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Lee JJ, Rapoport NA, Pipkorn P, Puram SV, Jackson RS. Airway protection and outcomes after staged versus concurrent bilateral neck dissections with transoral base of tongue cancer resection. Head Neck 2024; 46:1020-1027. [PMID: 38414192 DOI: 10.1002/hed.27696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/30/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To assess airway, safety, and resource utilization outcomes between transoral base of tongue (BOT) surgery with staged versus concurrent bilateral neck dissections (BND). METHODS A retrospective cohort study of patients with human papilloma virus (HPV)-related BOT cancer who underwent transoral surgery and BND from January 2015 through June 2022 was conducted. Free flap patients were excluded. RESULTS Of 126 patients (46 [37%] staged and 80 [63%] concurrent BND), there were no significant differences in rates of postoperative intubation, tracheostomy, intensive care admission, operative takebacks, gastrostomy, and 30-day readmission. Total operative time (median difference 1.4 [95% CI 0.9-1.8] hours), length of stay (1.0 [1.0-1.0] day), and time between primary surgery and adjuvant therapy initiation (4.0 [0.0-8.0] days) were lower in the concurrent BND cohort. CONCLUSION Concurrent BND alongside transoral BOT resection is safe with similar airway outcomes and lower total operative time, length of stay, and time to adjuvant therapy initiation compared to staged BND.
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Affiliation(s)
- Jake J Lee
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Rimbach H, Linxweiler M, Körner S, Smola S, Linxweiler B, Speicher S, Helfrich J, Solomayer EF, Wagner M, Schick B, Kühn JP. Prediction of lymph node status in patients with surgically treated head and neck squamous cell carcinoma via neck lavage cytology: A pilot study. Cancer Cytopathol 2024; 132:285-296. [PMID: 38329321 DOI: 10.1002/cncy.22800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Neck dissection is a standardized surgical procedure for patients with head and neck squamous cell carcinoma (HNSCC) and plays a critical role in the choice of adjuvant treatment based on histopathological findings. Saline irrigation is routinely performed at the end of surgery. However, this irrigant is not used for diagnostic purposes. METHODS Intraoperative irrigation of the neck dissection wound was performed in 56 patients with HNSCC (N = 93 neck dissections), and the cytological suspension obtained was processed via the liquid-based cytology (LBC) technique, Papanicolaou staining, and immunocytochemical staining. Microscopic preparations were screened for the presence of tumor cells and classified as positive, borderline, or negative. These results were correlated with the histopathological and clinical data. RESULTS Neck lavage LBC demonstrated high diagnostic value in detecting lymph node metastases (N+) with extracapsular spread (ECS), with a specificity, sensitivity, negative predictive value, and positive predictive value of 93.1%, 100%, 100%, and 80%, respectively. Tumor cells were detected in 4.8% of N- cases, 20% of N+ cases without ECS, and 100% of N+ cases with ECS. Receiver operating characteristic curve analysis showed an area under the curve of 0.8429 for the prediction of N+ (p < .0001) and 0.9658 for the prediction of N+ with ECS (p < .0001). CONCLUSIONS Differential lavage cytology can provide valid and rapid information on the lymph node status in patients with HNSCC and showed an excellent correlation with histopathology. Thus, neck lavage LBC may facilitate faster and more reasonable planning of adjuvant treatment and help improve the therapeutic management of patients with HNSCC.
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Affiliation(s)
- Hugo Rimbach
- Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
| | | | - Sandrina Körner
- Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University, Homburg/Saar, Germany
| | | | - Stefanie Speicher
- Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
| | - Johanna Helfrich
- Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
| | | | - Mathias Wagner
- Department of Pathology, Saarland University, Homburg/Saar, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
| | - Jan Philipp Kühn
- Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
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Tabaksert A, James T, Rusius C, Walters H, Lester S. Drainless, day-case lateral neck dissection with Artiss™ fibrin sealant: A prospective cohort study. Head Neck 2024; 46:1146-1151. [PMID: 38465445 DOI: 10.1002/hed.27715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Lateral neck dissection (LND) is performed for staging/treatment of head and neck lesions. This traditionally includes placement of a drain and inpatient admission. Drainless, day-case head and neck surgery is attractive due to cost-effectiveness and reduced length of stay, but evidence is lacking in LND. We aim to investigate Artiss™ as an alternative to drain placement, facilitating day-case LND. METHODS A prospective review was conducted of patients who underwent LND in a UK hospital over a 22-month period. RESULTS Thirty-nine patients were identified (27 Artiss™ only; 12 Artiss™ with a drain). Eight Artiss™ only patients were day-case. All drains were removed by post-operative day 2. There was no statistically significant difference in the number of complications between the two groups. CONCLUSION This observational study demonstrates that for selected patients, Artiss™ could facilitate drainless, day-case LND. Further controlled studies with matched groups and larger numbers are required to validate this.
