, Angelos P, Mäkitie AA, Shaha AR, Rodrigo JP, Hartl DM, Kowalski LP, Ferlito A. Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review. Head Neck 2021; 44:226-237. [PMID: 34590380 DOI: 10.1002/hed.26883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023] Open
Abstract
Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/IPS Universitaria/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello/Clínica Las Vegas-grupo Quirónsalud, Medellín, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia-Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Renan B Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ralph P Tufano
- Director of the FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Gregory W Randolph
- Thyroid/Parathyroid Endocrine Surgical Division, Thyroid Surgical Oncology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ricard Simo
- Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | | | - Jesus E Medina
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
31
|
Ortega G, Espinosa A, Alegret M, Monté-Rubio GC, Sotolongo-Grau O, Sanabria A, Tartari JP, Rodríguez-Gómez O, Marquié M, Vivas A, Gómez-Chiari M, Alarcón-Martín E, Pérez-Cordón A, Roberto N, Hernández I, Rosende-Roca M, Vargas L, Mauleón A, Abdelnour C, Esteban De Antonio E, López-Cuevas R, Alonso-Lana S, Moreno-Grau S, de Rojas I, Orellana A, Montrreal L, Tárraga L, Ruiz A, Boada M, Valero S. Combination of white matter hyperintensities and Aβ burden is related to cognitive composites domain scores in subjective cognitive decline: the FACEHBI cohort. Alzheimers Res Ther 2021; 13:141. [PMID: 34404456 PMCID: PMC8371791 DOI: 10.1186/s13195-021-00877-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND To explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aβ) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD). METHODS Two hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI), 18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables. RESULTS Adjusted multiple linear regression models showed that FreeSurfer (B - .245; 95% CI - .1.676, - .393, p = .016) and β burden (SUVR) (B - .180; 95% CI - 2.140, - .292; p = .070) were associated with face-name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face-name associative performance indicated that those individuals with either higher WMH load or higher Aβ burden showed the worst performance on the face-name associative memory CCs domain score. CONCLUSIONS Our results suggest that increased WMH load and increased Aβ are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.
Collapse
Affiliation(s)
- G Ortega
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain.
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.
| | - A Espinosa
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - M Alegret
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - G C Monté-Rubio
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - O Sotolongo-Grau
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - A Sanabria
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - J P Tartari
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - O Rodríguez-Gómez
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - M Marquié
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - A Vivas
- Departament de Diagnòstic Per La Imatge, Clínica Corachan, Barcelona, Spain
| | - M Gómez-Chiari
- Departament de Diagnòstic Per La Imatge, Clínica Corachan, Barcelona, Spain
| | - E Alarcón-Martín
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - A Pérez-Cordón
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - N Roberto
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - I Hernández
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - M Rosende-Roca
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - L Vargas
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - A Mauleón
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - C Abdelnour
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - E Esteban De Antonio
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - R López-Cuevas
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - S Alonso-Lana
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - S Moreno-Grau
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - I de Rojas
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - A Orellana
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - L Montrreal
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
| | - L Tárraga
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - A Ruiz
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - M Boada
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - S Valero
- Fundació ACE, Institut Català de Neurociències Aplicades, Research Center and Memory Clinic, Universitat Internacional de Catalunya, C/ Gran Via de Carles III, 85 bis- 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
32
|
Ronen O, Robbins KT, de Bree R, Guntinas-Lichius O, Hartl DM, Homma A, Khafif A, Kowalski LP, López F, Mäkitie AA, Ng WT, Rinaldo A, Rodrigo JP, Sanabria A, Ferlito A. Standardization for oncologic head and neck surgery. Eur Arch Otorhinolaryngol 2021; 278:4663-4669. [PMID: 33982178 DOI: 10.1007/s00405-021-06867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
The inherent variability in performing specific surgical procedures for head and neck cancer remains a barrier for accurately assessing treatment outcomes, particularly in clinical trials. While non-surgical modalities for cancer therapeutics have evolved to become far more uniform, there remains the challenge to standardize surgery. The purpose of this review is to identify the barriers in achieving uniformity and to highlight efforts by surgical groups to standardize selected operations and nomenclature. While further improvements in standardization will remain a challenge, we must encourage surgical groups to focus on strategies that provide such a level.
