Guidelines for the Use of Botulinum Toxin in Otolaryngology From the Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force

The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey's syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.

Clinical Utility of Quantitative Parameters of Salivary Gland Scintigraphy for Diagnosing Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a chronic disorder characterized by a burning sensation in the oral cavity, often accompanied by xerostomia, with no relevant clinical or laboratory findings. This study aimed to investigate diagnostic values of quantitative parameters of salivary gland scintigraphy for BMS in patients with xerostomia. A total of 164 patients who underwent salivary gland scintigraphy for the workup of xerostomia were retrospectively reviewed. All patients were classified into patient groups with primary BMS, secondary BMS, and non-specific xerostomia. From salivary gland scintigraphy, 22 quantitative parameters were calculated and their diagnostic values were assessed based on the area under the receiver operating characteristic curve (AUC) values. Among salivary gland scintigraphy parameters, uptake speed in the left submandibular gland showed the highest AUC value (0.647) for detecting BMS and pre-stimulatory oral activity showed the highest AUC value (0.710) for detecting primary BMS. A salivary gland scintigraphy scoring system based on these two parameters further enhanced the diagnostic ability, demonstrating AUC values of 0.731 for BMS and 0.782 for primary BMS. These results suggest a potential diagnostic value of the quantitative parameters of salivary gland scintigraphy for detecting BMS in patients with xerostomia.

Considerations for Balance Between Fundamental Treatment and Improvement of Quality of Life of Pediatric Thyroid Cancer Patient: Comparative Analysis With Adult Using Propensity Score Matching

BACKGROUND

Thyroid cancer is very rarely observed in children and adolescents, some reports have shown that the long-term outcome of treatment is better than that of adult patients, despite many treatment failures or a high risk of recurrence. This study considers whether it is appropriate to treat pediatric thyroid cancer patients aggressively, as per the ATA guidelines, based on the balance between the fundamental treatment of thyroid cancer and the improvement of the long-term quality of life of pediatric patients.

METHODS

A total of 1,950 patients were recruited, including 83 pediatric and 1,867 adult patients, who were diagnosed with thyroid cancer and underwent surgical treatment at one of our medical center hospitals from March 2000 to January 2020.

RESULTS

Sixty-nine pairs of pediatric and adult patients were matched in a ratio of 1:2 through propensity score matching. When compared through propensity score matching, there was no significant difference in prognosis such as recurrence rate in children and adults at the same stage.

CONCLUSION

This study showed that the prognosis of both pediatric and adult patients who underwent a total thyroidectomy and lobectomy was not significantly different. If more pediatric patients can be considered for the less-aggressive lobectomy than a total thyroidectomy through various preoperative examinations and meticulous pre-diagnosis, it may be possible to properly determine the balance between improving long-term quality of life while providing fundamental cancer treatment.

Effect of human acellular dermal matrix (Megaderm™) on infra-auricular depressed deformities, Frey's syndrome, and first bite syndrome following parotidectomy: a multi-center prospective study

Background

Parotidectomy is the primary treatment for parotid gland tumors. However, complications may include a prominent facial scar or infra-auricular depressed deformity, Frey's syndrome, first bite syndrome, or other facial pain, numbness, and paralysis. Acellular dermal matrix (ADM) has been widely used to prevent these complications in parotid surgery, but there have been no prospective, multi-center trials documenting its efficacy. This study evaluates the effectiveness of ADM implantation in preventing infra-auricular depressed deformity, Frey's syndrome and first bite syndrome after parotidectomy.

Methods

We analyzed 51 cases of standard parotidectomy and 58 cases of parotidectomy with implantation of Megaderm™ ADM through prospective multicenter trial. Acute complications including infection, seroma, hematoma, skin necrosis, and acute parotid area pain were evaluated 1 week postoperatively. Clinician grading of Frey's syndrome and blinded clinician evaluation of infra-auricular depressed deformities were conducted at 3, 6, and 12 months. Patients evaluated subjective satisfaction with neck appearance, Frey's syndrome quality, and acute parotid area pain at 3, 6, and 12 months.

Results

There was a higher incidence of seroma in the Megaderm™ group than in the control group at week 1. The incidence and total clinician-evaluated Frey's syndrome scores were significantly lower in the Megaderm™ group than in the control group at 3, 6, and 12 months. Both the objective and subjective evaluations of the facial contour showed a better outcome in the Megaderm™ group compared to the control group at 3, 6, and 12 months. There were no significant differences between the groups in the patient-reported Frey's syndrome quality scores at 3, 6, and 12 months, but the Megaderm™ group reported significantly less acute pain than the control group.

Conclusions

ADM implantation can effectively reduce the occurrence of Frey's syndrome, infra-auricular depressed deformity, and first bite syndrome after parotidectomy. ADM may be especially advantageous in complex parotidectomy cases when significant complications are expected.

Establishment and characterization of patient-derived xenografts as paraclinical models for head and neck cancer

Background

We investigated whether head and neck squamous cell carcinoma (HNSCC) patient-derived xenografts (PDXs) reaffirm patient responses to anti-cancer therapeutics.

Methods

Tumors from HNSCC patients were transplanted into immunodeficient mice and propagated via subsequent implantation. We evaluated established PDXs by histology, genomic profiling, and in vivo anti-cancer efficacy testing to confirm them as the authentic in vivo platform.

Results

From 62 HNSCCs, 15 (24%) PDXs were established. The primary cancer types were tongue (8), oropharynx (3), hypopharynx (1), ethmoid sinus cancer (1), supraglottic cancer (1), and parotid gland (1); six PDXs (40%) were established from biopsy specimens from advanced HNSCC. PDXs mostly retained donor characteristics and remained stable across passages. PIK3CA (H1047R), HRAS (G12D), and TP53 mutations (H193R, I195T, R248W, R273H, E298X) and EGFR, CCND1, MYC, and PIK3CA amplifications were identified. Using the acquisition method, biopsy showed a significantly higher engraftment rate when compared with that of surgical resection (100% [6/6] vs. 16.1% [9/56], P < 0.001). Specimens obtained from metastatic sites showed a significantly higher engraftment rate than did those from primary sites (100% [9/9] vs. 11.3% [6/53], P < 0.001). Three PDX models from HPV-positive tumors were established, as compared to 12 from HPV-negative (15.8% [3/19] and 27.9% [12/43] respectively, P = 0.311), suggesting that HPV positivity tends to show a low engraftment rate. Drug responses in PDX recapitulated the clinical responses of the matching patients with pan-HER inhibitors and pan-PI3K inhibitor.

