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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Campbell DA, Pipkorn P, Divi V, Stadler M, Massey B, Campbell B, Richmon JD, Graboyes E, Puram S, Zenga J. The effect of reconstruction on positive margin rates in oral cancer: Using length of stay as a proxy measure for flap reconstruction in a national database. Am J Otolaryngol 2021; 42:103012. [PMID: 33857781 DOI: 10.1016/j.amjoto.2021.103012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Planned flap reconstruction, allowing aggressive resections of oral cavity squamous cell carcinoma (OCSCC), may decrease positive surgical margins. The purpose of this study was to determine if length of stay (LOS), as a proxy measure for flap reconstruction, is associated with positive margin rates in OCSCC. MATERIALS AND METHODS Data from the National Cancer Database was retrospectively collected for patients undergoing surgery for previously untreated clinical T1-3 OCSCC. Post-operative LOS was dichotomized between ≤4 and >4 days as a proxy measure for whether patients may have received flap reconstruction. Patients with LOS >4 days represent a diverse group, but those with a LOS ≤4 days are less likely to have undergone an oral cavity flap reconstruction. RESULTS 10,107 patients were included, of which 5290 (52%) were clinical T1 and 4852 (48%) were clinical T2-3. 771 (8%) patients had a positive surgical margin. On multivariable logistic regression analysis, LOS ≤4 days was significantly associated with a positive margin resection in patients with clinical T2-3 tumors (OR 1.68, 95%CI 1.37-2.06) compared to patients with LOS >4 days. LOS was not associated with surgical margin status in patients with clinical T1 disease (OR 0.76, 95%CI 0.55-1.06). Patients with positive margin resections demonstrated worse overall survival (cT1: OR 1.35, 95%CI 1.06-1.72; cT2-3: OR 1.52, 95%CI 1.33-1.74). CONCLUSIONS LOS >4 days after oral cavity cancer resection was significantly associated with negative surgical margins in clinical T2-3 oral cavity cancer, suggesting the possibility that patients undergoing flap reconstruction after resection have fewer positive surgical margins.
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Khariwala SS, Weinreich HM, McCoul ED, Graboyes E, Francis DO, Baldassari C, Poetker DM, Tunkel DE, Davies L. Leveraging COVID-19–Inspired Changes to Advance Otolaryngology—Here to Stay. JAMA Otolaryngol Head Neck Surg 2020; 146:605-607. [DOI: 10.1001/jamaoto.2020.1188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Samir S. Khariwala
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Heather M. Weinreich
- Department of Otolaryngology–Head and Neck Surgery, University of Illinois, Chicago
| | - Edward D. McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana
| | - Evan Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | | | | | - David M. Poetker
- Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - David E. Tunkel
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Louise Davies
- Otolaryngology–Head and Neck Surgery, Geisel School of Medicine at Dartmouth, White River Junction, Vermont
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Graboyes E, Cramer J, Balakrishnan K, Cognetti DM, López-Cevallos D, de Almeida JR, Megwalu UC, Moore CE, Nathan CA, Spector ME, Lewis CM, Brenner MJ. COVID-19 pandemic and health care disparities in head and neck cancer: Scanning the horizon. Head Neck 2020; 42:1555-1559. [PMID: 32562325 PMCID: PMC7323088 DOI: 10.1002/hed.26345] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Received: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC-directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high-quality HNC care.