Collapse
Affiliation(s)
- Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Dana M Hartl
- Head and Neck Oncology Service, Gustave Roussy, Villejuif, France
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza Y Cuello, Medellín, Colombia
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
33
|
Domínguez LC, Dolmans D, Restrepo J, de Grave W, Sanabria A, Stassen L. How Surgical Leaders Transform Their Residents to Craft Their Jobs: Surgeons' Perspective. J Surg Res 2021; 265:233-244. [PMID: 33957575 DOI: 10.1016/j.jss.2021.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgeons should transform their residents to take the lead in their jobs and optimize their working conditions, so-called job crafting. We investigated the actions undertaken by surgeons with a transformational leadership style to encourage residents' job crafting, about which there is at present a paucity of information. METHODS We performed a qualitative study based on principles of constructivist grounded theory. In-depth interviews were held with a purposive sample of surgeons who were perceived as transformational leaders by their residents. During data analysis (open, axial, and selective coding), we compared inductive codes with deductive codes drawn from the job demands-resources and transformational leadership theories to reach a consensus on the interpretation of data and identification of the main themes. RESULTS Sixteen surgeons participated. Surgeons undertook five actions that enhanced job crafting in residents. They: one) modeled positive behaviors of a good surgeon; two) used a stepwise individual approach toward autonomy; three) connected with the resident as a person; four) supported residents in handling complications and errors; and five) they coached the resident to deal with competing interests. These actions had four consequences for residents. They led to: one) more responsibilities in patient care; two) more constructive relationships in the workplace; three) less pressure from workload and surgical care duties; and four) less personal difficulties and errors in patient care. CONCLUSIONS The actions undertaken by surgeons with a transformational leadership style have a positive association with the residents' ability to craft their jobs. This knowledge has implications for surgeons' leadership development with a view to workplace education.
Collapse
Affiliation(s)
| | - Diana Dolmans
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jorge Restrepo
- Department of Medical Education, Universidad de la Sabana, Chía, Colombia
| | - Willem de Grave
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Alvaro Sanabria
- Department of Surgery, Universidad de la Sabana, Chía, Colombia
| | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| |
Collapse
|
34
|
Matos LL, Forster CHQ, Marta GN, Castro Junior G, Ridge JA, Hirata D, Miranda-Filho A, Hosny A, Sanabria A, Gregoire V, Patel SG, Fagan JJ, D’Cruz AK, Licitra L, Mehanna H, Hao SP, Psyrri A, Porceddu S, Galloway TJ, Golusinski W, Lee NY, Shiguemori EH, Matieli JE, Shiguemori APAC, Diamantino LR, Schiaveto LF, Leão L, Castro AF, Carvalho AL, Kowalski LP. The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying-the head and neck cancer model. Cancer Causes Control 2021; 32:459-471. [PMID: 33704627 PMCID: PMC7950430 DOI: 10.1007/s10552-021-01411-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/27/2021] [Indexed: 11/13/2022]
Abstract
PURPOSE The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time-to-treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. METHODS An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. RESULTS The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time-to-treatment initiation. CONCLUSIONS This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.
Collapse
Affiliation(s)
- Leandro L. Matos
- Department of Head and Neck Surgery, Instituto Do Cancer Do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, Enéas de Carvalho Aguiar avenue, 255, 8th floor, room 8174, Sao Paulo, SP 05403-000 Brazil
| | | | - Gustavo N. Marta
- Division of Radiation Oncology, Department of Radiology Oncology, Instituto Do Cancer Do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Gilberto Castro Junior
- Department of Clinical Oncology, Instituto Do Cancer Do Estado de São Paulo (ICESP), University of São Paulo Medical School, São Paulo, Brazil
| | - John A. Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Daisy Hirata
- Instituto Tecnológico de Aeronáutica (ITA), Faculdade de Ciências Médicas de São José Dos Campos, São José dos Campos, Brazil
| | | | - Ali Hosny
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Hospital Universitario San Vicente Fundacion–CEXCA Centro de Excelencia en Enfermedades de Cabeza Y Cuello, Medellin, Colombia
| | - Vincent Gregoire
- Department of Radiation Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Snehal G. Patel
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Johannes J. Fagan
- Division of Otolaryngology, University of Cape Town Medical School, Cape Town, South Africa
| | - Anil K. D’Cruz
- Oncology Apollo Hospitals, Navi, Mumbai India
- President-Elect, Union for International Cancer Control (UICC), Geneve, Switzerland
| | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale Dei Tumori and University of Milan, Milan, Italy
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Sheng-Po Hao
- Department of Otolaryngology of Shin, Kong Wu Ho-Su Memorial Hospital and Fu Jen Catholic University in Taiwan, Taipei, Taiwan
| | - Amanda Psyrri
- Clinical Oncology Department, National Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Sandro Porceddu
- Department of Radiation Oncology, Brisbane’s Princess Alexandra Hospital of the University of Queensland, Brisbane, QLD Australia
| | - Thomas J. Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznań, Poland
| | - Nancy Y. Lee
- Department of Clinical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - José Elias Matieli
- Instituto Tecnológico de Aeronáutica (ITA), Faculdade de Ciências Médicas de São José Dos Campos, São José dos Campos, Brazil
| | | | | | | | - Lysia Leão
- Instituto Federal de Educação, Ciência E Tecnologia de São Paulo, Jacareí, Brazil
| | - Ana F. Castro
- Clinical Oncology Department, Lenitudes Medical Center & Research, Santa Maria da Feira, Portugal
| | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, and Department of Head and Neck Surgery and Otorhinolaryngology A C Camargo Cancer Center, São Paulo, Brazil