Conclusions

Genetically and clinically annotated HNSCC PDXs could be useful preclinical tools for evaluating biomarkers, therapeutic targets, and new drug discovery.

ICG-Guided Sentinel Lymph Node Sampling during Robotic Retroauricular Neck Dissection in cN0 Oral Cancer

In this study, we sought to evaluate the clinical feasibility of indocyanine green (ICG)-guided sentinel lymph node (SLN) sampling during robotic retroauricular neck dissection (RAND) in patients with cN0 oral cancer. Nine adult patients diagnosed with T1 to T2 oral squamous cell carcinoma were consecutively recruited. All of them underwent transoral partial glossectomy and robotic RAND (levels I-III) simultaneously. Twelve hours prior to surgery, ICG was injected into the 4 quadrants around primary tongue tumors. During robotic RAND, intraoperative and ex vivo ICG-stained LNs were identified using the Firefly system and examined for the presence of fluorescence. ICG-stained LNs were identified in all patients. Thirty-one ICG-stained LNs were detected in 313 retrieved LNs (9.9%). Occult metastases were detected among the ICG-stained LNs in 2 patients (22.2%). There was no metastasis identified in the ICG-unstained LNs. Upstaging rates, sensitivity, specificity, and negative predictive value of ICG-guided SLN sampling were 22.2%, 100%, 91.5%, and 100%, respectively.

Clinical Analysis of Pediatric Thyroid Cancer: A Single Medical Institution Experience of 18 Years

OBJECTIVE

The incidence of pediatric thyroid cancer is relatively low compared to the disease in adults. This study aims to present the data in our institution on pediatric thyroid cancer patients, with particular emphasis on the risk factors of recurrence together with treatment outcomes.

SUBJECTS AND METHODS

Between January 2000 and July 2018, patients <20 years who were diagnosed with thyroid carcinoma and primarily treated with surgery at a major large-volume tertiary medical center specializing in thyroid cancer were enrolled. A total of 83 patients were eligible for this study.

RESULTS

The majority of the studied patients were girls and adolescents (age ≥13 years). Papillary thyroid carcinoma (PTC) was the most common pathology (n = 74). PTC tumors >1 cm showed higher rate of lymph node metastasis and extrathyroidal extension than tumors ≤1 cm. All patients survived with nine PTC patients who displayed treatment failure. Age, tumor size, multifocality, lateral lymph node metastasis, and postoperative thyroglobulin levels were significant prognosticators for disease recurrence.

CONCLUSION

Pediatric thyroid cancer is relatively rare and should be considered a specific disease entity with respect to the thyroid cancer in adults, since there are several distinctive characteristics.

A Case of Unexpected Clinostomum complanatum Infection Initially Presenting as Foreign Body in Pharynx

A 46-year old man visited our outpatient clinic with complaint of foreign body sensation in throat after consuming raw freshwater fish 5 days ago. Laryngoscopic examination revealed a motile worm attached on posterior pharyngeal wall. The worm was removed using biopsy forceps under transnasal endoscopy and evidently identified as Clinostomum complanatum after microscopic examination. Patient's subjective foreign body sensation of throat and hyperemia of laryngeal mucosa remained for approximately 2 weeks post-removal, which were eventually resolved after administration of non-steroidal anti-inflammatory drug and anti-refluxant drug for 2 weeks. Treatment was ended at three weeks since the first visit. C. complanatum infections in humans are rare, and only four cases have been reported in Korea. Symptoms resembling pharyngitis or laryngitis occurs by consumption of raw, infected freshwater fish and treatment is done by mechanically removing the parasite.

Beyond EGFR inhibition: multilateral combat strategies to stop the progression of head and neck cancer

Epidermal growth factor receptor (EGFR) overexpression is common in head and neck squamous cell carcinoma. Targeted therapy specifically directed towards EGFR has been an area of keen interest in head and neck cancer research, as EGFR is potentially an integration point for convergent signaling. Despite the latest advancements in cancer diagnostics and therapeutics against EGFR, the survival rates of patients with advanced head and neck cancer remain disappointing due to anti-EGFR resistance. This review article will discuss recent multilateral efforts to discover and validate actionable strategies that involve signaling pathways in heterogenous head and neck cancer and to overcome anti-EGFR resistance in the era of precision medicine. Particularly, this review will discuss in detail the issue of cancer metabolism, which has recently emerged as a novel mechanism by which head and neck cancer may be successfully controlled according to different perspectives.

South Korean researchers propose novel combination strategies for overcoming drug resistance and halting the progression of head and neck cancer (HNC). Although high levels of epidermal growth factor receptor (EGFR) protein in HNC correlate with reduced survival, patients’ response to the EGFR inhibitor cetuximab often declines rapidly after a short period of effectiveness. Hyung Kwon Byeon at Korea University College of Medicine in Seoul and colleagues review current knowledge of the mechanisms underlying cetuximab resistance. They suggest that evaluating a patient’s genetic profile and combining cetuximab with drugs that enhance the effects of inhibiting EGFR signaling pathways (with inhibitors of other EGFR family members or proteins that mediate EGFR entry to the cell nucleus, for example) as well as with agents that inhibit cancer cell metabolism could be a more effective approach for treating HNC.

Oncologic and functional outcomes of salvage supracricoid partial laryngectomy

BACKGROUND

Supracricoid partial laryngectomy (SCL) can have a positive impact on patients' quality of life by circumventing dysphagia and voice problems resulting from creation of a permanent stoma after conventional total laryngectomy (TL) surgery.

AIMS/OBJECTIVES

The aim of this study was to investigate the oncologic and functional outcomes of salvage SCL for recurrent laryngeal carcinoma.

MATERIAL AND METHODS

Forty-five patients that underwent salvage surgery for recurrent laryngeal carcinoma between January 2004 and May 2015 after initial treatment failure were included in this retrospective study.

