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Rogers SN, Allmark C, Bekiroglu F, Edwards RT, Fabbroni G, Flavel R, Highet V, Ho MWS, Humphris GM, Jones TM, Khattak O, Lancaster J, Loh C, Lowe D, Lowies C, Macareavy D, Moor J, Ong TK, Prasai A, Roland N, Semple C, Spencer LH, Tandon S, Thomas SJ, Schache A, Shaw RJ, Kanatas A. Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial. Eur Arch Otorhinolaryngol 2021; 278:3435-3449. [PMID: 33346856 PMCID: PMC7751263 DOI: 10.1007/s00405-020-06533-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). METHODS A pragmatic cluster preference randomised control trial with 15 consultants, 8 'using' and 7 'not using' the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. RESULTS Consultants saw a median (inter-quartile range) 16 (13-26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (- 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. CONCLUSION This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.
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Affiliation(s)
- Simon N. Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, Liverpool, L39 4QP UK
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Christine Allmark
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Fazilet Bekiroglu
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, College of Human Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales UK
| | - Gillon Fabbroni
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | | | - Victoria Highet
- Liverpool Head and Neck Clinical Trials, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK
| | - Michael W. S. Ho
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Gerald M. Humphris
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Terry M. Jones
- Liverpool Head and Neck Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9GA UK
| | - Owais Khattak
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Christopher Loh
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | | | - Cher Lowies
- Liverpool Head and Neck Clinical Trials, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK
| | - Dominic Macareavy
- Chair of the Head and Neck Patient and Carer Research Forum, Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - James Moor
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - T. K. Ong
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - A. Prasai
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Nicholas Roland
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Cherith Semple
- Institute of Nursing and Health Research, Ulster University, Shore Road, Belfast, Newtownabbey, Co, BT37 0QB Antrim, Belfast UK
- South Eastern Health and Social Care Upper Newtownards Road, Belfast, BT16 1RH UK
| | - Llinos Haf Spencer
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, College of Human Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales UK
| | - Sank Tandon
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Steven J. Thomas
- Oral and Maxillofacial Surgery Department, Bristol University, Lower Maudlin Street, Bristol, UK
| | - Andrew Schache
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Richard J. Shaw
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
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James P, Bekiroglu F, Broderick D, Khattak O, Lowe D, Schache A, Shaw RJ, Rogers SN. Immediate postoperative care on high dependency unit or ward following microvascular free tissue transfer: lessons learnt from a change in practice imposed during the COVID-19 pandemic. Br J Oral Maxillofac Surg 2021; 60:343-349. [PMID: 34852938 PMCID: PMC8388193 DOI: 10.1016/j.bjoms.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic resulted in sudden changes to the established practice of using the high dependency unit (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic, and to reflect on the implications of ward-based rather than HDU care. A total of 235 patients had free tissue transfer between 3 January 2019 and 25 February 2021: 125 before (lockdown 23 March 2020), and 110 during the pandemic (52 ward-managed and 58 HDU-managed). There were subtle case-mix differences during the pandemic, with 92% of ward-treated patients having oral cancers compared with 64% of HDU patients, and 73% of ward patients having a tracheostomy compared with 40% of HDU patients. Ward patients were less likely to receive electrolyte replacement (45% HDU vs 0% ward) and inotropes (12% HDU vs 2% ward). There were fewer returns to theatre for evacuation of a haematoma or re-anastomosis during the pandemic than there were before it. Other than fewer haematoma complications during the pandemic, the nature of complications was similar. In conclusion, the dramatic changes imposed by the pandemic have shown that the ward is a safe place for patients to be cared for immediately postoperatively, and it alleviates the bed pressures experienced in HDU. Careful case selection and clear criteria are required to identify patients who need the HDU.
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Affiliation(s)
- P James
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - F Bekiroglu
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - D Broderick
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - O Khattak
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - A Schache
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - R J Shaw
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - S N Rogers
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK; Faculty of Health and Social Care, Edge Hill University, Ormskirk L39 4QP, UK.
