1
|
Oh MS, Vettikattu NT, Baddour HM, Gross JH, Boyce BJ, Patel MR, Schmitt NC, Arturo Solares C, Vuncannon JR, Kaka AS. Submental Island Flaps for Lateral Reconstruction: Technical Refinements for Optimal Outcomes and Resource Efficiency. OTO Open 2024; 8:e131. [PMID: 38618288 PMCID: PMC11015144 DOI: 10.1002/oto2.131] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 04/16/2024] Open
Abstract
Objective To describe our modifications to the submental island flap (SMIF) in a case series that demonstrates improved reproducibility, shortened length of stay (LOS), and reduced utilization of hospital resources. Study Design This retrospective case series with chart review included adult patients who underwent resection of malignant or benign tumors resulting in lateral facial, parotid, or temporal bone defects, which were reconstructed with SMIF. Setting A tertiary-care academic referral center. Methods Retrospective case series included all adult patients who underwent SMIF reconstruction between March 2020 and August 2021. Patient demographic and clinical data were collected. Primary outcomes were measures of hospital utilization including duration of surgery, LOS, and postoperative outcomes. Results Twenty-eight patients were included with a mean age of 71.7 years. Eighty percent were male. All patients underwent parotidectomy, and the mean operative time was 347 minutes. The median LOS was 2.5 days (range 0-16 days). Seventy-five percent of the flaps drained into the internal jugular vein, and 25% drained into the external jugular vein. No patients required reoperation or readmission. All flaps survived. Conclusion SMIFs are a safe and effective option for reconstruction of lateral facial, parotid, and temporal bone defects. Compared to free flap reconstruction, SMIFs offer reduced length of surgery, decreased use of health care resources, and lower rate of reoperation. As health care resource allocation is increasingly important, the SMIF offers an excellent alternative to free flap reconstruction of lateral defects.
Collapse
Affiliation(s)
- Melissa S. Oh
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Nikhil T. Vettikattu
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Harry Michael Baddour
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jennifer H. Gross
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brian J. Boyce
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Mihir R. Patel
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Nicole C. Schmitt
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Clementino Arturo Solares
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jackson R. Vuncannon
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Azeem S. Kaka
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| |
Collapse
|
2
|
Burnham AJ, Boyce BJ, Kaka AS, El-Deiry MW, Sebelik ME, Baddour HM, Patel MR, Gross JH, Nathan M, Waller JM, Schmitt NC, Ottenstein L. Survival and functional outcomes after total glossectomy with total laryngectomy: Case series from a high-volume tertiary institution. Oral Oncol 2023; 137:106301. [PMID: 36586379 DOI: 10.1016/j.oraloncology.2022.106301] [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: 09/08/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Total glossectomy with total laryngectomy (TGTL) is indicated for some cases of advanced oral squamous cell carcinoma. However, this procedure is rarely performed, as quality of life outcomes are often considered poor. Consequently, few studies to date have reported survival and functional outcomes in patients undergoing TGTL. Here, we present the largest cases series to date of TGTL patients and provide relevant data on survival and functional outcomes. METHODS Patients met inclusion criteria if they underwent TGTL (concurrent or staged) indicated for head and neck squamous cell carcinoma. Patient demographics and disease characteristics, survival outcomes, functional oral intake scores, time to oral intake, gastrostomy tube dependence, and communication methods post-surgery were retrospectively extracted from the electronic medical record. RESULTS Survival in patients undergoing TGTL was poor. Most patients in this study were eventually approved for some oral intake of restricted consistencies but remained gastrostomy tube dependent for most of their nutritional needs. Baseline oral intake was suboptimal in most patients but often re-achieved approximately 12 months following surgery. Communication methods following surgery included writing, text-to-speech, and augmentative and alternative communication devices. CONCLUSION Our data provide new insights comparing survival and functional outcomes of patients undergoing TGTL. Additional investigation particularly on patient-perceived quality of life following TGTL is needed to better understand the risks and benefits for patients who are candidates for TGTL.
Collapse
Affiliation(s)
- Andre J Burnham
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA
| | - Brian J Boyce
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Azeem S Kaka
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Mark W El-Deiry
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Merry E Sebelik
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - H Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Mihir R Patel
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Meghana Nathan
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Jonathan M Waller
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA.
| | - Lauren Ottenstein
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, USA; The Winship Cancer Institute at Emory University, USA
| |
Collapse
|
3
|
Gross JH, Patel MR, Switchenko JM, Chan TG, Baddour HM, Kaka A, Boyce BJ, Saba NF, Beitler JJ, El-Deiry M. Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy. JAMA Otolaryngol Head Neck Surg 2023; 149:24-33. [PMID: 36394866 PMCID: PMC9673019 DOI: 10.1001/jamaoto.2022.3597] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022]
Abstract
Importance Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy. Objective To explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy. Design, Setting, and Participants This cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with recurrent, clinically node-negative larynx or hypopharynx tumors after definitive nonsurgical treatment who were treated with a salvage total laryngectomy were included. Data were analyzed from October 2021 through September 2022. Exposures Elective neck dissection. Main Outcomes and Measures Presence and location of occult nodal metastasis in electively dissected necks, along with differences in fistula rates and overall and disease-free survival between patients receiving elective neck dissection vs observation. Results Among 107 patients receiving clinically node-negative salvage total laryngectomy (median [IQR] age, 65.0 [57.8-71.3] years; 91 [85.0%] men), 81 patients underwent elective neck dissection (75.7%) and 26 patients underwent observation (24.3%). Among patients with elective neck dissection, 13 patients had occult nodal positivity (16.0%). Recurrent supraglottic (4 of 20 patients [20.0%]) or advanced T classification (ie, T3-T4; 12 of 61 patients [19.7%]) had an occult nodal positivity rate of 20% or more, and positive nodes were most likely to occur in levels II and III (II: 6 of 67 patients [9.0%]; III: 6 of 65 patients [9.2%]; VI: 3 of 44 patients [6.8%]; IV: 3 of 62 patients [4.8%]; V: 0 of 4 patients; I: 0 of 18 patients). There was a large difference in fistula rate between elective neck dissection (12 patients [14.8%]) and observed (8 patients [30.8%]) groups (difference, 16.0 percentage points; 95% CI, -3.4 to 35.3 percentage points), while the difference in fistula rate was negligible between 50 patients undergoing regional or free flap reconstruction (10 patients [20.0%]) vs 57 patients undergoing primary closure (10 patients [17.5%]) (difference, 2.5 percentage points; 95% CI, -12.4 to 17.3 percentage points). Undergoing elective neck dissection was not associated with a clinically meaningful improvement in overall or disease-free survival compared with observation. Recurrent hypopharynx subsite was associated with an increased risk of death (hazard ratio, 4.28; 95% CI, 1.81 to 10.09) and distant recurrence (hazard ratio, 7.94; 95% CI, 2.07 to 30.48) compared with glottic subsite. Conclusions and Relevance In this cohort study, patients with recurrent supraglottic or advanced T classification tumors had an increased occult nodal positivity rate, elective neck dissection was not associated with survival, and patients with recurrent hypopharynx subsite were more likely to have a distant recurrence and die of their disease. These findings suggest that underlying disease pathology rather than surgical management may be associated with survival outcomes in this population.