RESULTS

Overall survival and disease free survival were non-significantly higher in the salvage SCL group (n = 14) than in the salvage TL group (n = 31) (87.5 versus 56.5%, 53.4 versus 41.9%). Multivariate analyses showed only positive resection margin to be significantly associated with survival and recurrence (HR 9.974, p = .007, and HR 9.196, p = .002, respectively). In the salvage SCL group, 92.8% achieved successful decannulation and all patients returned to an oral diet. All patients in the salvage TL group sustained a permanent stoma and conversation was possible only through esophageal voice or a voice prosthesis. 74.2% of patients in the group were able to tolerate an oral diet.

CONCLUSIONS AND SIGNIFICANCE

Salvage SCL showed comparable oncologic outcomes and favorable functional outcomes relative to the classic salvage TL. This study could provide a sufficient basis of SCL as salvage treatment for recurrent laryngeal carcinoma in selected patients.

Fibroblast growth factor receptor 3-mediated reactivation of ERK signaling promotes head and neck squamous cancer cell insensitivity to MEK inhibition

Recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) has been a longstanding challenge for head and neck oncologists, and current treatments still have limited efficacy. ERK is aberrantly overexpressed and activated in HNSCC. Herein, we aimed to investigate the cause of the limited therapeutic effect of selumetinib, a selective inhibitor of MEK in HNSCC, as MEK/ERK reactivation inevitably occurs. We assessed the effects of combining selumetinib with fibroblast growth factor receptor 3 (FGFR3) inhibitor (PD173074) on tumor growth. Selumetinib transiently inhibited MAPK signaling and reactivated ERK signaling in HNSCC cells. Rebound in the ERK and Akt pathways in HNSCC cells was accompanied by increased FGFR3 signaling after selumetinib treatment. Feedback activation of FGFR3 was a result of autocrine secretion of the FGF2 ligand. The FGFR3 inhibitor PD173074 prevented MAPK rebound and sensitized the response of HNSCC cells to selumetinib. These results provided rational therapeutic strategies for clinical studies of this subtype of patients that show a poor prognosis with selumetinib. Our data provide a rationale for combining a MEK inhibitor with inhibitors of feedback activation of FGFR3 signaling in HNSCC cells. ERK rebound as a result of the upregulation of FGFR3 and the ligand FGF2 diminished the antitumor effects of selumetinib, which was overcome by combination treatment with the FGFR3 inhibitor.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience

Objectives

A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology.

Methods

Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center.

Results

Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO₂ laser. There was no recurrence after the initial surgical treatment.

Conclusion

Saccular cysts can be managed endoscopically using CO₂ laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

Clinicopathological significance of cancer-associated fibroblasts in papillary thyroid carcinoma: a predictive marker of cervical lymph node metastasis

PURPOSE

Most tumors have obvious biologically active fibroblasts known variously as myofibroblasts or cancer-associated fibroblasts (CAFs) in the stroma. CAFs have been known as an important factor of cancer invasion and metastasis. This study aimed to investigate the presence of CAFs in patients with papillary thyroid carcinoma (PTC) and evaluate the correlation between CAFs and cervical lymph node (LN) metastasis in PTC through immunohistochemistry.

METHODS

The medical records of 128 patients who were diagnosed with PTC from January 1, 2010 to December 31, 2010 were reviewed, and 78 patients who underwent total thyroidectomy with or without neck dissection, were included in this study. A retrospective pathological evaluation was performed to verify the presence of CAFs. CD34 and α-smooth muscle actin (SMA) were used as markers of CAFs.

RESULTS

Among 78 patients with PTC, 65 had desmoplastic stromal reaction around the PTC. Through immunohistochemical study of anti-CD34 and α-SMA antibodies, CAFs were found in 42 (64.6%) cases with desmoplastic stroma around the PTC. Univariate analysis showed that tumor size and CAFs were the risk factors of LN metastasis in patients with PTC, while multivariate analysis revealed that CAFs were the only independent risk factor of LN metastasis in patients with PTC.

CONCLUSION

This study revealed the presence of CAFs in PTC. Furthermore, CAFs were found to be a risk factor of LN metastasis in PTC. Therefore, CAFs may be used as a predictive marker for LN metastasis in patients with PTC.

Abstract 670: Specific ROS generation and monitoring in cancer using radioactive gold nanoparticle

Radiotherapy is a key treatment and is beneficial in the treatment of about 50% of all cancer patients. Such treatment relies on the deposition of energy (the dose) in tumour cells, typically by irradiation with either high-energy gamma rays or X-rays (photons), or energetic beams of ions, sufficient to damage the cancer cells or their vasculature and thus induce tumour death or nutrient starvation. However, like chemotherapy, photon radiotherapy is non-specific, since a significant dose can be delivered to healthy tissue along the track of the photons, in front and behind the tumour. Therefore, recently several research groups have proposed the use of specifically targeted noble-metal nanoparticles irradiated by radiation as an effective therapeutic tool for treating various malignancies with minimum collateral damage to healthy tissue. In general, the photoelectric absorption cross sections of radiosensitive materials directly depend on atom radius, and thus their radiotherapy effects also depend on atom radius. This physical principle determines that gold (atomic-number Z=79) has a stronger radiation enhancement effect by photoelectric effect. Loading with gold nanoparticles (AuNPs) is one of the promising candidates in this area. Gold NPs have a larger atomic radius than gold atom (~0.17 nm), and thus should have a stronger radiation enhancement effect than gold atom. During irradiation, this results in an enhancement of the energy deposition in the vicinity of the gold particles generate the ROS on the surface due to the generation of photoelectrons, Auger electrons, and characteristic X-rays. ROS play important roles in various cellular process. In particularly, at sufficiently high concentrations, ROS could become an effect that is utilized for various therapeutic application such as apoptosis. Herein, we synthesized the radiosensitizer PEGylated gold nanoparticles (RPAuNPs) for generation and measuring of ROS on surface by radiation exposure. First, gold nanoparticles (AuNPs) was prepared by one-pot synthesis and the sharpness and size were efficiently controlled by adjusting the amount of reducing agent. Furthermore, they were replaced with heterobifunctional PEG (COOH-PEG-SH) not only to serve as a biocompatible stabilizer (PAuNPs) and but also to conjugate Dihydrorhodamine 123 (DHR 123) (RPAuNPs) as ROS sensor. Well-engineered formation of RPAuNPs was verified by transmission electron microscopy (TEM) showing their overall size of 50 nm. In addition, UV-Vis data strongly demonstrated successful synthesis. We evaluated their functional use in inducing ROS and the results showed that our radiosensitizing agents exhibited the feasibility of effective ROS generation under x-ray radiation. And we investigated there in vitro/in vivo imaging and therapeutic efficacies, optical properties, biocompatibility for tumor cell.