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Affiliation(s)
- Evan Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Cramer
- Department of Otolaryngology-Head & Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - David M Cognetti
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel López-Cevallos
- School of Language, Culture & Society, Oregon State University, Corvallis, Oregon, USA
| | - John R de Almeida
- University Health Network/ Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - Charles E Moore
- Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Cherie-Ann Nathan
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol M Lewis
- Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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5
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North L, Stadler M, Massey B, Campbell B, Shukla M, Awan M, Schultz CJ, Shreenivas A, Wong S, Graboyes E, Pipkorn P, Zenga J. Intermediate-grade carcinoma of the parotid and the impact of adjuvant radiation. Am J Otolaryngol 2019; 40:102282. [PMID: 31519432 DOI: 10.1016/j.amjoto.2019.102282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the influence of adjuvant radiotherapy on survival in surgically-managed early stage intermediate-grade mucoepidermoid and acinic cell carcinoma of the parotid. MATERIALS AND METHODS The National Cancer Database was reviewed between 2004 and 2015 to identify patients with intermediate-grade, early T-stage, node-negative parotid carcinoma who underwent parotidectomy ± radiotherapy. RESULTS There were 744 patients identified of which 81% had mucoepidermoid carcinoma and 19% had acinic cell carcinoma. Positive surgical margins were identified in 21% and adjuvant radiotherapy was administered in 38% of cases. Of the 159 patients with positive margins, 113 (71%) received adjuvant radiotherapy. Of the 585 patients with negative margins, 173 (30%) underwent adjuvant radiotherapy. In multivariable analysis, age (over 52 years: HR 5.19, 95%CI 2.33-11.57), insurance status (private insurance: HR 0.24 95%CI 0.13-0.43), and extent of parotidectomy (total parotidectomy: HR 2.02 95%CI 1.23-3.31) were significantly associated with overall survival, while adjuvant radiotherapy was not a significant predictive factor (HR 0.81, 95%CI 0.49-1.36). In patients with positive margin resections, however, adjuvant radiation was an independent predictor of improved survival when adjusted for age, insurance status, and extent of parotidectomy (HR 0.34, 95%CI 0.13-0.88). Conversely, in patients with negative margin resections, adjuvant radiation did not influence survival outcomes when adjusted for these covariates (HR 1.02, 95%CI 0.53-1.93). CONCLUSIONS AND RELEVANCE In patients with early stage intermediate-grade parotid carcinoma, adjuvant radiotherapy significantly and independently improves survival in those with post-operative positive margins. Adjuvant therapy, however, does not appear to improve survival outcomes in those with negative margin resections.
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Affiliation(s)
- Lauren North
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael Stadler
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Becky Massey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Bruce Campbell
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Monica Shukla
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Christopher J Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Aditya Shreenivas
- Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Stuart Wong
- Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Evan Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States of America
| | - Patrick Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States of America
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America.
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Sandulache VC, Lei YL, Heasley LE, Chang M, Amos CI, Sturgis EM, Graboyes E, Chiao EY, Rogus-Pulia N, Lewis J, Madabhushi A, Frederick MJ, Sabichi A, Ittmann M, Yarbrough WG, Chung CH, Ferrarotto R, Mai W, Skinner HD, Duvvuri U, Gerngross P, Sikora AG. Innovations in risk-stratification and treatment of Veterans with oropharynx cancer; roadmap of the 2019 Field Based Meeting. Oral Oncol 2019; 102:104440. [PMID: 31648864 DOI: 10.1016/j.oraloncology.2019.104440] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/01/2019] [Indexed: 01/17/2023]
Affiliation(s)
- V C Sandulache
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States; ENT Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
| | - Y L Lei
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - L E Heasley
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, United States
| | - M Chang
- Department of Radiation Oncology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States
| | - C I Amos
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - E M Sturgis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - E Graboyes
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - E Y Chiao
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - N Rogus-Pulia
- Speech Pathology, University of Wisconsin School of Medicine, Madison, WI, United States; William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - J Lewis
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - A Madabhushi
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - M J Frederick
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - A Sabichi
- Department of Medicine, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX, United States; Medical Care Line, Department of Medicine, Section of Hematology/Oncology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - M Ittmann
- Department of Pathology, Baylor College of Medicine, Houston, TX, United States; Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - W G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - C H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - R Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Weiyuan Mai
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, United States; Department of Radiation Oncology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - H D Skinner
- Department of Radiation Oncology, UPMC, Pittsburgh, PA, United States
| | - U Duvvuri
- Department of Otolaryngology Head and Neck Surgery, UPMC, Pittsburgh, PA, United States; ENT Section, Operative Care Line, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, United States
| | - P Gerngross
- Dental Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - A G Sikora
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States; ENT Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
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Zenga J, Graboyes E, Janz T, Drake V, Rettig E, Desai S, Nickel C, Shabani S, Padhya T, Scarpinato M, Stadler M, Massey B, Campbell B, Shukla M, Awan M, Schultz CJ, Wong S, Jackson RS, Pipkorn P. Salvage of Recurrence after Surgery and Adjuvant Therapy: A Multi-institutional Study. Otolaryngol Head Neck Surg 2019; 161:74-81. [PMID: 30753110 DOI: 10.1177/0194599819830664] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. STUDY DESIGN Retrospective case series with chart review. SETTING Five academic tertiary care centers. SUBJECTS AND METHODS Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. RESULTS A total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus-associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. CONCLUSION Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.