Collapse
Affiliation(s)
- Jennifer H. Gross
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mihir R. Patel
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tyler G. Chan
- Emory University School of Medicine, Atlanta, Georgia
| | - H. M. Baddour
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Azeem Kaka
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Brian J. Boyce
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nabil F. Saba
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathan J. Beitler
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mark El-Deiry
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| |
Collapse
|
4
|
Magliocca KR, Kaka AS, Barrow EM, Studer MB, Griffith CC, Ernst J, Meade T, Balicki A, Boyce BJ, Schmitt NC, Bur AM, Schmitt AC, Jackson R, Steuer CE, Beitler JJ, Patel MR. Specimen-Based Resection Margins and Local Control during Transoral Robotic Surgery for Oropharyngeal HPV-Mediated Squamous Cell Carcinoma. ORL J Otorhinolaryngol Relat Spec 2022; 85:80-87. [PMID: 36538901 DOI: 10.1159/000527369] [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] [Received: 06/29/2021] [Accepted: 08/29/2022] [Indexed: 12/24/2022]
Abstract
<b><i>Objectives:</i></b> The aim of the study was to investigate the association of surgical margin conditions, including positive specimen margins revised to negative relative to local recurrence, disease-free survival, and overall survival (OS) within a cohort of HPV-mediated oropharyngeal squamous cell carcinoma (OPSCC) who underwent en bloc resection via transoral robotic surgery (TORS). <b><i>Materials and Methods:</i></b> Retrospective cohort of patients with untreated HPV-mediated OPSCC cT1 or T2 undergoing TORS resection between October 2014 and March 2020. The methodologic description of our interdisciplinary institutional approach, number of cut-through margins (CTMs) during intraoperative consultation, percentage of final positive margin cases, and disease-free survival and OS stratified by margin status and margin tumor-free distance is identified. <b><i>Results:</i></b> 135 patients with primary cT1/T2 HPV-mediated OPSCC met inclusion criteria. Twenty-eight of 135 (20.7%) specimens revealed CTM and were revised during the same operative setting. Three of 135 (2.2%) surgical cases had positive final margin status. Local control rate was 97%. On univariate analysis, margin distance did not impact OS. CTM and final positive margins had lower OS than initially negative margins (<i>p</i> = 0.044). Pathologic N-stage significantly impacted OS (<i>p</i> < 0.001). <b><i>Conclusions:</i></b> High local control rate and low final positive margin status confound the study of specimen margin-based techniques in HPV-mediated OPSCC resected en bloc with TORS. Pathologic N-stage may impact OS more than margin status. Larger numbers are needed to confirm differences.
Collapse
Affiliation(s)
- Kelly R Magliocca
- Department of Pathology, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Azeem S Kaka
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Emily M Barrow
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Matthew B Studer
- Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Jacqueline Ernst
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Tara Meade
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Andrew Balicki
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Brian J Boyce
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Andres M Bur
- Department of Otolaryngology, University of Kansas, Kansas, Missouri, USA
| | | | - Ryan Jackson
- Department of Otolaryngology, Washington University, St. Louis, Missouri, USA
| | - Conor E Steuer
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jonathan J Beitler
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Burnham AJ, Ottenstein L, Boyce BJ, Kaka AS, El-Deiry MW, Baddour HM, Patel MR, Gross JH, Schmitt NC. Survival, functional, and quality of life outcomes between total glossectomy with and without total laryngectomy: A narrative review. Am J Otolaryngol 2022; 43:103440. [PMID: 35398743 DOI: 10.1016/j.amjoto.2022.103440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A total glossectomy (TG) may be required for advanced tongue tumors. TG with total laryngectomy (TGL) may be indicated in some cases with tumor extension into the larynx or high risk of aspiration. Total glossectomy with laryngeal preservation (TGLP) may preserve phonation ability relative to TGL, yet TGLP may increase the risk of aspiration. METHODS For this narrative review, we performed a comprehensive literature search of studies relevant to TG and TGL. Clinical studies investigating survival, functional outcomes, and quality of life in following TGLP or TGL were of particular interest. RESULTS Few studies in the literature directly compare survival, functional, and quality of life (QOL) outcomes between TGLP and TGL. TGLP is associated with intelligible speech. However, studies investigating gastrostomy tube dependence following TGLP versus TGL have generated conflicting results. CONCLUSION Further research on functional and QOL outcomes in patients undergoing TGL or TGLP is needed.
Collapse
|
6
|
Dhere VR, Escott CE, Tian S, Switchenko JM, Bell JP, Stokes WA, McDonald MW, Magliocca KR, Boyce BJ, Kaka AS, Steuer CE, Saba NF, Shin DM, Xiao C, Patel MR, Beitler JJ. The omission of intentional primary site radiation following transoral robotic surgery in 59 patients: No local-regional failures. Head Neck 2022; 44:382-390. [PMID: 34850994 PMCID: PMC8766901 DOI: 10.1002/hed.26928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/28/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND We assessed locoregional control with omission of intentional primary site radiation after transoral robotic surgery (TORS) and quantified nontargeted primary site dose. METHODS Following Institutional Review Board (IRB) approval, patients treated with primary TORS resection for squamous cell carcinomas of the oropharynx were reviewed. Patients with cT1-2 tumors, >2 mm margins, in whom the surgeon resected the primary without revising specimen-driven margins, qualified for omission of primary site radiation. RESULTS From 2014 to 2019, 112 patients met criteria. Fifty-nine (52%) patients did not receive radiation targeting the primary site; of whom, 22 received no radiation. In this group, there were no local failures; mean age was 58 years and median follow-up was 25 months. Thirty-seven patients received adjuvant radiation targeting the neck, mean bystander dose to the primary site was 28.8 Gy (range, 13.3-50.6 Gy). CONCLUSION In a 59 patient population, omission of radiation to the primary site after TORS resulted in no locoregional failures.