Citation Format: Jihye Choi, Yoon Woo Koh, Hyung Kwon Byeon, Guillem Pratx, Jaemoon Yang. Specific ROS generation and monitoring in cancer using radioactive gold nanoparticle [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 670.

Acquired resistance to BRAF inhibition induces epithelial-to-mesenchymal transition in BRAF (V600E) mutant thyroid cancer by c-Met-mediated AKT activation

Previously, the authors have identified that c-Met mediates reactivation of the PI3K/AKT pathway following BRAF inhibitor treatment in BRAF (V600E) mutant anaplastic thyroid cancer, thereby contributing to the acquired drug resistance. Therefore dual inhibition of BRAF and c-Met led to sustained treatment response, thereby maximizing the specific anti-tumor effect of targeted therapy. The present study goes one step further and aims to investigate the effect of acquired resistance of BRAF inhibitor on epithelial-to-mesenchymal transition (EMT) in BRAF mutant thyroid cancer cells and the effect of dual inhibition from combinatorial therapy. Two thyroid cancer cell lines, 8505C and BCPAP were selected and treated with BRAF inhibitor, PLX4032 and its effect on EMT were examined and compared. Further investigation was carried out in orthotopic xenograft mouse models. Unlike BCPAP cells, the BRAF inhibitor resistant 8505C cells showed increased expressions of EMT related markers such as vimentin, β-catenin, and CD44. The combinatorial treatment of PLX4032 and PHA665752, a c-Met inhibitor reversed EMT. Similar results were confirmed in vivo. c-Met-mediated reactivation of the PI3K/AKT pathway contributes to the drug resistance to PLX4032 in BRAF (V600E) mutant anaplastic thyroid cancer cells and further promotes tumor cell migration and invasion by upregulated EMT mechanism. Dual inhibition of BRAF and c-Met leads to reversal of EMT, suggesting a maximal therapeutic response.

HSPA5 negatively regulates lysosomal activity through ubiquitination of MUL1 in head and neck cancer

HSPA5/GRP78/BiP plays an important role in cell survival or tumor progression. For these reasons, HSPA5 is an emerging therapeutic target in cancer development. Here we report that HSPA5 contributes to head and neck cancer (HNC) survival via maintenance of lysosomal activity; however, a nonthermal plasma (NTP, considered as a next-generation cancer therapy)-treated solution (NTS) inhibits HNC progression through HSPA5-dependent alteration of lysosomal activity. HSPA5 prevents NTS-induced lysosome inhibition through lysosomal-related proteins or regulation of gene expression. However, NTS-induced MUL1/MULAN/GIDE/MAPL (mitochondrial ubiquitin ligase activator of NFKB 1) leads to downregulation of HSPA5 via K48-linked ubiquitination at the lysine 446 (K446) residue. MUL1 knockdown hinders NTS-induced lysosome inhibition or cytotoxicity through the reduction of HSPA5 ubiquitination in HNC cells. While MUL1 was suppressed, HSPA5 was overexpressed in tissues of HNC patients. NTS strongly inhibited HNC progression via alterations of expression of MUL1 and HSPA5, in vivo in a xenograft model. However, NTS did not induce inhibition of tumor progression or HSPA5 reduction in MUL1 knockout (KO) HNC cells which were generated by CRISPR/Cas9 system. The data provide compelling evidence to support the idea that the regulation of the MUL1-HSPA5 axis can be a novel strategy for the treatment of HNC.

Korean survey data reveals an association of chronic laryngitis with tinnitus in men

The association between chronic laryngitis and tinnitus is not a well-studied topic, unlike the association of these two conditions with many other disorders. Cross-sectional data of 11,347 adults (males: 4,934; females: 6,413), who completed the Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012 were used to investigate this association. Lifestyle patterns, including smoking and alcohol habits, regular exercise, physical and mental health status, socioeconomic status, nutritional status, and other chronic diseases, were analyzed. Chronic laryngitis and tinnitus were diagnosed by field survey teams, which included otolaryngologists, who conducted chronic disease surveillance using a health status interview, a nutritional status questionnaire, and a physical examination. Chronic laryngitis was significantly associated with age, education beyond high school, depressed mood, voice change, metabolic syndrome, and tinnitus in men. In women, chronic laryngitis was associated with body mass index and diabetes mellitus. Chronic laryngitis in men was significantly associated with tinnitus (odds ratio 1.671, [95% confidence interval: 1.167-2.393]) after adjusting for age, body mass index, smoking status, alcohol intake, regular exercise, metabolic syndrome, education beyond high school, and depressed mood. Additionally, the prevalence of chronic laryngitis increased with increasing severity of tinnitus in men alone (P = 0.002). The study revealed a significant association between chronic laryngitis and tinnitus.

FOXO3 induces ubiquitylation of AKT through MUL1 regulation

AKT (also known as protein kinase B, PKB) plays an important role in cell survival or tumor progression. For these reasons, AKT is an emerging target for cancer therapeutics. Previously our studies showed that mitochondrial E3 ubiquitin protein ligase 1 (MUL1, also known as MULAN/GIDE/MAPL) is suppressed in head and neck cancer (HNC) and acts as negative regulator against AKT. However, the MUL1 regulatory mechanisms remain largely unknown. Here we report that cisplatin (CDDP) induces thyroid cancer cell death through MUL1-AKT axis. Specifically, CDDP-induced MUL1 leads to ubiquitylation of active form of AKT. We also observed that the role of forkhead box O3 (FOXO3) is pivotal in CDDP-induced MUL1 regulation. FOXO3 knock-downed cells show resistance against CDDP-mediated MUL1-AKT axis. CDDP-mediated intracellular ROS increment plays an important role in FOXO3-MUL1-AKT signal pathway. The data provide compelling evidence to support the idea that the regulation of FOXO3-MUL1-AKT axis can be a novel strategy for the treatment of HNC with CDDP.