| |
Collapse
|
35
|
Sanabria A, Kowalski LP, Nixon IJ, Simo R. Microscopic positive surgical margins in thyroid carcinoma: a proposal for thyroid oncology teams. Langenbecks Arch Surg 2021; 406:563-569. [PMID: 33555410 DOI: 10.1007/s00423-021-02095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE In the case of well-differentiated thyroid cancer, the importance of microscopic margin status remains controversial. We discuss the relevance of the effect of microscopic positive surgical margins in the early stages of differentiated thyroid cancer. METHODS A comprehensive literature search and review of available evidence in English literature was undertaken. RESULTS A previous meta-analysis did not find an association between microscopic positive surgical margins and local recurrence. Heterogeneity of definitions and differences between microscopic surgical margins and extrathyroid extension are discussed. Impact on clinical decision-making is explored. CONCLUSION The finding of microscopic positive surgical margins in a patient with a thyroid tumor without intraoperative evidence of macroscopic invasion to adjacent structures, with complete resection made by the surgeon and without pathological report of extrathyroid extension, does not have a worse prognostic effect. We present a classification of surgical margins that may help thyroid oncology teams to tailor further management in patients with thyroid cancer.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello, Cra. 51d #62-29, Medellín, Colombia.
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School and Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Iain J Nixon
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Thyroid Oncology Unit Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
36
|
Sanabria A, Zafereo M, Thompson LDR, Hernandez-Prera JC, Kowalski LP, Nixon IJ, Shaha A, Rodrigo JP, Mäkitie A, Poorten VV, Suarez C, Zbären P, Rinaldo A, Ferlito A. Frozen section in thyroid gland follicular neoplasms: It's high time to abandon it! Surg Oncol 2020; 36:76-81. [PMID: 33316682 DOI: 10.1016/j.suronc.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
Thyroid nodules are a very common clinical condition. The 2015 American Thyroid Association (ATA) guidelines recommend surgical excision for Bethesda IV nodules. The use of intraoperative frozen section (FS) has been recommended as a strategy to tailor the extent of the initial surgery. We critically evaluated the literature that discusses the utility and cost-effectiveness of FS to make an intraoperative decision in patients with thyroid nodules classified as follicular neoplasm. FS should not be recommended as a routine intraoperative test to assess for malignancy in thyroid follicular patterned lesions due to its low performance; the high number of deferred results; the inability to adequately assess histologically defining features; the improvements in risk stratification guiding total thyroidectomy; and the low cost-effectiveness of FS.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello. Medellín, Colombia.
| | - Mark Zafereo
- Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Lester D R Thompson
- Department of Pathology. Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Department of Head and Neck Surgery University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Iain J Nixon
- Ear, Nose and Throat Department, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, NY, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, and Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven. Leuven, Belgium
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Peter Zbären
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
37
|
Asimakopoulos P, Shaha AR, Nixon IJ, Shah JP, Randolph GW, Angelos P, Zafereo ME, Kowalski LP, Hartl DM, Olsen KD, Rodrigo JP, Vander Poorten V, Mäkitie AA, Sanabria A, Suárez C, Quer M, Civantos FJ, Robbins KT, Guntinas-Lichius O, Hamoir M, Rinaldo A, Ferlito A. Management of the Neck in Well-Differentiated Thyroid Cancer. Curr Oncol Rep 2020; 23:1. [PMID: 33190176 DOI: 10.1007/s11912-020-00997-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
Collapse
Affiliation(s)
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Miquel Quer
- Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Surgery Department, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
38
|
Civantos FJ, Vermorken JB, Shah JP, Rinaldo A, Suárez C, Kowalski LP, Rodrigo JP, Olsen K, Strojan P, Mäkitie AA, Takes RP, de Bree R, Corry J, Paleri V, Shaha AR, Hartl DM, Mendenhall W, Piazza C, Hinni M, Robbins KT, Tong NW, Sanabria A, Coca-Pelaz A, Langendijk JA, Hernandez-Prera J, Ferlito A. Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era. Front Oncol 2020; 10:593164. [PMID: 33244460 PMCID: PMC7685177 DOI: 10.3389/fonc.2020.593164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with metastases in the lymph nodes of the neck and no obvious primary tumor, neck cancer with unknown primary (NCUP), represent a management challenge. A majority of patients have metastatic squamous cell carcinoma (SCC), although other histologies do occur. Methods We comprehensively reviewed the literature, compared available guidelines, and conferred with an international team of experts. Results Positron emission tomography-computed tomography (PET-CT) and fine needle aspiration (FNA) under ultrasound guidance increase accuracy of diagnosis. Immunohistochemistry (IHC), determination of human papilloma virus (HPV) status, by p16 staining or by in situ hybridization (ISH), and next-generation gene sequencing can guide us regarding probable primary sites and tumor biology. Narrow Band Imaging (NBI) has been introduced for the early detection of subtle mucosal lesions. Direct laryngoscopy (DL) and tonsillectomy have long been procedures used in the search for a primary site. More recently, TransOral Robotic Surgery (TORS) or Transoral LASER Microsurgery (TLM) have been introduced for lingual tonsillectomy. Conclusions New technologies have been developed which can better detect, diagnose, and treat occult primary tumors. Decisions regarding therapy are based on the primary tumor site (if discovered) and N stage. Options include neck dissection with or without postoperative adjuvant therapy, primary irradiation, or combined chemotherapy with irradiation. The preferred treatment of patients whose primary remains unidentified is controversial.