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Chieng CY, Davies A, Lowe D, Bekiroglu F, Khattak O, Schache A, Shaw R, Rogers SN. Clinical characteristics, treatment intent, and outcome in a consecutive 10-year cohort of oral cancer patients aged 75 years and older. Br J Oral Maxillofac Surg 2020; 59:303-311. [PMID: 33261937 DOI: 10.1016/j.bjoms.2020.08.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022]
Abstract
The prevalence of oral squamous cell carcinoma (OSCC) in the elderly is expected to increase by nearly a third in the next decade. Its management in older patients is potentially more challenging due to their pre-existing medical comorbidities, frailty, reduced life expectancy, and social issues. The aim of this retrospective review was to report on treatment given to patients aged 75 years and over, case mix, and survival. All patients aged 75 years and over who were diagnosed with OSCC in Merseyside between 1 January 2007 and 31 December 2016, and treated with either curative or palliative intent, were included. Their hospital notes were reviewed. Fisher's exact test and Kaplan-Meier analysis were used for data analysis. There were 236 patients (median (IQR) age 81 (78-86) years); 67% were treated curatively and 33% palliatively. Factors associated with palliation included older age, advanced tumour stage, cognitive impairment, and residence in a nursing or residential home. Of the 165 patients who were offered curative treatment, six (4%) declined due to personal or family reasons. Overall survival for palliative patients was 12% at one year and 7% at two years, whereas for patients treated curatively it was 74% at one year, 56% at two years, and 34% at five years. Patients over 85 years of age were less likely to have composite free flaps and postoperative radiotherapy. Perioperative mortality was 2.6%. Improvements in surgical techniques and perioperative management have enabled clinicians to offer treatment with curative intent to older frail patients, and with careful case selection outcomes can be very good.
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Affiliation(s)
- C Y Chieng
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - A Davies
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire.
| | - F Bekiroglu
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - O Khattak
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - A Schache
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - R Shaw
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - S N Rogers
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK; Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road.
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O'Connell JE, Brown JS, Rogers SN, Bekiroglu F, Schache A, Shaw RJ. Outcomes of microvascular composite reconstruction for mandibular osteoradionecrosis. Br J Oral Maxillofac Surg 2020; 59:1031-1035. [PMID: 34531074 DOI: 10.1016/j.bjoms.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022]
Abstract
The aim of this retrospective study was to compare outcomes and reconstruction-related complications in patients receiving a composite free flap reconstruction of the mandible for ORN with those reconstructed for other indications. The records of all patients who underwent composite reconstruction of a mandibular defect at Aintree University Hospital, Liverpool, were reviewed and analysed. Based on radiotherapy exposure and ORN history, the study cohort was divided into three separate case-matched groups. Local wound healing issues were markedly more common in the ORN setting, as was infection and subsequent osteosynthesis plate(s) removal. Free flap survival was similar among all three case-matched groups. Advanced mandibular ORN may be safely and predictably reconstructed with composite free flaps, and that while the rate of local complications is greater than non-irradiated, and non-ORN case-matched controls, the free flap survival rate compares favourably.
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Affiliation(s)
- J E O'Connell
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL.