Dose de-escalation to the normal larynx using conformal radiotherapy reduces toxicity while maintaining oncologic outcome for T1/T2 glottic cancer

We evaluated the efficacy of dose de-escalation to the normal larynx using conformal radiotherapy (CRT) for T1/T2 glottic cancer. For conventional RT (2DRT, n = 38), the laryngeal box received a median equivalent dose in 2 Gy fractions (EQD2) of 66 Gy. For CRT (n = 42; 3D-CRT, 20; intensity-modulated RT, 22), clinical target volume (CTV)1 (gross tumor with a 3-mm margin) and CTV2 (laryngeal box) received median EQD2s of 66.6 Gy and 52.2 Gy, respectively. With a 71-month median follow-up, five-year local control and overall survival rates for 2DRT vs. CRT were 88.1% vs. 95.1% (p = 0.405) and 94.7% vs. 90.7% (p = 0.102), respectively. Grade 2 and 3 pharyngitis rates were 52.6% and 5.3% for 2DRT vs. 35.7% and 2.4% for CRT (p = 0.121). Grade 2 and 3 dermatitis rates were 42.1% and 2.6% for 2DRT vs. 35.7% and 0% for CRT (p = 0.013). The maximum phonation time increased from 12.1 ± 7.1 to 14.0 ± 6.6 seconds after 2DRT (p = 0.375) and from 12.0 ± 5.5 to 13.8 ± 10.1 seconds after CRT (p = 0.313). Fundamental frequency decreased from 150.6 ± 40.3 to 121.9 ± 30.2 Hz after 2DRT (p = 0.039) and from 138.5 ± 31.9 to 126.1 ± 23.7 Hz after CRT (p = 0.058). CRT can effectively de-escalate the normal larynx dose while maintaining oncologic outcome and voice quality.

Epidemiological association of olfactory dysfunction with hearing loss and dysphonia in the Korean population: A cross-sectional study

The aim of the study is to investigate the association between olfactory dysfunction (OD), hearing loss, and dysphonia.The cross-sectional data for 17,984 adults who completed the Korea National Health and Nutrition Examination Surveys (2010-12) were analyzed. OD, hearing loss, and dysphonia were assessed using self-reporting questionnaires. The association of OD with hearing loss and dysphonia was evaluated.Hearing loss and dysphonia were significantly more prevalent in patients with OD than in those without OD (hearing loss, 28.1% vs 11.3%; dysphonia, 11.1% vs 5.9%; both P < .0001). After adjusting for confounders, including mental stress and metabolic syndrome, the risk of OD was significantly associated with hearing loss and dysphonia, and was greater in those with combined hearing loss and dysphonia than in both patients without these dysfunctions and in those with a single dysfunction (odds ratio 3.115, 95% confidence interval 1.973-4.917).OD was significantly associated with hearing loss and dysphonia.

Recent progress of retroauricular robotic thyroidectomy with the new surgical robotic system

OBJECTIVE

Previously, we have reported the feasibility of retroauricular (RA) robotic thyroidectomy. Despite its promising surgical outcomes, there were certain intrinsic mechanical limitations inherent to the da Vinci Si System (Intuitive Surgical, Sunnyvale, California, U.S.A.). Since the advent of an upgraded model, the Xi System (Intuitive Surgical), we have actively incorporated the new model into performing RA thyroidectomy. Here, we intend to verify the feasibility of RA robotic thyroidectomy using the new da Vinci Xi System (Intuitive Surgical) with comparison of the former Si-applied surgery (Intuitive Surgical).

STUDY DESIGN

Comparative analysis.

METHODS

There were total 165 consecutive patients who received RA robotic thyroidectomy from January 2013 to February 2016. The patients were divided into two groups: Si group (n = 125) and Xi group (n = 40). Perioperative and treatment outcomes were compared and analyzed.

RESULTS

Compared with the previous system, new da Vinci Xi system (Intuitive Surgical) enabled insertion of an extra third robotic instrumental arm. Unlike the previous robotic surgical technique, the robotic dissection could be initiated immediately after the establishment of working space and the resulting total operation time could be significantly decreased. There was no difference in the surgical completeness, as confirmed by postoperative thyroglobulin levels. Additionally, flexed EndoWrist (Intuitive Surgical) instruments equipped with the Erbe (Erbe USA Inc., Marietta, Georgia, U.S.A.) system could be mounted, which further facilitated the operation. There were no significant differences in postoperative complications between the two groups.

CONCLUSION

The RA robotic thyroidectomy with the new Xi System (Intuitive Surgical) can greatly facilitate the robotic surgery with comparable or improved surgical outcomes. Its application is expected to open up a new era of robotic neck surgery.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:1730-1737, 2018.

Tracheal reconstruction with a free vascularized myofascial flap: preclinical investigation in a porcine model to human clinical application

Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defects >50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resolve this problem, requires a long preparatory period for stem cell seeding on a scaffold and relatively invasive procedures for stem cell harvesting. As an alternative, we used a vascularized myofascial flap for tracheal reconstruction. In four porcine models, the deep inferior epigastric perforator (DIEP) was used in two and the superior epigastric artery perforator (SEAP) in two. Transformation of the surface of the transplanted myofascial flap was analyzed in the airway environment. The flaps failed in the DIEP group due to venous congestion. At 12 weeks postoperatively, none of SEAP group showed any signs of respiratory distress; the inner surface of the implant exhibited stratified squamous epithelium with sparse cilia. In the clinical setting, a patient who underwent a tracheal reconstruction with a vascularized myofascial flap and 2-year follow-up was in good health with no respiratory distress symptoms.