Collapse
Affiliation(s)
- Francisco J Civantos
- Department of Otolaryngology, Sylvester Cancer Center, University of Miami, Miami, FL, United States
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo, Brazil.,Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Kerry Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Primoz Strojan
- Department of Radiation Oncology Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - June Corry
- Department of Medicine Division Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Dana M Hartl
- Division of Surgical Oncology, Gustave Roussy Cancer Center and Paris-Sud University, Paris, France
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, AZ, United States
| | - K Thomas Robbins
- Southern Illinois University School of Medicine, Department of Otolaryngology, Springfield, IL, United States
| | - Ng Wai Tong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
39
|
Simó R, Nixon IJ, Rovira A, Vander Poorten V, Sanabria A, Zafereo M, Hartl DM, Kowalski LP, Randolph GW, Kamani D, Shaha AR, Shah J, Marie JP, Rinaldo A, Ferlito A. Immediate Intraoperative Repair of the Recurrent Laryngeal Nerve in Thyroid Surgery. Laryngoscope 2020; 131:1429-1435. [PMID: 33118630 DOI: 10.1002/lary.29204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Recurrent laryngeal nerve (RLN) injury is a recognized risk during thyroid and parathyroid surgery and can result in significant morbidity. The aim of this review paper is to consider the optimal approach to the immediate intraoperative repair of the RLN during thyroid surgery. METHODS A PubMed literature search was performed from inception to June 2020 using the following search strategy: immediate repair or repair recurrent laryngeal nerve, repair or reinnervation recurrent laryngeal nerve and immediate neurorraphy or neurorraphy recurrent laryngeal nerve. RESULTS Methods of immediate intraoperative repair of the RLN include direct end-to-end anastomosis, free nerve graft anastomosis, ansa cervicalis to RLN anastomosis, vagus to RLN anastomosis, and primary interposition graft. Techniques of nerve repair include micro-suturing, use of fibrin glue, and nerve grafting. Direct micro-suture is preferable when the defect can be repaired without tension. Fibrin glue has also been proposed for nerve repair but has been criticized for its toxicity, excessive slow reabsorption, and the risk of inflammatory reaction in the peripheral tissues. When the proximal stump of the RLN cannot be used, grafting could be done using transverse cervical nerve, supraclavicular nerve, vagus nerve, or ansa cervicalis. CONCLUSIONS Current evidence is low-level; however, it suggests that when the RLN has been severed, avulsed, or sacrificed during thyroid surgery it should be repaired intraoperatively. The immediate repair has on balance more advantages than disadvantages and should be considered whenever possible. This should enable the maintenance of vocal cord tone, better and prompter voice recovery and avoidance of aspiration. Laryngoscope, 131:1429-1435, 2021.