| | - J S Brown
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL
| | - S N Rogers
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - F Bekiroglu
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL
| | - A Schache
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Liverpool Head & Neck Centre, University of Liverpool Cancer Research Centre, 200 London Road Liverpool L3 9TA
| | - R J Shaw
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Liverpool Head & Neck Centre, University of Liverpool Cancer Research Centre, 200 London Road Liverpool L3 9TA
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Dalton CL, Milinis K, Houghton D, Ridley P, Davies K, Williams R, Hamilton D, Wilkie MD, Markey A, Clarke K, Lofthouse M, Helliwell TR, Triantafyllou A, Rodrigues J, Bheemireddy K, Hanlon R, Wieshmann H, Haridass A, Brammer C, Husband D, Shenoy A, Loh C, Roland NJ, Bekiroglu F, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: Equitable survival and enhanced function compared with contemporary standards of care. Eur J Surg Oncol 2020; 46:2042-2049. [PMID: 32893045 DOI: 10.1016/j.ejso.2020.06.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION We describe the 5-year oncological and functional outcomes of transoral laser microsurgery, neck dissection (TLM + ND) and adjuvant radiotherapy (PORT) used to treat patients with oropharyngeal carcinoma. The effectiveness of external carotid artery (ECA) ligation in reducing post-operative bleeding, and fibrin glue following ND in reducing wound drainage and length of hospital stay is reported. MATERIALS AND METHODS This retrospective case review of consecutive patients undergoing TLM between 2006 and 2017 used the Kaplan-Meier Estimator and Log-Rank Test for univariate, time-to-event analyses, and Cox-Proportionate Hazard modelling for multivariate analysis. RESULTS 264 consecutive patients were included. Mean follow-up was 49.4 months. 219 (82.9%) patients received PORT. Five-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 74.9%, 73.7%, and 86.2%, respectively. Five-year locoregional control was 89.4%. 65.5% of cases were Human papillomavirus associated (HPV+), for whom OS, DFS and DSS was 85.6%, 84.7% and 92.7%, respectively, and demonstrated significantly higher OS (hazard ratio (HR) 0.28, CI 0.16-0.49, p < 0.0001), DFS (HR 0.28, CI 0.17-0.47, p < 0.0001) and DSS (HR 0.2, CI 0.09-0.44, <0.001). Post-operative oropharyngeal bleeding occurred in 23 patients (8.7%), of which 5 were major/severe, in patients without ECA ligation. Fibrin glue significantly reduced neck drain output (p < 0.001), and length of hospital stay (p < 0.001). One-year gastrostomy dependence rate was 2.3%. CONCLUSIONS TLM + ND + PORT results in favourable 5-year survival and locoregional control rates, and low feeding tube dependency rates. ECA ligation and fibrin glue appear to reduce major post-operative haemorrhage, wound drainage and length of hospital stay.
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Affiliation(s)
- C Lucy Dalton
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Kristijonas Milinis
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - David Houghton
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Oral and Maxillofacial Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Paul Ridley
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Katharine Davies
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Richard Williams
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - David Hamilton
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Mark D Wilkie
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Anne Markey
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Otorhinolaryngology-Head and Neck Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Middlewich Road, Crewe, Cheshire, CW1 4QJ, United Kingdom
| | - Kim Clarke
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Matthew Lofthouse
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Timothy R Helliwell
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Cellular Pathology, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, United Kingdom
| | - Asterios Triantafyllou
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Cellular Pathology, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, United Kingdom
| | - Jennifer Rodrigues
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Krishna Bheemireddy
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Rebecca Hanlon
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Hulya Wieshmann
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Anoop Haridass
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - Caroline Brammer
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - David Husband
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - Aditya Shenoy
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - Christopher Loh
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Nicholas J Roland
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Fazilet Bekiroglu
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Oral and Maxillofacial Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Sankalap Tandon
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Jeffrey Lancaster
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Terence M Jones
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom.
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Bajwa MS, Houghton D, Java K, Triantafyllou A, Khattak O, Bekiroglu F, Schache AG, Brown JS, McCaul JA, Rogers SN, Lowe D, McMahon J, Shaw RJ. The relevance of surgical margins in clinically early oral squamous cell carcinoma. Oral Oncol 2020; 110:104913. [PMID: 32711167 DOI: 10.1016/j.oraloncology.2020.104913] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES There is controversy regarding surgical margins in the management of early oral squamous cell carcinoma (OSCC). The main objectives of this study were to assess the: relevance of the margin independent of tumour variables; threshold for a safe margin; relevance of dysplasia at the margin. MATERIALS & METHODS UK based retrospective multicenter cohort study of patients with previously untreated and clinically early OSCC between 1998 and 2016. All patients had surgery as the primary modality and had surgical staging of the neck. Minimum follow-up was 2 years. Margins were classified as: clear ≥5.0 mm; close 1.0-4.9 mm; involved not cut-through (INC-T) 0.1-0.9 mm; cut-through (C-T) 0 mm. RESULTS 669 patients were included. After adjusting for tumour variables Cox multivariate regression analysis demonstrated that close margins had similar survival outcomes to clear margins (Hazard Ratio(HR) 0.99 (95%CI 0.50-1.95) for Local Recurrence Free Survival (LRFS); HR 1.08 (95%CI 0.7-1.66) for Disease Free Survival (DFS); HR 0.74 (95%CI 0.44-1.25) for Disease Specific Survival (DSS); HR 0.80 (95%CI 0.58-1.11) for Overall Survival (OS)). C-T margins had significantly worse LRFS (HR 5.01 (95%CI 2.02-12.39)) and DFS (HR 2.58 (95%CI 1.28-5.20)). INC-T margins had significantly worse DFS (HR 1.98 (95% CI 1.01-3.87)). Time dependent receiver operating characteristic curve analysis did not demonstrate a clear margin threshold for LRFS within 24 months (AUC = 0.53 (95%CI 0.41-0.64)). Dysplasia at the margin did not influence LRFS or DFS. CONCLUSION Only resection margins <1 mm independently affected survival outcomes. This should be considered when making decisions regarding adjuvant treatment.