Abstract 4113: Acquired resistance to cetuximab is mediated by HER3 activation in head and neck squamous cell carcinoma

Cetuximab, an EGFR monocloanal antibody, is commonly known to be an effective treatment agent in head and neck squamous cell carcinoma (HNSCC). However, despite the clinical efficacy of cetuximab, a majority of patients with good initial response still suffer from side effects as the acquired resistance to cetuximab. To understand the mechanisms of acquired resistance to cetuximab, we developed a model by exposing a head and neck cancer cell line Cal27 to increasing concentrations of cetuximab and established cetuximab-resistant clones (CETr) derived from the cetuximab sensitive (CETp). We examined how the acquired resistance in the CETr influenced the signaling pathway compared to the CETp. We investigated the effect of lapatinib, a tyrosine kinase inhibitor inhibiting HER3, with or without cetuximab combination on CETr clones and in a xenograft mouse model. Cetuximab-resistant(CETr) clones showed robust overexpression on the HER family receptors HER3. CETr clones also expressed upregulated EGFR, HER2, and HER3 activation resulting in activation of PI3K/ATK and ERK signaling. We also showed that CETr clones exhibited increased EGFR/HER3 dimerization. Treatment of cetuximab and siHER3 RNA together reduced EGFR activation in CETr clones to re-sensitize cells against cetuximab and robustly decreased cell proliferation. Combined treatment of CETr clones with cetuximab and lapatinib led to potent anti-proliferative effects. Co-treatment with cetuximab and lapatinib blocked EGFR, HER2 and HER3 activities and inhibited downstream signaling pathways. Co-treatment resulted in suppression of cell growth more effectively than each drug alone and induced apoptotic cell death through mitochondrial ROS. Furthermore, Co-treatment with cetuximab and lapatinib also led to suppression of tumor growth in orthotopic xenograft mouse model of oral tongue cancer. Our results suggested the upregulation of HER3 as a mechanism underlying resistance to cetuximab in HNSCC, supporting further clinical treatment strategy for tumors displaying acquired resistance to cetuximab.

Citation Format: Yeon Ju Yang, Min Hee Cho, Yoo Jung Oh, Da Hee Kim, Jung Min Kim, Hyung Kwon Byeon, Myung Jin Ban, Ji Hoon Kim, Jae Wook Kim, Min Hee Ku, Jae Moon Yang, Eun Chang Choi, Yoon Woo Koh, Jeong Yeon Lee. Acquired resistance to cetuximab is mediated by HER3 activation in head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4113. doi:10.1158/1538-7445.AM2017-4113

Abstract 881: CD44-specific supramolecular hydrogels for fluorescence molecular imaging of EMT induced BRAF &lt;V600E&gt; mutant thyroid cancer cells

Previously, the authors have identified that the acquired drug resistance to BRAF inhibitor, PLX4032 in BRAF (V600E) mutant anaplastic thyroid cancer promotes not only tumor progression and proliferation, but also migration and invasion of cancer through upregulated epithelial-to-mesenchymal transition (EMT). The underlying mechanism to the acquired resistance to BRAF inhibition involves c-Met-mediated reactivation of PI3K/AKT pathway. Therefore combinatorial dual targeted therapy of BRAF and c-Met inhibition has shown to reverse EMT and show maximal antitumor effect. Previously, the authors have developed a novel in vivo imaging strategy using CD44-targetable near-infrared (NIR)-sensitive supramolecular hydrogels (NIRSHs) for the recognition of CD44-expressing cancer cells. In the present study, we applied this NIR-sensitive molecular imaging probe in detecting the upregulated EMT changes in PLX4032-treated 8505C cells. The CD44-targetable NIRSHs were fabricated by polyplexing Cy5.5-conjugated polyethyleimine and hyaluronic acid in an aqueous medium. Ectopic xenograft mouse models were prepared by injecting 8505C cells at the flank of male athymic nude BALB/c mice, aged 6 weeks. After confirming tumor formation at 3 weeks post-injection, the mice were randomly divided into four groups and were each treated under different conditions; DMSO, PLX4032, PHA665752, PLX4032 and PHA665752. After 3 weeks, the pre-established NIRSH probes were injected and confirmed by IVIS imaging. The injected NIRSH probes showed highest uptake in the PLX4032 single treatment group and lowest uptake in the PLX4032 and PHA665752 combination group. Sizes of tumor were verified by MRI which showed correlations with the NIRSH fluorescence imagings. The results suggest that CD44-targetable NIRSHs imaging shows potential as a non-invasive in vivo imaging tool in detecting the increased invasion potential of cancer cells and monitoring appropriate therapeutic effects.

Citation Format: Hyung Kwon Byeon, Minhee Ku, Yeon Ju Yang, Min Hee Cho, Yoojung Oh, Jae Wook Kim, Myung Jin Ban, Ji-Hoon Kim, Da Hee Kim, Joo Hyun Kim, Jaemoon Yang, Yoon Woo Koh. CD44-specific supramolecular hydrogels for fluorescence molecular imaging of EMT induced BRAF &lt;V600E&gt; mutant thyroid cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 881. doi:10.1158/1538-7445.AM2017-881

Secondary submucosal vocal cyst following pulsed dye laser application for sulcus vocalis

CONCLUSION

Submucosal vocal cyst can occur as a distinct long-term sequelae following pulsed dye laser (PDL) application for sulcus vocalis. It is recommended that the cyst lesion should be surgically removed for treatment. Optimal and precise irradiation of PDL is considered important to avoid the development of a such complication.

OBJECTIVE

After several years of clinical practice and an extended period of follow-up of the patients who received PDL application in treating sulcus vocalis, the authors have encountered several cases of secondary submucosal vocal cyst development. Therefore, this study aims to investigate this late complication following PDL laryngeal surgery.

METHODS

Patients who developed secondary submucosal vocal cyst after last PDL laryngeal surgery between March 2008 and January 2016 were analyzed after retrospectively reviewing clinical and operative data.

RESULTS

There were a total 11 patients who had been identified as presenting secondary submucosal vocal cyst among 186 patients who underwent PDL laryngeal surgery (5.9% incidence). All five patients who received surgery showed complete resolution and were free of symptoms. The remaining six patients were closely observed with conservative measures, with only one patient who showed resolution of the cyst.

Odontoid osteomyelitis with atlantoaxial subluxation in an infant

PURPOSE

To report a rare case of odontoid osteomyelitis with atlantoaxial subluxation in a 6-month-old infant.

BACKGROUND

Odontoid osteomyelitis with atlantoaxial subluxation is extremely rare in children. Although several cases have been reported, there have been no studies concerning proper surgical drainage and immobilization in this disease.