Collapse
Affiliation(s)
- Vishal R Dhere
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Chase E Escott
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - James P Bell
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Brian J Boyce
- Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Azeem S Kaka
- Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Conor E Steuer
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Dong M Shin
- Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Canhua Xiao
- Yale School of Nursing, New Haven, Connecticut, USA
| | - Mihir R Patel
- Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Ottenstein L, Cornett H, Switchenko JM, Nathan M, Thomas S, Gillespie AI, McColloch N, Barrett T, Studer MB, Brinkman M, Kaka AS, Boyce BJ, Ferris RL, Aiken AH, El-Deiry M, Beitler JJ, Patel MR. Characterizing postoperative physiologic swallow function following transoral robotic surgery for early stage tonsil, base of tongue, and unknown primary human papillomavirus-associated squamous cell carcinoma. Head Neck 2021; 43:1629-1640. [PMID: 33547716 PMCID: PMC8046724 DOI: 10.1002/hed.26632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/07/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Data objectively evaluating acute post-transoral robotic surgery (TORS) swallow function are limited. Our goal was to characterize and identify clinical variables that may impact swallow function components 3 weeks post-TORS. METHODS Retrospective cohort study. Pre/postoperative use of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scale (PAS) was completed on 125 of 139 TORS patients (2016-2019) with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores were retrospectively calculated. Uni/multivariate analysis was performed. RESULTS Dysfunctional pre-TORS DIGEST scores were predictive of post-TORS dysphagia (p = 0.015). Pre-TORS MBSImP deficits in pharyngeal stripping wave, swallow initiation, and clearing pharyngeal residue correlated with airway invasion post-TORS based on PAS scores (p = 0.012, 0.027, 0.048, respectively). Multivariate analysis of DIGEST safety scores declined with older age (p = 0.044). Odds ratios (ORs) for objective swallow function components after TORS were better for unknown primary and tonsil primaries compared to base of tongue (BOT) (OR 0.35-0.91). CONCLUSIONS Preoperative impairments in specific MBSImP components, older patients, and BOT primaries may predict more extensive recovery in swallow function after TORS.
Collapse
Affiliation(s)
- Lauren Ottenstein
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hannah Cornett
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeffrey M. Switchenko
- Department of Biostatistics & Bioinformatics, Winship Cancer Institute, Atlanta, Georgia, USA
| | - Meghana Nathan
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Susan Thomas
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amanda I. Gillespie
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy McColloch
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Meghan Brinkman
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Azeem S. Kaka
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| | - Brian J. Boyce
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| | - Robert L. Ferris
- Department of Otolaryngology – Head & Neck Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashley H. Aiken
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mark El-Deiry
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| | - Jonathan J. Beitler
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, Georgia, USA
| | - Mihir R. Patel
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| |
Collapse
|
8
|
List MA, Boyce BJ, Dziegielewski PT. Intravagal parathyroid adenomas: Case report and literature review. Clin Case Rep 2020; 8:1156-1161. [PMID: 32695348 PMCID: PMC7364057 DOI: 10.1002/ccr3.2855] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 01/25/2023] Open
Abstract
Intravagal parathyroid adenomas remain an exceedingly rare diagnosis; however, their true incidence may be higher than currently known. It is important to keep intravagal sites within the list of potential ectopic locations of parathyroid adenomas.
Collapse
Affiliation(s)
- Marna A List
- College of Medicine University of Florida Gainesville Florida
- Department of Otolaryngology University of Florida Gainesville Florida
| | - Brian J Boyce
- Department of Otolaryngology-Head and Neck Surgery Emory University Atlanta Georgia
| | - Peter T Dziegielewski
- Department of Otolaryngology University of Florida Gainesville Florida
- UF Health Cancer Center UF Health Shands Hospital Gainesville Florida
| |
Collapse
|
9
|
Al-Mulki K, Hamilton J, Kaka AS, Boyce BJ, Baddour HM, El-Deiry M, Solares CA, Magliocca K, Summers K, Aiken A, Saba NF, Beitler JJ, Patel MR. Narrowband Imaging for p16+ Unknown Primary Squamous Cell Carcinoma Prior to Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2020; 163:1198-1201. [PMID: 32571149 DOI: 10.1177/0194599820933204] [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] [Indexed: 01/07/2023]
Abstract
Our purpose was to assess the potential utility of narrowband imaging (NBI) as a tool in diagnosing and treating unknown primary oropharyngeal squamous cell carcinoma (OPSCC) in patients prior to diagnostic resection with transoral robotic surgery (TORS). Between 2016 and March 2019, 29 patients with carcinoma of unknown primary meeting inclusion criteria were identified and treated with TORS. NBI was used preoperatively in 9 of 29 patients. A suspected tumor site was delineated by NBI in 8 of 9 patients (89%). Of the patients imaged with NBI, 8 of 9 (89%) patients had a pathologically confirmed tumor following TORS, corresponding to the same 8 suspected tumor sites identified with NBI. In contrast, a primary tumor was localized following TORS in 15 of 20 (75%) patients not evaluated with NBI. Thus, we see NBI as a potentially useful tool for the diagnosis and management of p16+ carcinoma of unknown primary.Level of Evidence: IIb.