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Affiliation(s)
- Mandeep S Bajwa
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - David Houghton
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK.
| | - Kapil Java
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK
| | - Asterios Triantafyllou
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Oral Pathology, School of Dentistry, University of Liverpool, Liverpool, UK.
| | - Owais Khattak
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK
| | - Fazilet Bekiroglu
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK.
| | - Andrew G Schache
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - James S Brown
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - James A McCaul
- Department of Oral & Maxillofacial Surgery, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Simon N Rogers
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Edge Hill University, Ormskirk, UK.
| | - Derek Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - Jeremy McMahon
- Department of Oral & Maxillofacial Surgery, NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - Richard J Shaw
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
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McDonald C, Lowe D, Bekiroglu F, Schache A, Shaw R, Rogers SN. Health-related quality of life in patients with T1N0 oral squamous cell carcinoma: selective neck dissection compared with wait and watch surveillance. Br J Oral Maxillofac Surg 2019; 57:649-654. [PMID: 31230853 DOI: 10.1016/j.bjoms.2019.05.021] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
Management of the neck in patients with clinical T1N0 oral squamous cell carcinoma (SCC) is controversial. The aim of this study was to report the health-related quality of life (HRQoL) in a consecutive group of patients with stage 1 disease at a time closest to two years after primary surgery. Of 216 patients treated between 2007 and 2012 (after excluding early death and regional recurrence), 195 were eligible. HRQoL was measured using the University of Washington quality of life questionnaire version 4. The overall response rate was 65% (126/195). HRQoL outcomes were good, but compared with patients in the wait and watch group, those who had selective neck dissection (SND) had more problems regarding appearance (14% compared with 1%, p=0.008) and pain (19% compared with 6%, p=0.04). Similar trends were seen for shoulder (14% compared with 8%), mood (16% compared with 8%), and speech (5% compared with 1%), and for poorer overall QoL (30% compared with 16%). It is difficult to establish why patients did or did not have neck dissection in a retrospective sample, but it is likely that those who had SND had larger tumours. The findings highlight the impact that SND has on HRQoL in domains such as appearance, pain, speech, swallowing, and chewing. Previous studies on SND have tended to focus on injury to the accessory nerve and shoulder function, but these new data emphasise the need to include other domains in future trials that compare wait and watch, SND, and sentinel lymph node biopsy.
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Affiliation(s)
- C McDonald
- Specialty Trainee Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool.
| | - D Lowe
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St. Helens Road, Ormskirk, L39 4QP.
| | - F Bekiroglu
- Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK.
| | - A Schache
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool; Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK.
| | - R Shaw
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool; Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK.
| | - S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St. Helens Road, Ormskirk, L39 4QP; Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK.
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Wilkie MD, Upile NS, Lau AS, Williams SP, Sheard J, Helliwell TR, Robinson M, Rodrigues J, Beemireddy K, Lewis-Jones H, Hanlon R, Husband D, Shenoy A, Roland NJ, Jackson SR, Bekiroglu F, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach. Head Neck 2016; 38:1263-70. [PMID: 27042800 DOI: 10.1002/hed.24432] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 08/06/2015] [Revised: 11/27/2015] [Accepted: 01/13/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM). METHODS A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high-risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan-Meier statistics. RESULTS Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV-positive (n = 101; 66.0%). Three-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV-positivity portended favorable oncologic outcomes. One-year gastrostomy tube (G-tube) dependency was 1.3%. CONCLUSION To the best of our knowledge, this is the largest single-center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/- postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263-1270, 2016.