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Affiliation(s)
- Joseph Zenga
- 1 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Evan Graboyes
- 2 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tyler Janz
- 3 Medical University of South Carolina, Charleston, South Carolina, USA
| | - Virgina Drake
- 4 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eleni Rettig
- 4 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shaun Desai
- 4 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christopher Nickel
- 5 Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Sepehr Shabani
- 5 Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Tapan Padhya
- 5 Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | | | - Michael Stadler
- 1 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Becky Massey
- 1 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bruce Campbell
- 1 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Monica Shukla
- 7 Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Musaddiq Awan
- 7 Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher J Schultz
- 7 Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stuart Wong
- 8 Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ryan S Jackson
- 9 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Patrick Pipkorn
- 9 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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8
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Pipkorn P, Sinha P, Zenga J, Graboyes E, Haughey BH. Acellular dermal graft pharyngeal repair augmentation after laryngectomy. Am J Otolaryngol 2017; 38:329-332. [PMID: 28196713 DOI: 10.1016/j.amjoto.2017.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/29/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Pharyngocutaneous fistula (PCF) after laryngectomy continues to be a serious complication, especially after radiation. Recruitment of non-radiated tissue into the surgical defect may decrease the risk of fistula. These techniques however have significant morbidity and increases operative time. We hypothesized that using acellular dermal graft to reinforce the pharyngeal closure could decrease the risk of fistula, without the added morbidity of a vascularized flap. METHODS We performed a retrospective chart review of all patients that underwent a laryngectomy between 2005 and 2015 at an acedemic tertiary referral center. Patients who underwent primary pharyngeal closure with Alloderm® reinforcement without any other flap reconstruction were identified. Basic demographics, previous treatment, operative technique and fistula were extracted from the medical records. The primary outcome was PCF rate. The time to closure, margin status and disease recurrence was also evaluated. RESULTS Among 16 patients with AlloDerm® augmentation, eight had primary laryngectomy and eight had salvage laryngectomy. A total of three in the salvage laryngectomy with prior history of radiation developed PCF. The fistula closed in all three cases with conservative treatment. There was no PCF in the primary laryngectomy group without prior history of radiation. CONCLUSION The rate of PCF among the salvage laryngectomy group with previous radiation did not differ from historical data. AlloDerm® can however, provide a simple alternative for repair in radiation patients where flap cannot be performed for pharyngeal reconstruction. In non-radiated patients, AlloDerm® augmentation may have a protective effect on fistula formation.
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Neely JG, Lieu JEC, Sequeira SM, Graboyes E, Paniello RC, Nussenbaum B, Grindler DJ, Voelker CCJ. Practical guide to understanding multivariable analyses, Part B: conjunctive consolidation. Otolaryngol Head Neck Surg 2012; 148:359-65. [PMID: 23264117 DOI: 10.1177/0194599812471500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
Conjunctive consolidation, one method of multivariable analysis by arranging data into clusters, is intuitive and transparent. An unexpected consequence in writing this article was the discovery of just how useful it is in critically analyzing articles and in designing new projects. It has stimulated a fresh understanding as to the value of multivariable thinking in all clinical research. This article is organized into the sequential steps for performing conjunctive consolidation for critically analyzing an article of interest and for completing the process, pending all required data are available. Investigators, particularly those who perform clinical research, should consider conjunctive consolidation as a valuable method of multivariable analysis with which to report data.
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Affiliation(s)
- J Gail Neely
- Practical Guides Writing Group, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
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