Collapse
Affiliation(s)
| | - James Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Azeem S Kaka
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Brian J Boyce
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - H Michael Baddour
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Mark El-Deiry
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Kelly Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Kelly Summers
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Jonathan J Beitler
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.,Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
10
|
Gore A, Baugnon K, Beitler J, Saba NF, Patel MR, Wu X, Boyce BJ, Aiken AH. Posttreatment Imaging in Patients with Head and Neck Cancer without Clinical Evidence of Recurrence: Should Surveillance Imaging Extend Beyond 6 Months? AJNR Am J Neuroradiol 2020; 41:1238-1244. [PMID: 32554418 DOI: 10.3174/ajnr.a6614] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of residual or recurrent disease is important for effective salvage treatment in patients with head and neck cancer. Current National Comprehensive Cancer Network guidelines do not recommend standard surveillance imaging beyond 6 months unless there are worrisome signs or symptoms on clinical examination and offer vague guidelines for imaging of high-risk patients beyond that timeframe. Our goal was to evaluate the frequency of clinically occult recurrence in patients with head and neck squamous cell carcinoma with positive imaging findings (Neck Imaging Reporting and Data Systems scores of 2-4), especially after 6 months. MATERIALS AND METHODS This institutional review board-approved, retrospective data base search queried neck CT reports with Neck Imaging Reporting and Data Systems scores of 2-4 from June 2014 to March 2018. The electronic medical records were reviewed to determine outcomes of clinical and radiologic follow-up, including symptoms, physical examination findings, pathologic correlation, and clinical notes within 3 months of imaging. RESULTS A total of 255 cases, all with Neck Imaging Reporting and Data Systems scores of 2 or 3, met the inclusion criteria. Fifty-nine patients (23%) demonstrated recurrence (45 biopsy-proven, 14 based on clinical and imaging progression), and 21 patients (36%) had clinically occult recurrence (ie, no clinical evidence of disease at the time of the imaging examination). The median overall time to radiologically detected, clinically occult recurrence was 11.4 months from treatment completion. CONCLUSIONS Imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease in patients with head and neck squamous cell carcinoma. More than one-third of all recurrences were seen in patients without clinical evidence of disease; and 81% of clinically occult recurrences occurred beyond 6 months.
Collapse
Affiliation(s)
- A Gore
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - K Baugnon
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | | | - N F Saba
- Hematology/Oncology (N.F.S.).,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - M R Patel
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - X Wu
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - B J Boyce
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.) .,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
11
|
Balamohan SM, Sawhney R, Lang DM, Cherabuddi K, Varadarajan VV, Bernard SH, Mackinnon LM, Boyce BJ, Antonelli PJ, Efron PA, Dziegielewski PT. Prophylactic antibiotics in head and neck free flap surgery: A novel protocol put to the test. Am J Otolaryngol 2019; 40:102276. [PMID: 31447185 DOI: 10.1016/j.amjoto.2019.102276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/03/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent evidence supports the use of ampicillin-sulbactam as a favored choice for antibiotic prophylaxis following head and neck free flap reconstructive surgery. However, there is a paucity of evidence guiding the optimal duration of antibiotic prophylaxis. The aim of this study is to compare the infection rates of short courses of ampicillin-sulbactam versus extended courses of various antibiotics in head and neck free flap reconstructive surgery. METHODS This is a retrospective cohort study conducted from 2012 to 2017 at a tertiary academic center on 266 consecutive patients undergoing head and neck surgery with free flap reconstruction. The primary outcome measure was the rate of any infection within 30 days of surgery. RESULTS There were 149 patients who received antibiotic prophylaxis for an extended duration of at least seven days. 117 patients received a short course of antibiotics defined as 24 h for non-radiated patients and 72 h for radiated patients. Postoperative infections occurred in 45.9% of patients, of which 92.6% occurred at surgical sites. There was no significant difference in terms of postoperative infection rate between patients receiving an extended duration of antibiotics versus a short duration (p = 0.80). This held true for subgroups of surgical site infections (p = 0.38) and distant infections (p = 0.59 for pneumonia and p = 0.76 for UTI). Risk factors for infections were identified as hypothyroidism (p = 0.047) and clean contaminated wound classification (p = 0.0002). CONCLUSION Shorter duration of ampicillin-sulbactam prophylaxis in free flap reconstruction of head and neck defects does not negatively affect postoperative infection rates. LEVEL OF EVIDENCE Level 2b.
Collapse
Affiliation(s)
| | - Raja Sawhney
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Dustin M Lang
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Kartik Cherabuddi
- Division of Infectious Disease, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Stewart H Bernard
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Lauren M Mackinnon
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | | | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA; University of Florida Health Cancer Center, Gainesville, FL, USA.
| |
Collapse
|
12
|
Kimball H, Kimball D, Siroy A, Tuna IS, Boyce BJ, Albayram MS. Novel diagnostic imaging features of facial lupus panniculitis: ultrasound, CT, and MR imaging with histopathology correlate. Clin Imaging 2019; 58:177-181. [PMID: 31386960 DOI: 10.1016/j.clinimag.2019.07.006] [Citation(s) in RCA: 5] [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: 04/17/2019] [Revised: 07/05/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
Lupus panniculitis (LP), also referred to as lupus erythematosus profundus (LEP), is a chronic recurrent inflammation condition of the subcutaneous fat. It occurs in 1 to 3% of patients with systemic lupus erythematosus (SLE) and in 10% of patients with discoid lupus erythematosus (DLE), but can also occur as an entity of its own. Patients with lupus panniculitis usually present with persistent, often tender and painful skin lesions, or subcutaneous nodules, that range from 1 to 5 cm in diameter. The overlying skin may appear erythematous; lesions may become ulcerated, and heal with atrophy, skin depression, dimpling and scaring. Lesions tend to resolve spontaneously and may follow a chronic course of remission and exacerbation that persists for months to years. The imaging features of facial LP are extremely scarce in the literature. We present a case of facial lupus panniculitis and describe the associated characteristic ultrasound, CT, and MR imaging findings along with histopathologic correlation.
Collapse
Affiliation(s)
- Heather Kimball
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - David Kimball
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Alan Siroy
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, College of Medicine, Gainesville, FL, United States
| | - Ibrahim Sacit Tuna
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, United States.
| | - Brian J Boyce
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mehmet Sait Albayram
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, United States
| |
Collapse
|
13
|
Abstract
OBJECTIVES A shift in the microbiota of chronic rhinosinusitis has been described after radiotherapy to the sinonasal cavity and skull base. There is a paucity of literature characterizing the bacteriology of post radiation sinusitis using next-generation gene sequencing techniques. This study aims to describe and compare the microbial flora of rhinosinusitis after radiotherapy using both culture and molecular techniques for microbial DNA detection. METHODS The medical records of patients treated with external beam radiation for sinonasal, nasopharyngeal, or skull base malignancy were reviewed at a tertiary care facility. Patients' sinonasal cavities were swabbed for routine culture or brushed for molecular gene sequencing. Swab specimens were processed for standard microbial culture, and brush specimens were sent for gene sequencing at Micro GenX Laboratory (Lubbock, Texas, USA). RESULTS Twenty-two patients were diagnosed with chronic sinusitis after undergoing radiotherapy. Staphylococcus aureus was the most common organism identified by both culture and gene sequencing, followed by Pseudomonas aeruginosa. Several additional organisms were detected by gene sequencing that were not isolated by routine culture techniques. Gene sequencing identified pathogens differing from culture results in 50% of patients examined. CONCLUSION The bacteriology of post radiation sinusitis appears to resemble the microorganisms responsible for chronic sinusitis in healthy adults. Next generation gene sequencing techniques may reveal additional organisms responsible for sinusitis and provide complementary results that may impact the medical treatment of post radiation sinusitis.