METHODS

A 6-month-old infant with odontoid osteomyelitis with atlantoaxial subluxation was surgically treated. The patient underwent a 3-month intravenous and oral antibiotic course and the Minerva body jacket cast was used for 3 months. Follow-up was carried out with computed tomographic scans and a cervical spine dynamogram.

RESULTS

At 18 months post-surgery, the patient had completely recovered with no cervical instability. Computed tomographic scans revealed complete fusion of odontoid synchondrosis. The infant remained asymptomatic with a full range of head movement.

CONCLUSION

Surgical drainage and proper immobilization appears to be a satisfactory treatment for pyogenic osteomyelitis of odontoid synchondrosis secondary to retropharyngeal abscess and atlantoaxial subluxation.

LEVEL OF EVIDENCE

N/A.

Downregulation of Nrf2 by the combination of TRAIL and Valproic acid induces apoptotic cell death of TRAIL-resistant papillary thyroid cancer cells via suppression of Bcl-xL

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) represents an effective agent for the treatment of many cancers, though the majority of thyroid cancers are found to be resistant. Therefore it would be necessary to identify agents capable of increasing the sensitivity of these cancers to TRAIL-mediated cell death. Here, we examined the therapeutic effect and its underlying mechanism of combination treatment of TRAIL and histone deacetylase inhibitor, Valproic acid (VPA) in vitro using human papillary thyroid cancer (PTC) cells and in vivo using an orthotopic mouse model of PTC. TRAIL-VPA combination therapy synergistically induced apoptotic cell death in TRAIL-resistant PTC through caspase activation. In addition, downregulation of antioxidant transcription factor, Nrf2 by co-treatment of TRAIL-VPA induces cell death via suppression of Bcl-xL in vitro and in vivo; these effects were further enhanced following siRNA inhibition of these proteins in combination with TRAIL or TRAIL-VPA. Taken together, VPA sensitized TRAIL-resistant PTC cells to apoptotic cell death through involvement of Nrf2 and Bcl-xL. Thus, the combination of VPA and TRAIL may be a promising therapy for TRAIL-resistant PTC.

A Study Comparing Free-Flap Reconstruction via the Retroauricular Approach and the Traditional Transcervical Approach for Head and Neck Cancer: A Matched Case-Control Study

BACKGROUND

Free-flap reconstruction via a retroauricular approach (RRA) after robot-assisted neck dissection (RAND) could have cosmetic benefits. This study aimed to compare the surgical outcomes of free-flap reconstruction via a RRA and via a transcervical approach in head and neck cancer.

METHODS

For this matched case-control study, 50 patients with head and neck cancer requiring free-flap reconstruction were divided into two groups: those reconstructed via a RRA group and those reconstructed via a transcervical approach (RTA group). The total operation time for free-flap reconstruction, the flap survival rate, the length of the hospital stay, the complications, and the scar satisfaction scores were compared between the two groups.

RESULTS

The RRA group comprised 25 patients, and the RTA group had 25 patients. The mean operation time for reconstruction was 288 ± 77 min in the RRA group and 250 ± 98 min in the RTA group (p = 0.132). Flap failure occurred for two patients in the RRA group (8 %) and for one patient in the RTA group (4 %) (p = 1.000). The mean hospital stay was 21 ± 18 days in the RRA group and 23 ± 14 days in the RTA group (p = 0.669). The complications were comparable between the two groups. However, the overall scar satisfaction was significantly higher in the RRA group (p = 0.000).

CONCLUSIONS

For patients with head and neck cancer, RRA has better cosmetic outcomes than RTA. The RRA approach could be used for select patients who undergo RAND and prefer to avoid a visible anterior neck scar.

Comprehensive application of robotic retroauricular thyroidectomy: The evolution of robotic thyroidectomy

OBJECTIVES/HYPOTHESIS

As an evolvement of the robotic application to the thyroidectomy, we sought to seek the potential role of robotic thyroidectomy with the retroauricular (RA) approach prior to future comparative study between RA and transaxillary thyroidectomy. This study aims to verify the surgical feasibility of robotic RA thyroidectomy.

STUDY DESIGN

Case series with planned data collection.

METHODS

A total of 87 patients who underwent robotic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January 2013 to May 2014 were retrospectively reviewed and analyzed.

RESULTS

All robotic surgeries via RA approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars.

CONCLUSION

Robotic RA thyroidectomy is technically feasible and safe, with satisfactory cosmetic results for patients where indicated.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:1952-1957, 2016.

Hypoxia Induces Epithelial-Mesenchymal Transition in Follicular Thyroid Cancer: Involvement of Regulation of Twist by Hypoxia Inducible Factor-1α

PURPOSE

Although follicular thyroid cancer (FTC) has a relatively fair prognosis, distant metastasis sometimes results in poor prognosis and survival. There is little understanding of the mechanisms contributing to the aggressiveness potential of thyroid cancer. We showed that hypoxia inducible factor-1α (HIF-1α) induced aggressiveness in FTC cells and identified the underlying mechanism of the HIF-1α-induced invasive characteristics.

MATERIALS AND METHODS

Cells were cultured under controlled hypoxic environments (1% O₂) or normoxic conditions. The effect of hypoxia on HIF-1α, and epithelial-to-mesenchymal transition (EMT) related markers were evaluated by quantitative real-time PCR, Western blot analysis and immunocytochemistry. Invasion and wound healing assay were conducted to identify functional character of EMT. The involvement of HIF-1α and Twist in EMT were studied using gene overexpression or silencing. After orthotopic nude mouse model was established using the cells transfected with lentiviral shHIF-1α, tissue analysis was done.

RESULTS

Hypoxia induces HIF-1α expression and EMT, including typical morphologic changes, cadherin shift, and increased vimentin expression. We showed that overexpression of HIF-1α via transfection resulted in the aforementioned changes without hypoxia, and repression of HIF-1α with RNA interference suppressed hypoxia-induced HIF-1α and EMT. Furthermore, we also observed that Twist expression was regulated by HIF-1α. These were confirmed in the orthotopic FTC model.