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Affiliation(s)
- Ayla Tabaksert
- Department of Ear, Nose and Throat, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Tobias James
- Department of Ear, Nose and Throat, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Christopher Rusius
- Department of Ear, Nose and Throat, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Holt Walters
- Department of Ear, Nose and Throat, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Shane Lester
- Department of Ear, Nose and Throat, James Cook University Hospital, Middlesbrough, United Kingdom
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Vos DJ, Arianpour K, Fritz MA, Hadford S, Liu SW, Prendes BL, Ciolek PJ. Minimally Invasive Approach to Access Vessels for Microvascular Anastomosis in Head and Neck Reconstruction. Laryngoscope 2024; 134:2177-2181. [PMID: 37942819 DOI: 10.1002/lary.31168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To describe our technique, review indications, and evaluate the outcomes of the minimal access approach for recipient vessel identification in microvascular tissue transfer. METHODS Retrospective chart review of all patients who underwent microvascular reconstruction using the minimal access technique between 2015 and 2021. RESULTS We report 236 cases, comprising 214 patients with a mean age of 60.2 years (3-88). The most common primary defect sites were the mandible (22.6%), cranium (14%), maxilla (13.2%), skull base (12.8%), and nose/nasal cavity (10.6%). Indications for free flap reconstruction included head and neck cancer extirpation (32.2%), osteoradionecrosis (29.7%), acquired deformity (14.0%), chronic wound (11.9%) and oral motor dysfunction (7.2%). Free flap donor sites used were the anterolateral thigh (84.3%), fibula (7.2%), and radial forearm (6.4%). Vessels utilized include superficial temporal (49.8%), facial (38.3%), angular (11.1%), and transverse cervical (0.4%). The overall complication rate was 14% (n = 33), with surgical complications at the recipient site accounting for 67.6% (n = 25). Flap failure occurred in 3.4% of procedures. Prior head and neck surgery and free flaps were associated with an increased risk of major recipient site complications (n = 20, p = 0.0257 and n = 14, p = 0.0117, respectively). CONCLUSION Minimal access techniques allow consistent recipient vessel identification for microvascular-free tissue transfer. These approaches may be utilized in reconstructing a broad range of head and neck defects, are low morbidity, and contribute to an overall shorter length of stay. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2177-2181, 2024.
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Affiliation(s)
- Derek J Vos
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | | | - Michael A Fritz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Stephen Hadford
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Sara W Liu
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | | | - Peter J Ciolek
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Struckmeier AK, Buchbender M, Lutz R, Agaimy A, Kesting M. Comparison of the prognostic value of lymph node yield, lymph node ratio, and number of lymph node metastases in patients with oral squamous cell carcinoma. Head Neck 2024; 46:1083-1093. [PMID: 38501325 DOI: 10.1002/hed.27748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The aim of this study was to assess the prognostic significance of lymph node yield (LNY), lymph node ratio (LNR), and the number of lymph node metastases (LNMs) in patients affected by oral squamous cell carcinoma (OSCC). METHODS The study included patients who underwent surgical treatment for primary OSCC. Receiver operating characteristic curves were generated to determine the optimal threshold values. Kaplan-Meier curves were employed, along with the log-rank test, for the analysis of survival. To compare the performance in terms of model fit, we computed Akaike's information criterion (AIC). RESULTS This study enrolled 429 patients. Prognostic thresholds were determined at 22 for LNY, 6.6% for LNR, and 3 for the number of LNMs. The log-rank test revealed a significant improvement in both overall survival and progression-free survival for patients with a LNR of ≤6.6% or a number of LNMs of ≤3 (p < 0.05). Interestingly, LNY did not demonstrate prognostic significance. The AIC analyses indicated that the number of LNMs is a superior prognostic indicator compared to LNY and LNR. CONCLUSIONS Incorporating LNR or the number of LNMs into the TNM classification has the potential to improve the prognostic value, as in other types of cancers. Particularly, the inclusion of the number of LNMs should be contemplated for future N staging.