Collapse
Affiliation(s)
| | | | | | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, USA
| | - Jeb M Justice
- Department of Otolaryngology, University of Florida, Gainesville, USA
| |
Collapse
|
14
|
Bennion DM, Dziegielewski PT, Boyce BJ, Ducic Y, Sawhney R. Fellowship training in microvascular surgery and post-fellowship practice patterns: a cross sectional survey of microvascular surgeons from facial plastic and reconstructive surgery programs. J Otolaryngol Head Neck Surg 2019; 48:19. [PMID: 31072392 PMCID: PMC6509799 DOI: 10.1186/s40463-019-0342-y] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is a lack of published literature on the training in microvascular reconstructive techniques in facial plastic and reconstructive surgery (FPRS) fellowships or of the extent these techniques are continued in practice. This cross-sectional web-based survey study was conducted to describe the volume, variety, and intended extent of practice of free tissue transfers during fellowship and the post-fellowship pattern of microsurgical practice among FPRS surgeons in various private and academic practice settings across the United States. Methods This survey was sent to recent graduates (n = 94) of a subset of U.S. Facial Plastic and Reconstructive Surgery fellowship programs that provide significant training in microvascular surgery. Results Among survey respondents (n = 21, 22% response rate), two-thirds completed 20–100 microvascular cases during fellowship using mainly radial forearm, fibula, anterior lateral thigh, latissimus and rectus free tissue transfers. In post-fellowship practice, those who continue practicing microvascular reconstruction (86%) complete an average of 33 cases annually. The choice of donor tissues for reconstruction mirrored their training. They are assisted primarily by residents (73%) and/or fellows (43%), while some worked with a micro-trained partner, surgical assistant, or performed solo procedures. Interestingly, among those who began in private practice (29%), only half remained with that practice, while those who joined academic practices (71%) largely remained at their initial post-fellowship location (87%). Conclusions These results provide the first formal description of the training and practice patterns of FPRS-trained microvascular surgeons. They describe a diverse fellowship training experience that often results in robust microvascular practice. The maintenance of substantial microsurgical caseloads after fellowship runs counter to the perception of high levels of burnout from free tissue transfers among microvascular surgeons. Trial Registration This study was approved as exempt by the University of Florida Institutional Review Board (#201601526).
Collapse
Affiliation(s)
- Douglas M Bennion
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, College of Medicine, University of Florida, 1600 SW Archer Drive, PO BOX 100264, Gainesville, FL, 32610, USA.
| | - Brian J Boyce
- Department of Otolaryngology, College of Medicine, University of Florida, 1600 SW Archer Drive, PO BOX 100264, Gainesville, FL, 32610, USA
| | - Yadro Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA
| | - Raja Sawhney
- Department of Otolaryngology, College of Medicine, University of Florida, 1600 SW Archer Drive, PO BOX 100264, Gainesville, FL, 32610, USA
| |
Collapse
|
15
|
Lang DM, Danan D, Sawhney R, Silver NL, Varadarajan VV, Balamohan S, Bernard SH, Boyce BJ, Dziegielewski PT. Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days. Otolaryngol Head Neck Surg 2019; 160:829-838. [DOI: 10.1177/0194599819835545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Length of stay (LOS) includes time medically necessary in the hospital and time waiting for discharge (DC) afterward. This DC delay is determined in head and neck free flap patients. Reasons for and factors leading to DC delay, as well as associated adverse outcomes, are elucidated. Methods Retrospective chart review was performed for all head and neck free flap surgeries from 2012 to 2017. Data including demographics, comorbidities, and perioperative factors were collected. Regression analyses were performed to identify factors associated with DC delay. Results In total, 264 patients were included. Mean total LOS was 13.1 days. DC delay occurred in 65% of patients with a mean of 4.8 days. Factors associated with DC delay on univariate analysis included Medicaid/self-pay insurance, DC to a facility, and not having children ( P < .05). Multivariate analysis showed prolonged medically necessary LOS and surgery on a Monday/Friday ( P < .05) were associated with DC delay. Top reasons for DC delay included case management shortages, rejection by facility, and awaiting supplies. Eleven percent experienced complications during the DC delay. Discussion DC delay can add days and complications to the LOS. Prevention begins preoperatively with DC planning involving the patient’s closest family. Understanding limitations of the patient’s insurance may help plan DC destination. Optimizing hospital resources when available should be a focus. Implications for Practice Head and neck free flap patients require a team of teams unified in optimizing quality of care. DC delay is a novel quality metric reflecting the team’s overall performance. Through strategic DC planning and capitalizing on available resources, DC delay can be minimized.
Collapse
Affiliation(s)
- Dustin M. Lang
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Raja Sawhney
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Natalie L. Silver
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
- University of Florida Health Cancer Center, Gainesville, Florida, USA
| | | | - Sanjeev Balamohan
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Stewart H. Bernard
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Brian J. Boyce
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Peter T. Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
- University of Florida Health Cancer Center, Gainesville, Florida, USA
| |
Collapse
|
16
|
Reddy R, Woods TR, Allan RW, Malhotra P, Mehta HJ, Sarkar PK, Boyce BJ, Asirvatham JR. NUT (Nuclear Protein in Testis) Carcinoma: A Report of Two Cases With Different Histopathologic Features. Int J Surg Pathol 2018; 27:225-229. [DOI: 10.1177/1066896918796606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
NUT (nuclear protein in testis) carcinoma (NC) is an aggressive carcinoma characterized by rearrangements of the NUT gene on chromosome 15q14. Histologically, it is a poorly differentiated carcinoma composed of monotonous, medium-sized, round cells with scant amphophilic or eosinophilic cytoplasm. Foci of abrupt keratinization are often seen. In this report, we compare the morphology of 2 cases of NC. The first case shows characteristic features of uniform, round epithelioid cells admixed with foci of abrupt keratinization. The second case demonstrates nests of epithelioid-polygonal cells that appear to be loosely cribriform within a mucoid stroma. Although considered rare, the actual incidence of NC may be underestimated, as it is likely that many go undiagnosed because the morphology deviates from what is typical. Our report demonstrates that NC should always be considered in any case of an undifferentiated carcinoma and should not be excluded if typical histologic and immunohistochemical features of squamous differentiation are lacking.