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Affiliation(s)
- Mark D Wilkie
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Navdeep S Upile
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Andrew S Lau
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Stephen P Williams
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Jon Sheard
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Pathology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Tim R Helliwell
- Department of Pathology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle, United Kingdom
| | - Jennifer Rodrigues
- Department of Anaesthetics, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Krishna Beemireddy
- Department of Anaesthetics, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Huw Lewis-Jones
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Rebecca Hanlon
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - David Husband
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Aditya Shenoy
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Nicholas J Roland
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Shaun R Jackson
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Fazilet Bekiroglu
- Department of Oral and Maxillofacial Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sankalap Tandon
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Jeffrey Lancaster
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Terence M Jones
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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Rogers SN, Pinto RS, Lancaster J, Bekiroglu F, Lowe D, Tandon S, Jones TM. Health related quality of life following the treatment of oropharyngeal cancer by transoral laser. Eur Arch Otorhinolaryngol 2016; 273:3913-3920. [DOI: 10.1007/s00405-016-4035-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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Barry CP, Ahmed F, Rogers SN, Lowe D, Bekiroglu F, Brown JS, Shaw RJ. Influence of surgical margins on local recurrence in T1/T2 oral squamous cell carcinoma. Head Neck 2014; 37:1176-80. [DOI: 10.1002/hed.23729] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/05/2014] [Accepted: 04/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Conor P. Barry
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Ferhan Ahmed
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Simon N. Rogers
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
- Evidence Based Practice Research Centre (EPRC), Faculty of Health; Edge Hill University; Ormskirk United Kingdom
| | - Derek Lowe
- Evidence Based Practice Research Centre (EPRC), Faculty of Health; Edge Hill University; Ormskirk United Kingdom
| | - Fazilet Bekiroglu
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - James S. Brown
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Richard J. Shaw
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
- Department of Surgery and Oncology, School of Cancer Studies; University of Liverpool; Liverpool United Kingdom
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Scott B, Ghazali N, Lowe D, Bekiroglu F, Rogers SN. The Patients Concerns Inventory in head and neck cancer: Comparison between self-completed paper and touch screen versions in the clinic setting. Eur J Oncol Nurs 2013; 17:863-9. [DOI: 10.1016/j.ejon.2013.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/19/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
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Ho MWS, Rogers SN, Brown JS, Bekiroglu F, Shaw RJ. Prospective Evaluation of a Negative Pressure Dressing System in the Management of the Fibula Free Flap Donor Site. JAMA Otolaryngol Head Neck Surg 2013; 139:1048-53. [DOI: 10.1001/jamaoto.2013.4544] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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)
| | - Simon N. Rogers
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, England2Evidence-Based Practice Research Centre, Faculty of Health, Edge Hill University, Ormskirk, England
| | - James S. Brown
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, England3Molecular and Clinical Cancer Medicine, School of Cancer Studies, University of Liverpool, England
| | - Fazilet Bekiroglu
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, England
| | - Richard J. Shaw
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, England3Molecular and Clinical Cancer Medicine, School of Cancer Studies, University of Liverpool, England
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Barry C, Woolgar J, Shaw R, Rogers S, Lowe D, Bekiroglu F, Brown J. The significance of the surgical margin for local recurrence and survival in early oral cancer. Br J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.bjoms.2013.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ghazali N, Kanatas A, Bekiroglu F, Scott B, Lowe D, Rogers SN. The Patient Concerns Inventory: A Tool to Uncover Unmet Needs in a Cancer Outpatient Clinic. ACTA ACUST UNITED AC 2013. [DOI: 10.1308/147363513x13500508919899] [Citation(s) in RCA: 16] [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: 11/22/2022]
Abstract
The Patient Concerns Inventory (PCI) is a holistic, patient reported tool that aids in identifying concerns and issues. it is a 55-item checklist of issues that may be grouped into categories of general function, specific head and neck function, emotional-psychological and others, which include finances, treatment related matters and social care. The PCI also gives patients an opportunity to identify from a list of 15 multidisciplinary team (MDT) members whom they would like to see or be referred on to.