Collapse
Affiliation(s)
- Ricard Simó
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, United Kingdom
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | - Aleix Rovira
- Guy's and St Thomas' Hospital NHS Foundation Trust, St Thomas' Street, Guy's Hospital, SE1 9RT, United Kingdom
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Hospital Universitario San Vicente Fundacion, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Mark Zafereo
- Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Dana M Hartl
- Department of Otorhinolaryngology Head and Neck Surgery, Thyroid Surgery Unit, Institute Gustave Roussy, Paris, France
| | - Luiz P Kowalski
- Department of Otorhinolaryngology Head and Neck Surgery, A.C. Camargo Cancer Center, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ashok R Shaha
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York, U.S.A
| | - Jatin Shah
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weil Medical College of Cornell University, New York, New York, U.S.A
| | - Jean-Paul Marie
- Experimental Surgery Laboratory, Institute of Biomedical Research, University Hospital Rouen, Rouen, France
| | | | - Alfio Ferlito
- Department of Otorhinolaryngology Head and Neck Surgery, University of Udine School of Medicine, Udine, Italy
| |
Collapse
|
40
|
Köhler HF, Mehanna H, Shah JP, Sanabria A, Fagan J, Kuriakose MA, Rene Leemans C, O'Sullivan B, Krishnan S, Kowalski LP. Comparison of different guidelines for oral cancer. Eur Arch Otorhinolaryngol 2020; 278:2961-2973. [PMID: 33057952 DOI: 10.1007/s00405-020-06423-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/05/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Guidelines should provide accessible and reliable information for decision-making. Also, they should be translatable to multiple settings, allowing their use in diverse situations. METHODS We searched in GOOGLE, PUBMED, SCIELO, and SCOPUS for guidelines on oral squamous cell carcinoma. They were evaluated using the AGREE II protocol. RESULTS We identified 16 guidelines that fulfilled inclusion criteria. The mean score and range for each AGREE II domain were: "scope and purpose" 74.1% (6-100.0%); "stakeholder" 78.6% (0-100.0%); "rigor of development" 71.4% (0-100.0%); "clarity of presentation" 71.4% (6-100.0%); "applicability" 50.0% (0-85.7%); "editorial independence" 57.1% (14.3-85.7%) and "overall assessment" 57.1% (14.3-100.0%). CONCLUSION Guidelines for oral cancer present variable quality. Among those available, only four surpassed the 70% AGREE II score threshold.
Collapse
Affiliation(s)
- Hugo Fontan Köhler
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Rua Professor Antônio Prudente, 211, São Paulo, SP, CEP 01509-010, Brazil.
| | - Hisham Mehanna
- The Institute of Global Innovation, University of Birmingham, Birmingham, UK
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellin, Colombia
| | - Johannes Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | | | - C Rene Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands
| | - Brian O'Sullivan
- Cancer Clinical Research Unit, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Suren Krishnan
- Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Rua Professor Antônio Prudente, 211, São Paulo, SP, CEP 01509-010, Brazil.,Head and Neck Surgery Department, University of Sao Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
41
|
Ronen O, Robbins KT, Olsen KD, Shaha AR, Randolph GW, Nixon IJ, Zafereo ME, Hartl DM, Kowalski LP, Rodrigo JP, Coca-Pelaz A, Mäkitie AA, Vander Poorten V, Sanabria A, Angelos P, Rinaldo A, Ferlito A. Case for staged thyroidectomy. Head Neck 2020; 42:3061-3071. [PMID: 32761849 DOI: 10.1002/hed.26393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/01/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022] Open
Abstract
Recent modifications in the management of well-differentiated thyroid cancer have resulted in significant alterations in clinical approach. Utilizing a series of preoperative and postoperative risk factors involving both the patient and the disease pathology, we offer the term "staged thyroidectomy" to help organize these risk factors for patients and the endocrine team to optimize management. This approach is intended to incorporate our latest nuanced understanding of certain endocrine pathology and may serve to optimize patient outcomes.
Collapse
Affiliation(s)
- Ohad Ronen
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, Illinois, USA
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,Department of Otolaryngology, University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,Department of Otolaryngology, University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Department of Surgery, CEXCA-Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
42
|
Takes RP, Halmos GB, Ridge JA, Bossi P, Merkx MAW, Rinaldo A, Sanabria A, Smeele LE, Mäkitie AA, Ferlito A. Value and Quality of Care in Head and Neck Oncology. Curr Oncol Rep 2020; 22:92. [PMID: 32651680 PMCID: PMC7351804 DOI: 10.1007/s11912-020-00952-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. RECENT FINDINGS This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.