Collapse
Affiliation(s)
| | - Tina R. Woods
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Alotaiby F, Song F, Boyce BJ, Cao D, Zhao Y, Lai J. Unusual Papillary Squamous Cell Carcinoma of the Tip of Tongue Presenting in a Patient Status Post Heart Transplant. Anticancer Res 2018; 38:4203-4206. [PMID: 29970551 DOI: 10.21873/anticanres.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/01/2018] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 02/08/2023]
Abstract
Oral papillary squamous cell carcinoma (PSCC) is an unusual variant of squamous cell carcinoma with a better prognosis. The most common location of PSCC in the oral cavity is the gingiva and buccal mucosa, and it is exceedingly rare in the tongue. Herein, we present a case of PSCC in an 85-year-old male with a history of heart transplant and long-term use of immunosuppression medication. A verrucous pedunculated mass measuring 3.5 cm in the greatest dimension was present on the tip of tongue and a partial glossectomy was performed. Histological diagnosis was well differentiated PSCC with focal and minimal stalk invasion. No vascular nor perineural invasion was identified. Based on the current WHO and AJCC oral cancer staging system, the tumor stage was T2N0M0. The tumor cells were focally positive for p16, but in situ hybridization was negative for low-risk HPV (types 6 and 11) and high-risk HPV (types 16, 18, 31, 33 and 51). To the best of our knowledge, this is the first documented case of PSCC present on the tip of tongue in patients with long-term immune suppression. The pathogenesis, stage and prognosis of this entity are discussed. More case studies with long-term follow up are needed to achieve an accurate tumor stage and definite prognosis.
Collapse
Affiliation(s)
- Faraj Alotaiby
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, U.S.A
| | - Fenglin Song
- Division of Cardiac Surgery, Department of Surgery, Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Brian J Boyce
- Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Dengfeng Cao
- Department of Pathology, Immunology, and Laboratory Medicine, Washington University in Saint Louis, St. Louis, MO, U.S.A
| | - Yulin Zhao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.
| |
Collapse
|
18
|
Baskin RM, Boyce BJ, Amdur R, Mendenhall WM, Hitchcock K, Silver N, Dziegielewski PT. Transoral robotic surgery for oropharyngeal cancer: patient selection and special considerations. Cancer Manag Res 2018; 10:839-846. [PMID: 29719420 PMCID: PMC5916264 DOI: 10.2147/cmar.s118891] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 12/04/2022] Open
Abstract
The increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) emphasizes the importance of optimizing treatment for the disease. Historical protocol has utilized definitive radiation and invasive open procedures; these techniques expose the patient to significant risks and morbidity. Transoral robotic surgery (TORS) has emerged as a therapeutic modality with promise. Here, the literature regarding proper patient selection and other considerations for this procedure was reviewed. Multiple patient and tumor-related factors were found to be relevant for successful use of this treatment strategy. Outcomes regarding early and advanced-stage OPSCC were analyzed. Finally, the literature regarding use of TORS in three distinct patient populations, individuals with primary OPSCC, carcinoma of unknown primary and those with recurrent OPSCC, was examined.
Collapse
Affiliation(s)
- R Michael Baskin
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Robert Amdur
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - William M Mendenhall
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Kathryn Hitchcock
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Natalie Silver
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| |
Collapse
|
19
|
Dziegielewski PT, Reschly WJ, Morris CG, DeJesus RD, Silver N, Boyce BJ, Santiago I, Amdur RJ, Mendenhall WM. Tumor volume as a predictor of survival in T3 glottic carcinoma: A novel approach to patient selection. Oral Oncol 2018; 79:47-54. [PMID: 29598950 DOI: 10.1016/j.oraloncology.2018.02.015] [Citation(s) in RCA: 14] [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: 10/27/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optimal treatment for T3 glottic cancers continues to be debated. Organ preservation has become the standard of care, but not all tumors respond equally. The purpose of this was to investigate the long-term survival outcomes of organ preservation protocols based on tumor volume. METHODS A retrospective review of prospectively collected data from 1966 to 2016 was performed. Patients with T3 vocal cord cancer treated with radiation therapy (RT) at the University of Florida were included. Local control rates as well as survival rates were determined with a Kaplan Meier and Cox regression analysis. Survival was analyzed as a function of tumor volume and an optimal cut point was determined. RESULTS 107/234 patients were included. 79% received RT and 21% chemo-RT. 5-year local control was 61.5% and 5-year disease specific survival was 79.3%. Tumor volume was a significant predictor of survival (p = 0.007). An optimal cut point for tumor volume was 2.5 cc. Patients with tumor volumes ≥2.5 cc had significantly worse (p < 0.05) tumor control rates (100% vs. 70.4%). CONCLUSION Tumor volume is a significant predictor of survival outcomes in T3 vocal cord cancers, but will need external validation. Tumors <2.5 cc have favorable outcomes. Those with higher volume tumors should be counselled appropriately and be considered for primary surgical management.