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Affiliation(s)
- N Ghazali
- Clinical Research Fellow, Aintree University Hospitals NHS Foundation Trust
| | - A Kanatas
- Specialist Registrar, Leeds Teaching Hospitals NHS Trust
| | - F Bekiroglu
- Consultant, Aintree University Hospitals NHS Foundation Trust
| | - B Scott
- Senior Physiotherapist, Aintree University Hospitals NHS Foundation Trust
| | - D Lowe
- Medical Statistician, Aintree University Hospitals NHS Foundation Trust
| | - SN Rogers
- Consultant, Aintree University Hospitals NHS Foundation Trust
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Brown J, Shaw R, Bekiroglu F, Rogers S. Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2012; 50:481-9. [DOI: 10.1016/j.bjoms.2011.08.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/15/2011] [Indexed: 11/17/2022]
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Dhanda J, Risk J, Stanbury J, Woolgar J, Triantafyllou A, Brown J, Rogers S, Bekiroglu F, Shaw R, Sibson R. Invasive properties in OSCC are both tumour and stroma dependent: compelling evidence from organotypic models. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rafiq R, D'Souza J, Bekiroglu F, Shaw R, Brown J, Rogers S. Does choice of plate or choice of flap influence osseous union in composite reconstruction for osteoradionecrosis of the mandible. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brown JS, Bekiroglu F, Shaw RJ, Woolgar JA, Triantafyllou A, Rogers SN. First report of elective selective neck dissection in the management of squamous cell carcinoma of the maxillary sinus. Br J Oral Maxillofac Surg 2012; 51:103-7. [PMID: 22578881 DOI: 10.1016/j.bjoms.2012.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/09/2012] [Indexed: 11/30/2022]
Abstract
Controversy remains about management of the neck in squamous cell carcinoma (SCC) of the maxillary sinus and we know of no reports of the use of elective selective neck dissection for management in this site. We retrospectively reviewed 18 consecutive patients with SCC of the maxillary sinus who were managed by primary operation with curative intent. A total of 13 patients had an elective selective neck dissection, which was invaded in one case 8%. Four patients had regional metastases, two with positive nodal disease confirmed after elective selective neck dissection, and two who developed regional recurrence (both after elective selective neck dissections which were negative (pN0)). A review of other published articles in the English language showed no cases of elective selective neck dissections reported. The mean regional recurrence rate was 12% (range 0-26%) and total mean regional metastases rate 21% (range 5-36%). Elective selective neck dissection did not contribute to an improved rate of neck control with regional recurrence of 11% (2/18) compared with 12% in the review. There is no evidence in this report to indicate that elective selective neck dissections for maxillary sinus SCC will result in better disease control. Future research may indicate fewer radiotherapy fields for necks with pathologically clear nodes after elective selective neck dissection.
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Affiliation(s)
- James S Brown
- Regional Head and Neck Unit, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, United Kingdom.