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Affiliation(s)
- Ann-Kristin Struckmeier
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Abbas Agaimy
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
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Patel AM, Haleem A, Choudhry HS, Brody RM, Brant JA, Carey RM. Elective Neck Dissection in cT1-4 N0M0 Head and Neck Basaloid Carcinoma. Otolaryngol Head Neck Surg 2024. [PMID: 38613196 DOI: 10.1002/ohn.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck basaloid carcinoma (HNBC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 hospital-based National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented. RESULTS Of 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1-2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1-2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3-4 disease (66.7% vs 57.9%, R2 = .062). One-hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57-0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71-1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78-1.61, P = .551) were not associated with OS. CONCLUSION END is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Zhang K, Wang X, Wei T, Li Z, Zhu J, Chen YW. Radioactive iodine therapy improves overall survival outcome in oncocytic carcinoma of the thyroid by reducing death risks from noncancer causes: A competing risk analysis of 4641 patients. Head Neck 2024. [PMID: 38572629 DOI: 10.1002/hed.27758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Oncocytic carcinoma of the thyroid (OCA) is an independent type of thyroid cancer. Radioactive iodine (RAI) therapy was frequently administered to OCA patients, but its contribution to improving survival is indefinite. METHODS 4641 OCA patients from 2000 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard regression and competing risk analysis were applied. RESULTS Tumor size, SEER stage, primary surgery, and neck dissection were prognostic factors for cancer-specific survival. The results of competing risk analysis demonstrated that age over 55 years dramatically increased non-OCA death risks. Treatments that improve non-OCA survival (including total thyroidectomy, RAI therapy, and systemic therapy) should be recommended in OCA patients older than 55 years of age. Neck lymphadenectomy should not be recommended for OCA, since the metastatic lymph node ratio was low (about 3%). CONCLUSIONS RAI therapy can improve survival in OCA by reducing noncancer death risks.
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Affiliation(s)
- Kun Zhang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinyi Wang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqiang Zhu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ya-Wen Chen
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cell, Developmental, and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Epithelial and Airway Biology and Regeneration, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Airway Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang ES, Hair BB, Lamarre ED, Koyfman SA, Burkey BB. Occult Nodal Metastases in Individuals with Clinically Node-Negative Salivary Gland Malignancies. Laryngoscope 2024; 134:1705-1715. [PMID: 37847121 DOI: 10.1002/lary.31119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/03/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Salivary gland malignancies comprise a heterogeneous group of pathologies, for which treatment of the clinically negative neck may vary depending on numerous factors. Herein we present data on occult nodal metastases (ONM) as well as survival and recurrence from a large series of cN0 salivary gland malignancies. METHODS Retrospective chart review was conducted on 532 patients, with 389 patients with major salivary gland cancers and 143 patients with minor salivary gland cancers. Demographic and treatment data were included and rates of ONM, overall survival, local recurrence, regional recurrence, and distant recurrence were analyzed. RESULTS We found that the overall rate of ONM for parotid was 27% (63/235), for submandibular/sublingual was 35% (18/52), and for minor was 15% (4/26). Analysis of ONM rate at each nodal level was also performed, finding higher rates of level IV and V ONM than prior studies. Submandibular/sublingual and minor salivary gland malignancies showed a predominance of ONMs at levels I-III. Our survival and recurrence rates were similar to those found in previous studies. CONCLUSION Our data also demonstrate a predominance of ONM in levels I-III for submandibular/sublingual and minor salivary gland cancers, suggesting elective dissection in these levels. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1705-1715, 2024.