Collapse
Affiliation(s)
- Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA; University of Florida Health Cancer Center, Gainesville, FL, USA.
| | - William J Reschly
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Chris G Morris
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | | | - Natalie Silver
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Inocente Santiago
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Robert J Amdur
- University of Florida Health Cancer Center, Gainesville, FL, USA; Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - William M Mendenhall
- University of Florida Health Cancer Center, Gainesville, FL, USA; Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
20
|
Baskin RM, Zhang J, Dirain C, Lipori P, Fonseca G, Sawhney R, Boyce BJ, Silver NL, Dziegielewski PT. Predictors of returns to the emergency department after head and neck surgery. Head Neck 2017; 40:498-511. [DOI: 10.1002/hed.25019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/30/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- R. Michael Baskin
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Jingnan Zhang
- Department of Biostatistics; University of Florida; Gainesville Florida
| | - Carolyn Dirain
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Paul Lipori
- College of Medicine; University of Florida; Gainesville Florida
| | - Gileno Fonseca
- College of Medicine; University of Florida; Gainesville Florida
| | - Raja Sawhney
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Brian J. Boyce
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Natalie L. Silver
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology; University of Florida; Gainesville Florida
- University of Florida Health Cancer Center; Gainesville Florida
| |
Collapse
|
21
|
Kennedy WR, Amdur RJ, Boyce BJ, Dziegielewski P, Morris CG, Mendenhall WM. Neck Management with Total Laryngectomy and Adjuvant Radiotherapy in Locally Advanced Larynx Cancer. Oncol Res Treat 2017; 40:503-506. [PMID: 28848123 DOI: 10.1159/000477463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine whether patients with clinically node-negative (cN0) locally advanced squamous cell carcinoma (SCC) of the larynx who receive total laryngectomy (TL) benefit from elective neck dissection (END) before adjuvant postoperative radiotherapy (RT). METHODS A retrospective review of 36 patients who received TL and adjuvant postoperative RT for laryngeal SCC between 1988 and 2013 was carried out. Patients had either T3 (n = 7; 19%) or T4a (n = 29; 81%) primaries, and all had clinically node-negative disease. All patients underwent TL and adjuvant RT. Patients underwent either a planned unilateral END, a bilateral END, or no END. RESULTS Median follow-up was 3.3 years (range, 0.3-18.4 years). Occult nodal metastases were found in 9 (32%) of 28 patients receiving END. 5-year control and survival rates for all patients were: local-regional control, 92% (END 91% vs. no END 100%; p = 0.4922); cause-specific survival, 80%; distant metastasis-free survival, 88%; and overall survival, 52%. Local-regional control and survival were not influenced by END. 5 (14%) patients experienced grade 3 or 4 toxicities. CONCLUSION In this patient population, those not receiving END at the time of TL had equivalent rates of local-regional control and survival as those receiving END, although our sample size not receiving END was relatively small.
Collapse
|
22
|
Dziegielewski PT, Boyce BJ, Old M, Teknos TN, Agrawal A, Patwa H, Ozer E. Transoral robotic surgery for tonsillar cancer: Addressing the contralateral tonsil. Head Neck 2017; 39:2224-2231. [DOI: 10.1002/hed.24887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/21/2017] [Accepted: 06/15/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Peter T. Dziegielewski
- Department of Otolaryngology; University of Florida; Gainesville Florida
- University of Florida Health Cancer Center; University of Florida; Gainesville Florida
| | - Brian J. Boyce
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Matthew Old
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| | - Theodoros N. Teknos
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| | - Hafiz Patwa
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| |
Collapse
|
23
|
Christopherson K, Morris CG, Kirwan JM, Amdur RJ, Dziegielewski PT, Boyce BJ, Mendenhall WM. Radiotherapy alone or combined with chemotherapy for base of tongue squamous cell carcinoma. Laryngoscope 2017; 127:1589-1594. [PMID: 28233903 DOI: 10.1002/lary.26460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/17/2016] [Revised: 10/25/2016] [Accepted: 11/14/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the long-term disease control, survival, and complications after definitive radiotherapy (RT) alone or combined with adjuvant chemotherapy with or without planned neck dissection for base of tongue squamous cell carcinoma (SCC). STUDY DESIGN We retrospectively reviewed the medical records of 467 patients treated at the University of Florida with definitive RT alone or combined with adjuvant chemotherapy between 1964 and 2011 for base of tongue SCC. METHODS Median follow-up was 5.6 years. Median total dose to the primary site was 74.4 Gy. Eighty-seven patients (19%) were treated with once-daily fractionation, and 380 (81%) received altered fractionation schedules. Intensity-modulated RT was used in 128 patients (27%). Chemotherapy was administered to 173 (37%) patients. Planned neck dissection after RT was performed in 226 patients (48%). Data regarding p16 pathway activation were available for 25 patients. RESULTS At 5 years, the local, local-regional, and regional control rates were 85.5%, 80.0%, and 90.0%, respectively. The 5-year overall, cause-specific, and distant metastasis-free survival rates were 59.1%, 71.5%, and 84.1%, respectively. Sixty-four patients (14%) developed one or more severe late complications. Fifty patients (11%) required late gastrostomy tube placement. CONCLUSIONS This study supports the continued use of RT alone or combined with adjuvant chemotherapy for patients with base of tongue SCC, as this treatment yields high rates of cause-specific survival and disease control, with a relatively low rate of late complications. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1589-1594, 2017.
Collapse
Affiliation(s)
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, U.S.A
| | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, U.S.A
| | - Robert J Amdur
- Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A
| | | | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, U.S.A
| |
Collapse
|
24
|
Boyce BJ, Curry JM, Luginbuhl A, Cognetti DM. Transoral robotic approach to parapharyngeal space tumors: Case series and technical limitations. Laryngoscope 2016; 126:1776-82. [PMID: 27010862 DOI: 10.1002/lary.25929] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 08/17/2015] [Revised: 01/04/2016] [Accepted: 01/25/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The transoral robotic approach to parapharyngeal space (PPS) tumors is a new technique with limited data available on its feasibility, safety, and efficacy. We analyzed our experience with transoral robotic excisions of PPS tumors to evaluate the safety and efficacy of this technique. STUDY DESIGN Retrospective chart analysis at tertiary academic medical center. From July 2010 to June 2014, 17 patients who had transoral robotic excision of PPS tumors were included in the study. Our cohort had an average age of 61.6 years and was 52.9% male. RESULTS All patients had successful removal of their PPS tumors, and the average size of the tumors was 27.3 cm(3) (range 2-80 cm(3) ). Two cases (11.7%) required a cervical incision to assist with tumor removal. The average total operative time was 140.5 minutes. Two PPS PAs had focal areas of capsule rupture and one was fragmented. The average length of stay was 1.8 days (range 1-7 days), and all patients were discharged on an oral diet. Three patients experienced complications. There was no clinical or radiographic evidence of recurrence. CONCLUSION This is the largest single-institution case series of transoral robotic approaches to PPS tumors. We demonstrate that this approach is feasible and safe but also note limitations of the robotic approaches for tumors on the far lateral and superior areas of the PPS, which required transcervical assistance. There were no patients who demonstrated recurrent tumor either radiographically or clinically. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1776-1782, 2016.