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Brown JS, Bekiroglu F, Shaw RJ, Woolgar JA, Rogers SN. Management of the neck and regional recurrence in squamous cell carcinoma of the maxillary alveolus and hard palate compared with other sites in the oral cavity. Head Neck 2012; 35:265-9. [DOI: 10.1002/hed.22957] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/06/2022] Open
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21
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Ho M, Brown J, Magennis P, Bekiroglu F, Rogers S, Shaw R, Vaughan E. Salvage outcomes of free tissue transfer in Liverpool: trends over 18 years (1992–2009). Br J Oral Maxillofac Surg 2012; 50:13-8. [DOI: 10.1016/j.bjoms.2010.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
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22
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Lwin CT, Hanlon R, Lowe D, Brown JS, Woolgar JA, Triantafyllou A, Rogers SN, Bekiroglu F, Lewis-Jones H, Wieshmann H, Shaw RJ. Accuracy of MRI in prediction of tumour thickness and nodal stage in oral squamous cell carcinoma. Oral Oncol 2011; 48:149-54. [PMID: 22154129 DOI: 10.1016/j.oraloncology.2011.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/29/2011] [Accepted: 11/01/2011] [Indexed: 11/28/2022]
Abstract
We aim to compare radiological with histological tumour thickness (RTT with HTT) for oral squamous cell carcinoma (OSCC), and the ability of both to predict cervical metastasis. The MRI images and histopathology reports of 102 consecutive OSCC cases were compared and the relationship between RTT and HTT, calculated as a "shrinkage factor" by the gradient of the best fitting regression line. Most (69%) tumours appeared thicker on MRI than was revealed by histopathology. Shrinkage factor was 0.70 (interquartile range 0.63-0.77, correlation co-efficient 0.63) for all cases, 0.87 (IQR 0.80-0.95, CC 0.88) for tongue and 0.65 (IQR 0.49-0.82, CC 0.45) for floor of mouth sub-sites. RTT did not correlate well with the presence of nodal metastases in any sub-site, i.e. there was no clinically applicable cut-off value of RTT to determine the prescription of elective neck dissection. Although RTT has some predictable relationship with HTT, this varies between sub-sites with tongue the most accurately predicted shrinkage using axial MRI. It is not possible from either the MRI staging of neck or tumour thickness to safely determine the need for neck dissection in OSCC. It is necessary to re-evaluate the benefit of MRI as a staging investigation (particularly for early stage OSCC) and further explore the contribution of molecular biomarkers and ultrasound.
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Affiliation(s)
- Christine T Lwin
- OMFS, Aintree University Hospitals NHS Foundation Trust, United Kingdom
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Bekiroglu F, Ghazali N, Laycock R, Katre C, Lowe D, Rogers S. Adjuvant radiotherapy and health-related quality of life of patients at intermediate risk of recurrence following primary surgery for oral squamous cell carcinoma. Oral Oncol 2011; 47:967-73. [DOI: 10.1016/j.oraloncology.2011.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/30/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
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Brown J, Bekiroglu F, Shaw R. Indications for the scapular flap in reconstructions of the head and neck. Br J Oral Maxillofac Surg 2010; 48:331-7. [DOI: 10.1016/j.bjoms.2009.09.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
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Ho M, Brown J, Magennis P, Rogers S, Shaw R, Bekiroglu F, Vaughan E. 56 Salvage outcomes of free tissue transfer in Liverpool. Br J Oral Maxillofac Surg 2010. [DOI: 10.1016/s0266-4356(10)60057-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Pinto A, Bekiroglu F, McViegh K, Bainton R. Intermaxillary fixation using bondable arch bars. Br J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.bjoms.2008.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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McVeigh KP, Bekiroglu F, Pinto A, Bainton R. Applications of DBX demineralised bone matrix putty in craniofacial trauma. Br J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.bjoms.2008.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Bekiroglu F, Brown A, Martin T, Parmar S. O.221 The versatility of the scapular flap in facial reconstruction. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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29
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McVeigh K, Bekiroglu F, Bainton R. Creeping DBX—A method of improving handling characteristics. Br J Oral Maxillofac Surg 2008; 46:257-258. [DOI: 10.1016/j.bjoms.2007.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
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30
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Burke G, Bekiroglu F, Martin T, Parmar S. Transposition of the cephalic vein facilitated by an osseous subclavicular passage. Br J Oral Maxillofac Surg 2007; 45:686-7. [DOI: 10.1016/j.bjoms.2007.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2007] [Indexed: 11/29/2022]
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31
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Bekiroglu F, Whear NM. An unusual “sebaceous cyst”. Br J Oral Maxillofac Surg 2007; 45:338. [PMID: 16376002 DOI: 10.1016/j.bjoms.2005.10.014] [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: 06/17/2005] [Revised: 10/04/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
Abstract
A 41-year-old man was referred by his general practitioner to the general surgeons with an "infected sebaceous cyst" above the right medial canthus. "Cyst" was excised by the general surgeons. But this was followed by its recurrence after a number of weeks. A lateral skull radiograph showed the presence of a radio-opaque foreign body within the right orbit.