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Affiliation(s)
- Emily S Zhang
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Bryan B Hair
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, Cleveland, Ohio, U.S.A
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Brian B Burkey
- Department of Otolaryngology, Cleveland Clinic Florida, Vero Beach, Florida, U.S.A
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Guarino P, Tesauro P, Giordano L, Caporale CD, Presutti L, Mattioli F. Surgical and radiological perspectives for the spinal accessory nerve passing through a fenestrated internal jugular vein: case series and literature review. J Surg Case Rep 2024; 2024:rjae099. [PMID: 38617811 PMCID: PMC11014881 DOI: 10.1093/jscr/rjae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 04/16/2024] Open
Abstract
The preservation of the spinal accessory nerve represents a key goal in head and neck oncologic surgery during selective neck dissection. This study aims to illustrate the anatomical variants of the XI cranial nerve, delving into the relationship between the spinal nerve and the internal jugular vein, as well as the surgical implications. Two cases of patients who underwent oncologic surgery with neck dissection are described. Both cases found the spinal accessory nerve passing through the fenestration of the internal jugular vein. Alongside this case series, an independent literature review was conducted using the Medline and PubMed databases. In the majority of cases (67% - 96%), the spinal accessory nerve traces a lateral course to the internal jugular vein. Less frequently, the XI cranial nerve courses medial to the internal jugular vein. More rarely, as described in this case series, the nerve crosses through the fenestration of the vein (0.48% - 3.3%).
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Affiliation(s)
- Pierre Guarino
- U.O.C di Otorinolaringoaitra e Chirurgia Cervico-Facciale, Azienda USL di Pescara, 65124 Pescara, Italy
| | - Paolo Tesauro
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Leone Giordano
- Otolaryngology and Audiology Unit, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Claudio Donadio Caporale
- U.O.C di Otorinolaringoaitra e Chirurgia Cervico-Facciale, Azienda USL di Pescara, 65124 Pescara, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Mattioli
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
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Agcaoglu O, Sucu S, Toprak S, Tezelman S. Techniques for Thyroidectomy and Functional Neck Dissection. J Clin Med 2024; 13:1914. [PMID: 38610679 PMCID: PMC11012902 DOI: 10.3390/jcm13071914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Thyroidectomy is a commonly performed surgery for thyroid cancer, Graves' disease, and thyroid nodules. With the increasing incidence of thyroid cancer, understanding the anatomy and surgical techniques is crucial to ensure successful outcomes and minimize complications. This review discusses the anatomical considerations of the thyroid and neck, including lymphatic drainage and the structures at risk during thyroidectomy. Emphasis is placed on the significance of cautious dissection to preserve critical structures, such as the parathyroid glands and recurrent laryngeal nerve. Neck dissection is also explored, particularly in cases of lymph node metastasis, in which its proper execution is essential for better survival rates. Additionally, this review evaluates various thyroidectomy techniques, including minimally invasive approaches, highlighting their potential benefits and limitations. Continuous surgical knowledge and expertise updates are necessary to ensure the best results for patients undergoing thyroidectomy.
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Affiliation(s)
| | | | | | - Serdar Tezelman
- Department of General Surgery, School of Medicine, Koç University, Istanbul 34450, Turkey; (O.A.); (S.S.); (S.T.)
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11
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Altawil M, Stanisz I, Van Den Berg NH, Sheahan P. Pattern of regional recurrence after selective neck dissection for clinically positive neck in mucosal squamous carcinoma. Head Neck 2024. [PMID: 38476090 DOI: 10.1002/hed.27727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Selective neck dissection (SND) has traditionally been applied to clinically negative (cN0) necks in mucosal squamous cell carcinoma (SCC). We aimed to examine the oncological safety and patterns of regional recurrence (RR) of SND in clinically positive (cN+) necks. METHODS Retrospective review of prospective cohort of 206 patients with mucosal SCC undergoing neck dissection. RR was classified as occurring within previously dissected levels, within ipsilateral undissected levels, within unusual locations of ipsilateral neck, or contralateral neck. RESULTS Seven of seventy-seven (9.1%) cN+ patients undergoing SND developed isolated RR, versus 16.2% after MRND, and 8.7% after SND for cN0 disease. RR was rarely seen within undissected levels of the ipsilateral neck. RR and survival rates were not associated with ND extent (SND vs. MRND) among either cN+ or pN+ patients. CONCLUSION SND can be safely performed in most patients with cN+ SCC, who do not have gross sternocleidomastoid infiltration or level V metastases.