Collapse
Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek Hospital, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
43
|
Abstract
Background: The incidence of thyroid carcinoma is growing worldwide. More than 50% of new malignant tumors are classified as classical papillary carcinomas in low-risk category with a low rate of recurrence and high long-term survival. Active surveillance is a strategy to control low-risk tumor evolution with the intention to avoid unnecessary treatments and maintain thyroid function. The aim of this study was to report a cohort of patients with thyroid nodules classified as Bethesda V-VI and who are under active surveillance in Colombia. Methods: A prospective cohort was assembled since January 2015. All patients had been evaluated clinically, biochemically with ultrasonography and fine needle aspiration biopsy previous to the first evaluation. Active surveillance was proposed to patients with asymptomatic low-risk carcinoma (<1.5 cm, encapsulated, without evidence of lymph node metastasis), independent of sex or age. The strategy included a specific discussion about the surgical option and expected risk of complications, risk of long-term thyroxine support, and the active surveillance strategy. The data on age, sex, reason for an ultrasound examination, ultrasound risk by American Thyroid Association (ATA) classification, size and volume of the nodule, reason to consider active surveillance and follow-up ultrasounds, and surgical decision were recorded prospectively. A Kaplan-Meier curve was constructed for the rate of growth and increase in volume of the nodule, growth >3 mm and increase in volume >50%, and need of operation. Results: One hundred two patients were analyzed. Seventy-five percent of patients had a nodule smaller than 1 cm. Only 24/102 (23%) nodules were classified as ATA low risk. Thirty-four of 102 (33.3%) nodules were classified as Bethesda VI and the others were Bethesda V. The median follow-up was 13.9 months, and 32.3% of patients had more than 24 months of follow-up. Only 11/102 (10.8%) nodules grew more than 3 mm and 26/102 (25.5%) nodules grew more than 50% in volume. 12.7% patients were submitted to surgery. The overall stability rate without growth >3 mm, without volume increase >50%, and without surgery at 24 months were 89.8%, 77.0%, and 85.5%, respectively Conclusions: Active surveillance is possible in developing Western countries with similar results to those provided by Asian and American authors.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y Cuello (CEXCA), Medellín, Colombia
| |
Collapse
|
44
|
Coca-Pelaz A, Shah JP, Hernandez-Prera JC, Ghossein RA, Rodrigo JP, Hartl DM, Olsen KD, Shaha AR, Zafereo M, Suarez C, Nixon IJ, Randolph GW, Mäkitie AA, Kowalski LP, Vander Poorten V, Sanabria A, Guntinas-Lichius O, Simo R, Zbären P, Angelos P, Khafif A, Rinaldo A, Ferlito A. Papillary Thyroid Cancer-Aggressive Variants and Impact on Management: A Narrative Review. Adv Ther 2020; 37:3112-3128. [PMID: 32488657 PMCID: PMC7467416 DOI: 10.1007/s12325-020-01391-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction Aggressive variants of papillary thyroid cancer (PTC) have been described with increasing frequency. These variants include diffuse sclerosing variant, tall cell variant, columnar cell variant, solid variant, and hobnail variant. Methods We have performed a review of the more aggressive variants of PTC with respect to main characteristics, histological and molecular features, and the consequences that the knowledge of these variants should have in the treatment of the patients. Results At the present time, we do not know the prognostic value of these aggressive PTC variants. The extent of the surgical treatment and adjuvant therapy necessary should be decided on the basis of the extent of the tumor at presentation and the opinion of experienced clinicians. Conclusion These aggressive variants should be known by clinicians, to avoid underdiagnosis, and treated according to the latest recommendations in the literature.
Collapse
Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Asturias, Spain.
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain.
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain
| | - Dana M Hartl
- Division of Surgical Oncology, Gustave Roussy Cancer Center and Paris-Sud University, Villejuif Cedex, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Zafereo
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain
| | - Iain J Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, Scotland, UK
| | - Gregory W Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, São Paulo, Brazil
| | - Vincent Vander Poorten
- Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación-CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Ricard Simo
- Head and Neck Cancer Unit, Guy's and St Thomas' Hospital NHS Foundation Trust London, London, UK
| | - Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
| | - Peter Angelos
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
45
|
Mehanna H, Hardman JC, Shenson JA, Abou-Foul AK, Topf MC, AlFalasi M, Chan JYK, Chaturvedi P, Chow VLY, Dietz A, Fagan JJ, Godballe C, Golusiński W, Homma A, Hosal S, Iyer NG, Kerawala C, Koh YW, Konney A, Kowalski LP, Kraus D, Kuriakose MA, Kyrodimos E, Lai SY, Leemans CR, Lennon P, Licitra L, Lou PJ, Lyons B, Mirghani H, Nichols AC, Paleri V, Panizza BJ, Parente Arias P, Patel MR, Piazza C, Rischin D, Sanabria A, Takes RP, Thomson DJ, Uppaluri R, Wang Y, Yom SS, Zhu YM, Porceddu SV, de Almeida JR, Simon C, Holsinger FC. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020; 21:e350-e359. [PMID: 32534633 PMCID: PMC7289563 DOI: 10.1016/s1470-2045(20)30334-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
Collapse
Affiliation(s)
- Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
| | - John C Hardman
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Jared A Shenson
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Ahmad K Abou-Foul
- Department of Otolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK
| | - Michael C Topf
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Mohammad AlFalasi