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Affiliation(s)
- Fazilet Bekiroglu
- New Cross Hospital, Department of Oral and Maxillofacial Surgery, Wednesfield Road, Wolverhampton, West Midlands, United Kingdom.
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Burke GAE, Bekiroglu F, Brown AMS, Martin TJM, Parmar SC. Tracheostomy tape: more trouble than it's worth? Int J Oral Maxillofac Surg 2007; 36:550-1. [PMID: 17287110 DOI: 10.1016/j.ijom.2006.12.014] [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: 10/16/2006] [Accepted: 12/15/2006] [Indexed: 10/23/2022]
Abstract
In many units where microvascular free-tissue transfer in the head and neck region is practised, tracheostomy is completed with the suturing of the tube in place and the removal of the supporting struts from the tube flange. The thinking is that in removing the struts the risk of occlusion of the vascular pedicle of the free flap, as it lies in the neck, is reduced as the cervical tape cannot be applied. The evidence base for vascular obstruction resulting from a correctly positioned tape is lacking. Presented here is a case in which potential flap failure, as a result of a cervical tracheostomy tape, was avoided by early detection of ischaemia using microdialysis.
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Affiliation(s)
- G A E Burke
- Maxillofacial Unit, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
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Bekiroglu F, Wright S, Grew N. Chondroradionecrosis of larynx following radiotherapy for metastatic neck disease originating from oral carcinoma. Int J Oral Maxillofac Surg 2006; 36:459-61. [PMID: 17145167 DOI: 10.1016/j.ijom.2006.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 06/08/2006] [Revised: 10/01/2006] [Accepted: 10/18/2006] [Indexed: 10/23/2022]
Abstract
Chondroradionecrosis of larynx is a rare but serious complication of radiotherapy. Here is described a case of chondroradionecrosis after 20 years of completion of radiotherapy for oral cancer. The patient underwent excision of necrotic anterior skin of the neck, together with devitalized thyroid cartilage and most of the cricoid cartilage, and reconstruction with pectoralis major muscle transposition. This resulted in preservation of laryngeal function, and avoided further exploration of the irradiated neck and possible further skin loss.
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Affiliation(s)
- F Bekiroglu
- Maxillofacial Department, New Cross Hospital, Wolverhampton, United Kingdom.
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Wright S, Bekiroglu F, Whear NM, Grew NR. Use of Palacos®R-40 with gentamicin to reconstruct temporal defects after maxillofacial reconstructions with temporalis flaps. Br J Oral Maxillofac Surg 2006; 44:531-3. [PMID: 16387397 DOI: 10.1016/j.bjoms.2005.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 07/12/2005] [Revised: 11/13/2005] [Accepted: 11/15/2005] [Indexed: 11/26/2022]
Abstract
The temporalis muscle flap is a useful flap for the reconstruction of oral ablative defects. A complication of its use that was overlooked was the crater-like defect created when the muscle is stripped from its attachment on the temporal fossa. The cold-cure acrylic we use is Palacos R-40 with Gentamicin (Heraeus Kulzer GmbH). This material is radio-opaque, rapidly setting and contains gentamicin. We present a total of 41 cases over an 11-year period (1994-2005). We have a 97.6% (n = 40) success rate. Infection developed in only one case, which leads to the removal of the acrylic implant. The use of Palacos R-40 with Gentamicin is easy to use, it can be custom-moulded to fit and fill the defect any of shape and size. It has minimal complications and high success rate with acceptable results to the patients.
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Affiliation(s)
- S Wright
- Department of Oral & Maxillofacial Surgery, New Cross Hospital, Wolverhampton WV10 0QP, United Kingdom.
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Bekiroglu F, Rout PG. Surgical emphysema following dental treatment: two cases. Dent Update 1997; 24:412-4. [PMID: 9534416] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surgical emphysema is an uncommon complication of dental treatment despite the frequent use of air-driven handpieces and high-speed water-cooled equipment in dental practice. As a consequence it may either go unrecognized or be misdiagnosed. Although most cases resolve spontaneously, some patients require emergency intervention. This article outlines the condition and its management and describes two cases that arose during routine dental treatment.
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