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Affiliation(s)
- Mohammad Altawil
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Isabella Stanisz
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Nadia H Van Den Berg
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Patrick Sheahan
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
- ENTO Research Unit, College of Medicine and Health, University College, Cork, Ireland
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Iszlai Z, Ottor P, Tóth E, Korcsmáros A, Karosi T. [Tumor-like lesion in a 13-year-old boy: post-COVID bartonellosis]. Orv Hetil 2024; 165:351-355. [PMID: 38431866 DOI: 10.1556/650.2024.32973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/10/2024] [Indexed: 03/05/2024]
Abstract
Egy 13 éves fiú lázzal, köhögéssel, szaglásvesztéssel és kb. 2 × 3 cm átmérőjű,
jobb oldali nyaki elváltozással jelentkezett hozzátartozójának kíséretében
kórházunk gyermekgyógyászati szakambulanciáján. A vizsgálat előtt 24 nappal a
dokumentált nasopharyngealis COVID–19-gyorstesztje pozitivitást mutatott. Mivel
az ultrahangvizsgálaton beolvadási jeleket nem tapasztaltak, orális
antibiotikumterápiát (klaritromicin, 2 × 500 mg) javasoltak 7 napig, szerológiai
vizsgálatokra vért vettek. A beteg 2 nap elteltével újból jelentkezett az
elváltozás progresszív növekedése miatt. Osztályunkon vékonytű-biopszia,
valamint nyaki és mellkasi CT-vizsgálatok történtek. A citológiai vizsgálat
C3-diagnózissal zárult anélkül, hogy egyértelműen kizárta volna az aspirált
sejtek rosszindulatú jellemzőit. A nyaki és mellkasi CT kb. 60 × 46 × 40 mm-es,
supraclavicularisan elhelyezkedő inhomogén nyaki daganatot írt le, az
intrathoracalis régió inváziója nélkül, tályogképződés lehetséges jeleivel,
azonos oldali vena jugularis kompresszióval. Idővel a Bartonella
henselae szerológiai vizsgálat pozitivitást mutatott. A nyaki
képlet műtéti eltávolítása mellett döntöttünk. Szövettani vizsgálattal
nekrotizáló és nem nekrotizáló granulomák voltak kimutathatók atípusos sejtek
jelenléte nélkül. Ezek és a szerológiai eredmény alapján a bartonellosis
diagnózisát állítottuk fel. Bár a SARS-CoV-2-fertőzés hatásáról a bartonellosis
klinikai lefolyására az irodalomban nem találtunk adatot, esetünk kapcsán
elképzelhetőnek tartjuk, hogy a COVID–19 által legyengített szervezetben a
bakteriális fertőzés az egyébként ártalmatlan betegség helyett a bartonellosis
súlyosabb klinikai képét okozta, melynek megoldását a gyógyszeres kezelésre
nehezen reagáló nyaki elváltozás teljes eltávolítása jelentette. Orv Hetil.
2024; 165(9): 351–355.
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Affiliation(s)
- Zoltán Iszlai
- 1 Borsod-Abaúj-Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Fül-orr-gégészeti és Fej-nyaksebészeti Osztály Miskolc, Szentpéteri kapu 72-76., 3526 Magyarország
| | - Prince Ottor
- 1 Borsod-Abaúj-Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Fül-orr-gégészeti és Fej-nyaksebészeti Osztály Miskolc, Szentpéteri kapu 72-76., 3526 Magyarország
| | - Erika Tóth
- 2 Országos Onkológiai Intézet, Daganatpatológiai Központ, Sebészeti és Molekuláris Patológiai Osztály Budapest Magyarország
| | - Anikó Korcsmáros
- 3 Borsod-Abaúj-Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Patológiai Osztály Miskolc Magyarország
| | - Tamás Karosi
- 1 Borsod-Abaúj-Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Fül-orr-gégészeti és Fej-nyaksebészeti Osztály Miskolc, Szentpéteri kapu 72-76., 3526 Magyarország
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Rullière A, Danion J, Fieux M, Tonnerre D, Faure JP, Legré M, Favier V, Oriot D, Dufour X, Carsuzaa F. SimLife®: A New Dynamic Model for Head and Neck Surgical Oncology Simulation. Otolaryngol Head Neck Surg 2024; 170:972-976. [PMID: 38111133 DOI: 10.1002/ohn.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/20/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023]
Abstract
The SimLife® model consists in a human cadaver dynamized by pulsatile vascularization. The objective was to evaluate the face, contents, and constructs validity of the SimLife® model in head and neck surgical oncology simulation. Head and neck surgical oncology simulation sessions on SimLife® models were organized with lateral neck dissection and total laryngectomy. Face and contents validity were addressed by questionnaires. Constructs validity was assessed by objective structured assessment of technical skills (OSATS) score. High realism was demonstrated for consistency of tissues (7.1 ± 1.4), color of arteries and veins (7.3 ± 1.9, 8.5 ± 1.1, respectively), and vein consistency (8.5 ± 1.2). The mean OSATS score was 19.7 ± 5.4 for residents and 32.7 ± 1.9 for senior surgeon (P = .0022). SimLife® is a hyperrealistic model for head and neck surgical oncology simulation and it might become a core component of the surgical resident curriculum.