- Department of Otolaryngology, United Arab Emirates University, Alain, United Arab Emirates
| | - Jason Y K Chan
- Department of Otorhinolaryngology and Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Pankaj Chaturvedi
- Department of Otorhinolaryngology and Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - Velda Ling Yu Chow
- Department of Surgery, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andreas Dietz
- Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Christian Godballe
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sefik Hosal
- Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre and Singapore General Hospital, Singapore
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, School of Medical Science, Kumasi, Ghana
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Dennis Kraus
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine, Northwell Health Cancer Institute, New York, NY, USA
| | - Moni A Kuriakose
- Department of Otolaryngology-Head and Neck Surgery, Cochin Cancer Research Centre, Cochin, India
| | - Efthymios Kyrodimos
- First Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephen Y Lai
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Rene Leemans
- Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centre, Cancer Center Amsterdam, VU University, Amsterdam, Netherlands
| | - Paul Lennon
- Department of Otolaryngology and Head and Neck Surgery, St James's Hospital and The Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Lisa Licitra
- Foundation IRCCS, Division of Medical Oncology, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Bernard Lyons
- Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Haitham Mirghani
- Department of Otolaryngology and Head and Neck Surgery, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Anthonny C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Department of Oncology, University of Western Ontario, London, ON, Canada
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Benedict J Panizza
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pablo Parente Arias
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Hospital Universitario San Vicente Fundación, Medellin, Colombia; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Robert P Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - David J Thomson
- Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Dana-Farber and Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Yi-Ming Zhu
- Department of Head and Neck Surgery, National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sandro V Porceddu
- Department of Cancer Services, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Chrisian Simon
- Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
46
|
Kowalski LP, Sanabria A, Ridge JA, Ng WT, de Bree R, Rinaldo A, Takes RP, Mäkitie AA, Carvalho AL, Bradford CR, Paleri V, Hartl DM, Vander Poorten V, Nixon IJ, Piazza C, Lacy PD, Rodrigo JP, Guntinas‐Lichius O, Mendenhall WM, D'Cruz A, Lee AWM, Ferlito A. COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck 2020; 42:1259-1267. [PMID: 32270581 PMCID: PMC7262203 DOI: 10.1002/hed.26164] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.
Collapse
Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery DepartmentUniversity of Sao Paulo Medical SchoolSao PauloBrazil
- Department of Head and Neck Surgery and OtorhinolaryngologyA C Camargo Cancer CenterSao PauloBrazil
| | - Alvaro Sanabria
- Department of Surgery, School of MedicineUniversidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello‐CEXCAMedellinColombia
| | - John A. Ridge
- Head and Neck Surgery Section, Department of Surgical OncologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | - Wai Tong Ng
- Department of Clinical OncologyPamela Youde Nethersole Eastern HospitalHong KongChina
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Robert P. Takes
- Department of Otolaryngology‐Head and Neck SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Research Program in Systems Oncology, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and TechnologyKarolinska Institute and Karolinska HospitalStockholmSweden
| | - Andre L. Carvalho
- Screening GroupInternational Agency for Research in Cancer. IARCLyonFrance
| | - Carol R. Bradford
- Department of OtolaryngologyUniversity of MichiganAnn ArborMichiganUSA
| | - Vinidh Paleri
- Head and Neck UnitThe Royal Marsden HospitalLondonUK
| | - Dana M. Hartl
- Department of Otolaryngology Head and Neck SurgeryInstitut Gustave Roussy and University Paris‐SudVillejuif CedexFrance
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck OncologyKU LeuvenLeuvenBelgium
- Otorhinolaryngology, Head and Neck SurgeryUniversity Hospitals Leuven, Leuven Cancer InstituteLeuvenBelgium
| | - Iain J. Nixon
- Department of Otolaryngology, Head and Neck Surgery, NHS LothianUniversity of EdinburghEdinburghUK
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of MilanUniversity of MilanMilanItaly
| | - Peter D. Lacy
- Department of OtolaryngologyBeaumont HospitalDublinIreland
| | - Juan P. Rodrigo
- Servicio de OtorrinolaringologíaHospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Universidad de OviedoOviedoSpain
| | - Orlando Guntinas‐Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/PedaudiologyJena University HospitalJenaGermany
| | | | - Anil D'Cruz
- Head Neck ServicesTata Memorial HospitalMumbaiMaharashtraIndia
| | - Anne W. M. Lee
- Department of Clinical OncologyThe University of Hong KongHong KongChina
| | - Alfio Ferlito
- International Head and Neck Scientific GroupUdineItaly
| |
Collapse
|
47
|
Sanabria A, Shah JP, Medina JE, Olsen KD, Robbins KT, Silver CE, Rodrigo JP, Suárez C, Coca-Pelaz A, Shaha AR, Mäkitie AA, Rinaldo A, de Bree R, Strojan P, Hamoir M, Takes RP, Sjögren EV, Cannon T, Kowalski LP, Ferlito A. Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review. Cancers (Basel) 2020; 12:cancers12041059. [PMID: 32344717 PMCID: PMC7225965 DOI: 10.3390/cancers12041059] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín 050010, Colombia;
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Jatin P. Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.S.); (A.R.S.)