CONCLUSION

Hypoxia induced HIF-1α, which in turn induced EMT, resulting in the increased capacity for invasion and migration of cells via regulation of the Twist signal pathway in FTC cells. These findings provide insight into a possible therapeutic strategy to prevent invasive and metastatic FTC.

c-Met-mediated reactivation of PI3K/AKT signaling contributes to insensitivity of BRAF(V600E) mutant thyroid cancer to BRAF inhibition

BRAF (V600E) mutation is the most commonly detected genetic alteration in thyroid cancer. Unlike its high treatment response to selective BRAF inhibitor (PLX4032) in metastatic melanoma, the treatment response in thyroid cancer is reported to be low. The purpose of this study is to investigate the resistance mechanism responsible for this low treatment response to BRAF inhibitor in order to maximize the effect of targeted therapy. We examined the expression of feedback regulation mechanisms and alterations in the upper signal transduction pathway in thyroid cancer cell lines harboring BRAF mutation. Also, we investigated the effect of dual inhibition from combinatorial therapy. Two thyroid cancer cell lines, 8505C (anaplastic thyroid cancer) and BCPAP (papillary thyroid cancer) were selected and treated with PLX4032 and its drug sensitivity were examined and compared. Further investigation on the changes in signals responsible for the different treatment response to PLX4032 was carried out and the same experiment was performed on orthotopic xenograft mouse models. Unlike BCPAP cells, 8505C cells presented drug resistance to PLX4032 treatment and this was mainly due to increased expression of c-Met. Effective inhibitions of c-Met, p-AKT, and p-ERK were achieved after dual treatment with BRAF inhibitor (PLX4032) and c-Met inhibitor (PHA665752). Similar results were confirmed by in vivo study with orthotopic xenograft mouse model. c-Met-mediated reactivation of the PI3K/AKT pathway and MAPK pathway contributes to the relative insensitivity of BRAF (V600E) mutant anaplastic thyroid cancer cells to PLX4032. Dual inhibition of BRAF and c-Met leads to sustained treatment response. © 2015 Wiley Periodicals, Inc.

A low grade fibromyxoid sarcoma originating from the masseter muscle: a case report

INTRODUCTION

Low grade fibromyxoid sarcoma is a distinctive variant of fibrosarcoma. We recently experienced a rare case of low grade fibromyxoid sarcoma arising in the masseter muscle.

CASE PRESENTATION

A 63-year-old Korean woman with a large growing mass in her right parotid gland area for 1 year visited our clinic. Complete removal of the tumor was achieved by parotidectomy with facial nerve preservation. The tumor measured over 4cm with pathologic findings compatible with low grade fibromyxoid sarcoma.

CONCLUSIONS

Low grade fibromyxoid sarcoma is an extremely rare tumor, and report of the present case is noteworthy since it represents a rare localization of low grade fibromyxoid sarcoma in the head and neck. Close follow up on a long-term basis is considered necessary because of its high potential to metastasize.

Robot-assisted Sistrunk operation via a retroauricular approach for thyroglossal duct cyst

BACKGROUND

Traditionally, simple excisions of midline neck masses were typically performed through an incision on the overlying skin causing displeasing cosmetic outcomes. From the recent demonstrations to overcome these disappointing aesthetic results from overt scars, we propose a novel approach to successfully remove lesions with satisfactory cosmetic outcomes from well-hidden scars. A detailed surgical technique is provided.

METHODS

A 20-year-old female patient with thyroglossal duct cyst (TGDC) was successfully treated via a retroauricular approach utilizing the robotic surgical system.

RESULTS

The operative procedure was successfully completed with no conversion to open surgery. The operative time was reasonable and there were no intraoperative complications. Videographic demonstration of the robotic-assisted surgery is included in this study online.

CONCLUSION

Surgical removal of midline neck mass (TGDC) via a retroauricular approach utilizing the robotic surgical system can be a technically feasible and safe treatment option with excellent cosmetic outcomes.

Robot-assisted neck dissection via a transaxillary and retroauricular approach versus a conventional transcervical approach in papillary thyroid cancer with cervical lymph node metastases

BACKGROUND

Recently, robot-assisted neck dissection (ND) using a transaxillary approach in thyroid cancer patients with lateral neck metastases (LNM) was demonstrated to be feasible. The aim of this study was to compare the surgical outcomes of a modified transaxillary and retroauricular (TARA) versus a conventional transcervical approach in papillary thyroid carcinoma (PTC) patients with LNM.

PATIENTS AND METHODS

In total, 47 patients with PTC underwent total thyroidectomy with central compartment ND and modified radical ND except Level I. Twenty-two NDs were performed via the TARA approach, and 25 unilateral NDs were performed via the conventional transcervical approach.

RESULTS

The TARA and the open ND groups consisted of 22 and 25 patients, respectively. The operation time for ND in the TARA group was longer than that in the open ND group (209.4±38.2 minutes versus 143.1±30.5 minutes; P=.000). The mean scar satisfaction score in the TARA group was higher than in the conventional ND group (3.9±1.0 versus 2.8±1.0; P=.000). There were no differences in the mean number of retrieved lymph nodes.

CONCLUSIONS

The robot-assisted ND via the TARA approach can be an alternative option that produces excellent esthetic results for the management of LNM in PTC patients.

Comparison study of transoral robotic surgery and radical open surgery for hypopharyngeal cancer

CONCLUSIONS

The oncologic outcome of transoral robotic surgery (TORS) was comparable to radical open surgery. The TORS group showed a better functional recovery and quality of life (QOL) than the radical surgery group. Therefore, TORS was a valid treatment option as a minimally invasive surgery for selected patients with hypopharyngeal cancer.

OBJECTIVES

To affirm rapid functional recovery and improved QOL of patients who underwent TORS, which is a minimally invasive surgical technique.

METHODS

Between April 2008 and November 2011, 56 patients were enrolled in the study. During the study period, 30 patients underwent TORS and 26 patients underwent radical open surgery.

RESULTS

In the TORS and radical surgery groups, the 3-year overall survival rate was 85% and 78%, respectively, and disease-free survival was 81% and 76%, respectively. Significant differences were not observed in the overall survival and disease-free survival rates. As regards postoperative functional recovery, the TORS group showed statistically better results for decannulation, swallowing, and hospitalization compared with the radical surgery group. On the University of Washington (UW)-QOL, the TORS group showed better results than the radical open surgery group in the domains of pain, activity, recreation, swallowing, speech, anxiety, and health-related QOL.