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Affiliation(s)
- Anne Rullière
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jérôme Danion
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Maxime Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Denis Tonnerre
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Pierre Faure
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Margaux Legré
- Service ORL et chirurgie cervico-faciale, Institut Arthur Vernes, Paris, France
| | - Valentin Favier
- Département d'ORL, chirurgie cervico faciale et maxillo-faciale, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier, France
| | - Denis Oriot
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Xavier Dufour
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Florent Carsuzaa
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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14
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Schilling C, Collins L, Farrow A, McGurk M, Bisase B, Kerawala C, Wan S, Hall G, Thavaraj S. Incidental Thyroid Tissue in Sentinel Nodes From Oral Squamous Cell Carcinoma. Laryngoscope 2024; 134:1278-1281. [PMID: 37610258 DOI: 10.1002/lary.30996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Sentinel node biopsy (SNB) is a surgical staging test in which sentinel nodes (SNs) undergo intensive histological analysis. SNB diagnoses early cancer spread, but can also reveal unexpected findings within the SNs. We review cases of incidental thyroid cells (TC) found in SNs from patients with oral squamous cell carcinoma (OSCC) to assess the prevalence of TC, and the clinical significance of these. METHODS Multicenter retrospective review of SNB performed for cT1-T2N0 OSCC. Incidental TC were identified by TTF-1 or thyroglobulin positivity. Anatomical location of nodes containing TC, TC morphology, and ongoing management/follow up of this incidental finding was recorded. Neck dissections performed during the same period were reviewed to establish the expected incidence of TC in neck nodes without serial sectioning analysis. RESULTS 278 SNB cases were reviewed. Ten procedures detected TC in nine patients (10/278, 3.6%). During the same time period 725 neck dissections were performed, six containing TCs (6/725, 0.8%). One patient underwent SNB twice with TC identified on both occasions. Three patients had both OSCC metastasis and thyroid cells. All SNB patients with TC identified underwent thyroid USS with no primary tumours identified. Three patients underwent thyroidectomy, in all cases no primary thyroid tumour was found. CONCLUSION Prevalence of incidental TC in SNs appears to be higher than that reported in neck dissections, these are not likely to be clinically relevant and can be managed on a conservative basis in the absence of clear metastatic features. LEVEL OF EVIDENCE Multicentre retrospective cohort study, 3 Laryngoscope, 134:1278-1281, 2024.
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Affiliation(s)
- Clare Schilling
- Head and Neck Academic Centre, University College London, London, UK
- Head & Neck Surgery, University College London Hospital, London, UK
| | - Lisette Collins
- Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Adrian Farrow
- Head & Neck Surgery, University College London Hospital, London, UK
| | - Mark McGurk
- Head and Neck Academic Centre, University College London, London, UK
- Head & Neck Surgery, University College London Hospital, London, UK
| | - Brian Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Cyrus Kerawala
- Head and Neck Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Simon Wan
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, London, UK
| | - Gill Hall
- Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Selvam Thavaraj
- Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK
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15
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Hollenbeak CS, Duan F, Subramaniam RM, Taurone A, Sicks J, Lowe VJ, Stack BC. Quality of life following surgery for head and neck cancer: Evidence from ACRIN 6685. Head Neck 2024. [PMID: 38353324 DOI: 10.1002/hed.27673] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND This study examined the trajectory of health-related quality of life (HRQoL) for patients with clinical stage N0 HNSCC enrolled in ACRIN 6685 who underwent elective neck dissection(s). METHODS HRQoL of 230 patients in the ACRIN 6685 trial was measured prospectively up to 2 years following surgery using the University of Washington Quality of Life instrument. RESULTS General Health Within the Last 7 Days did not differ significantly from baseline at any follow-up. General Health Relative to Before Cancer fell significantly by 5.8 points following surgery (p = 0.048), and then returned to 3.0 points above baseline at 1 year (p = 0.65). For Overall Quality of Life, HRQoL fell significantly by 4.3 points following surgery (p = 0.031) and then returned to levels not significantly different from baseline. CONCLUSIONS Patients with stage N0 HNSCC experience significant declines in HRQoL immediately following surgery, including neck dissection, which recovers to near or better than baseline within 1-2 years.