Collapse
Affiliation(s)
- Brian J Boyce
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| |
Collapse
|
25
|
Durmus K, Boyce BJ, Ozer E. Evaluation of Lymph Node Metastasis in Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a85] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: (1) Examine the association between histopathologic variables and neck metastasis. (2) Analyze the effect of human papillomavirus (HPV) status on lymph node (LN) metastasis. Methods: Medical records of 93 patients who underwent transoral robotic surgery (TORS) with concurrent neck dissection for oropharyngeal squamous cell carcinoma (SCC) between 2008 and 2013 were reviewed. Results: At the time of presentation, 60 (64.5%) patients had tonsil cancer, 14 (15%) had base of tongue, and 19 (21%) had carcinoma of unknown primary. High risk types of HPV and p16 positivity were 74.4% and 85.4%, respectively. Mean primary tumor size was 2.3 cm (range, 0.3-5.1 cm). Nodal status based on pathologic examination were N0 in 7 (7.5%) patients, N1 in 12 (12.9%), N2a in 25 (26.9%), N2b in 37 (39.8), N2c in 5 (5.4%), and N3 in 7 (7.5%). Average positive LN number was 2.56 (range, 0-37). Extracapsular spread (ECS) was identified in 29.1% of all patients. Primary tumor size had no effect on positive LN size, number or ECS. HPV positivity (rs = 0.25, P = .021), p16 overexpression (rs = 0.36, P = .001), and lymphovascular invasion (rs = 0.34, P = .001) were significantly associated with increased positive LN number. Positive LN number correlates with ECS (rs = 0.28, P =.009). Conclusions: HPV positivity, p16 overexpression, and lymphovascular invasion increase the risk of cervical lymph node metastasis. Increased primary tumor size does not necessarily mean advanced neck disease.
Collapse
|
26
|
Boyce BJ, deSilva BW. Spontaneous MRSA postcricoid abscess: A case report and literature review. Laryngoscope 2014; 124:2583-5. [DOI: 10.1002/lary.24819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/04/2014] [Accepted: 06/12/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Brian J. Boyce
- Department of Otolaryngology-Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio U.S.A
| | - Brad W. deSilva
- Department of Otolaryngology-Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio U.S.A
| |
Collapse
|
27
|
Dziegielewski PT, Boyce BJ, Manning A, Agrawal A, Old MO, Ozer E, Teknos TN. Predictors and Cost of Readmissions at an Academic Head and Neck Cancer Service. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a120] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: With healthcare reform nationally debated, surgeons are increasingly called upon to improve quality of care while lowering cost of delivery. Rate of hospital readmission within thirty days of discharge (RA30) is a quality measure monitored by CMS and will subject healthcare systems to fines if they fall outside of acceptable standards. Unfortunately, few benchmarks in head and neck surgery (HNS) exist. Our goal was to determine: 1) the rate and predictors of readmissions, and 2) a detailed cost breakdown of readmissions on an academic head and neck surgery service. Methods: A prospective-cohort study at a tertiary-care academic center was conducted. Six hundred and ninety-four patients from 2011-2012 underwent HNS procedures. Demographic, pathological, and follow-up data were collected. Financial information for each admission was obtained from the hospital billing database. RA30 was the primary outcome. Multivariate analysis identified peri-admission factors predictive of re-admission. A cost analysis was performed. Results: C4QI cancer hospital-readmission benchmarks for fiscal year 2011 were 17.29%. On the HNS service, 39 (5.6%) patients were re-admitted to the hospital. Thirty-six of 39 patients were admitted due to wound complications and 3/39 due to pneumonia (2) or C difficile (1) colitis. Predictors of re-admission were age >65 years, advanced stage cancer, previous radiation therapy, multiple medical comorbidities, and high-acuity procedures ( P < 0.05). Median cost of readmission was $20,877.84 (range: $3,201.50-$174,693.30). The highest source of readmission cost was the operating room. Conclusions: Readmission rates on a busy HNS service can be low, but costly. Knowing factors predictive of readmission may help create preventative and minimize excess costs.
Collapse
|
28
|
Gourin CG, Kaboli KC, Boyce BJ, Burkhead LM. Factors associated with nonparticipation in one-year quality-of-life assessment in patients with head and neck squamous cell carcinoma. Laryngoscope 2010; 120:1435-43. [DOI: 10.1002/lary.20952] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
29
|
Gourin CG, Boyce BJ, Williams HT, Herdman AV, Bilodeau PA, Coleman TA. Revisiting the role of positron-emission tomography/computed tomography in determining the need for planned neck dissection following chemoradiation for advanced head and neck cancer. Laryngoscope 2009; 119:2150-5. [PMID: 19544378 DOI: 10.1002/lary.20523] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Planned neck dissection following chemoradiation (CR) has been advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease and a clinical complete response to CR because of the potential for residual occult nodal disease. The utility of positron-emission tomography/computed tomography (PET-CT) in identifying occult nodal disease in this scenario is controversial. METHODS The medical records of all patients treated with CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2007 were reviewed. Patients with a complete clinical response were included if PET-CT performed 8 to 11 weeks after CR showed no distant disease and they underwent planned neck dissection. RESULTS Thirty-two patients met study criteria. PET-CT was positive for residual nodal disease in 20 patients (63%). Pathology revealed carcinoma in 10 patients (31%): six of 20 patients with positive PET-CT scans (30%) and four of 12 patients with negative PET-CT scans (33%). The sensitivity and specificity of PET-CT was 60% and 36%. Regional recurrence developed in two patients (6%) who were not successfully salvaged. CONCLUSIONS PET-CT performed 8 to 11 weeks after CR does not reliably predict the need for planned post-treatment neck dissection in patients with a complete clinical response following CR. Regional recurrence rates are comparable to those reported for patients observed with PET-CT, suggesting no advantage for planned neck dissection, and salvage rates were poor. These data suggest that delaying the timing of PET-CT, with surgery reserved for positive findings, is a reasonable alternative to planned neck dissection to avoid unnecessary surgery.
Collapse
Affiliation(s)
- Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Gourin CG, Boyce BJ, Vaught CC, Burkhead LM, Podolsky RH. Effect of comorbidity on post-treatment quality of life scores in patients with head and neck squamous cell carcinoma. Laryngoscope 2009; 119:907-14. [DOI: 10.1002/lary.20199] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|