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55902, USA;
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA;
| | - Carl E. Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ 85259, USA;
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.)
- University of Oviedo-IUOPA, 33011 Oviedo, Spain
- Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.)
- University of Oviedo-IUOPA, 33011 Oviedo, Spain
- Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain
| | - Ashok R. Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.S.); (A.R.S.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands;
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, SI-1000 Ljubljana, Slovenia;
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium;
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands;
| | - Elisabeth V. Sjögren
- Department of Otolaryngology—Head and Neck Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands;
| | - Trinitia Cannon
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, NC 27609, USA;
| | - Luiz P. Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, 01509-900 São Paulo, Brazil;
- Department of Head and Neck Surgery, University of São Paulo Medical School, 05402-000 São Paulo, Brazil
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100 Padua, Italy
- Correspondence:
| |
Collapse
|
48
|
Nixon IJ, Shah JP, Zafereo M, Simo RS, Hay ID, Suárez C, Zbären P, Rinaldo A, Sanabria A, Silver C, Mäkitie A, Vander Poorten V, Kowalski LP, Shaha AR, Randolph GW, Ferlito A. The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective. Eur J Surg Oncol 2020; 46:754-762. [PMID: 31952928 DOI: 10.1016/j.ejso.2020.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/16/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.
Collapse
Affiliation(s)
- I J Nixon
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, University of Edinburgh, UK.
| | - J P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M Zafereo
- Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - R S Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - I D Hay
- Division of Endocrinology and Internal Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - C Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - P Zbären
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - A Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - C Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | - V Vander Poorten
- Department of Oncology, section Head and Neck Oncology, KU Leuven, and Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - L P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, and Head and Neck Surgery Department, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - A R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - G W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
49
|
Abstract
OBJECTIVES To evaluate the diagnostic performance of frozen section in thyroid nodules classified as follicular neoplasm. METHODS A diagnostic test meta-analysis was designed. Studies that assessed frozen section in patients with thyroid nodules and a fine-needle aspiration biopsy result of Bethesda IV were selected. The outcomes measured were the number of false- and true-positive and -negative results. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) instrument for methodological quality assessment and a bivariate mixed-effects regression framework and a likelihood-based estimation of the exact binomial approach. RESULTS Forty-six studies from 1991 to 2018 were included. Most studies had moderate methodological quality. The overall sensitivity and specificity were 43% (95% confidence internal [CI], 0.34-0.53) and 100% (95% CI, 0.99-1.00), respectively. The hierarchic summary receiver operating characteristic curve showed an area under the curve of 0.91 (95% CI, 0.80-0.97). CONCLUSIONS Frozen section demonstrates moderate diagnostic performance in patients with follicular neoplasm, and its utility for making intraoperative decisions is limited. Its routine use should be discouraged.
Collapse
Affiliation(s)
- Jhorman Grisales
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Cirugia de Cabeza y Cuello, CEXCA, Medellín, Colombia
| |
Collapse
|
50
|
Coca-Pelaz A, Rodrigo JP, Suárez C, Nixon IJ, Mäkitie A, Sanabria A, Quer M, Strojan P, Bradford CR, Kowalski LP, Shaha AR, de Bree R, Hartl DM, Rinaldo A, Takes RP, Ferlito A. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck 2019; 42:456-466. [PMID: 31750595 DOI: 10.1002/hed.26016] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/22/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Second primary tumors (SPTs) are a common cause of reduced life expectancy in patients treated for head and neck cancer (HNC). This phenomenon forms an area to be addressed during posttreatment follow-up. METHODS We conducted a systematic review of literature following PRISMA guidelines, from 1979 to 2019, to investigate incidence of SPTs, synchronous, and metachronous, in HNC population. RESULTS Our review includes data of 456 130 patients from 61 articles. With a minimum follow-up of 22 months, mean incidence of SPTs was 13.2% (95% CI: 11.56-14.84): 5.3% (95% CI: 4.24-6.36) for synchronous SPTs and 9.4% (95% CI: 7.9-10.9) for metachronous SPTs. The most frequent site for SPTs was head and neck area, followed by the lungs and esophagus. CONCLUSION Although with wide variations between studies, the rate of SPTs in HNC patients is high. Given the impact in the prognosis, we must develop strategies for the early diagnosis of SPTs.
Collapse
Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Iain J Nixon
- Ear, Nose and Throat Department, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|