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Affiliation(s)
- Christopher S Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame Australia, Sydney, Australia
- Department of Radiology, Duke University, Durham, North Carolina, USA
- Department of Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Alexander Taurone
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - JoRean Sicks
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Kim MJ, Kang SH, Kwon M, Jung YH, Choi SH, Nam SY, Lee YS. Clinical implication of neck dissection for metastatic lymph nodes originating from non-head and neck regions. Acta Otolaryngol 2024; 144:153-157. [PMID: 38491920 DOI: 10.1080/00016489.2024.2327406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Cervical lymph node metastasis (CLNM) from remote primary sites is rare in head and neck cancer. The efficacy of neck dissection is still being investigated for therapeutic benefits of local management in oligometastasis from non-head and neck cancer. OBJECTIVES To evaluate the clinical efficacy of neck dissection (ND) in CLNM from distant primary cancers and identify factors contributing to improved survival. MATERIALS AND METHODS This retrospective case-control study enrolled patients who underwent ND for CLNM from distant primary cancer at Asan Medical Centre between January 2010 and December 2020. We analysed overall survival and association between clinical covariate and survival. RESULTS The study included 31 (14 males, 17 females) among 114 patients. Ovarian cancer was the most common primary malignancy (32.3%). Patients with fewer than three metastatic lymph nodes, without extranodal extension and with adjuvant therapy after surgery had better survival rates. CONCLUSION AND SIGNIFICANCE In patients with CLNM from a distant primary cancer, ND is beneficial as local treatment. And adequate selection of patients for ND is pivotal to improve prognosis.
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Affiliation(s)
- Min Ji Kim
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - So Hee Kang
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - MinSu Kwon
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Ho Jung
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ho Choi
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
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17
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Bekyarova AI, Velikova AV, Atanasova NV, Zhelezov MD. A Rare Anastomosis Between the Internal and the External Jugular Veins: A Case Report. Cureus 2024; 16:e55212. [PMID: 38558638 PMCID: PMC10981499 DOI: 10.7759/cureus.55212] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Usually, the external jugular vein (EJV) is located superficially over the sternocleidomastoid muscle and joins the subclavian vein or the venous angle. The internal jugular vein (IJV) lies deeply in close relation with the common carotid artery and vagus nerve, enveloped by the carotid sheath. Normally, there is no direct connection between those vessels. During a routine neck dissection, we found a rare anastomosis between IJV and EJV. The anastomosis was localized on the level of the cricoid cartilage. It was approximately 1 cm long, with the diameter of the lumen being 0.3 cm. There was no obstruction along the length of the vessel. The direction was oblique and followed the blood flow from IJV to EJV. The observed variation has high clinical importance related to numerous procedures executed in the neck region, such as placement of hemodialysis catheter in patients with renal failure, insertion of central venous line in the care of critically ill patients, and radical neck dissections.
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Affiliation(s)
| | - Adelina V Velikova
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
| | - Nikol V Atanasova
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
| | - Marin D Zhelezov
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
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18
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Ferrari L, Cariati P, Zubiate I, Martínez-Sahuquillo Rico Á, Arroyo Rodriguez S, Pulgar Encinas RM, Ferrari S, Martínez Lara I. Controversies in the treatment of early-stage oral squamous cell carcinoma. Curr Probl Cancer 2024; 48:101056. [PMID: 38096653 DOI: 10.1016/j.currproblcancer.2023.101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/27/2023] [Accepted: 11/29/2023] [Indexed: 03/10/2024]
Abstract
The treatment of early-stage oral squamous cell carcinoma (OSCC) is still a controversial issue. Thanks to the 8th edition of TNM by AJCC there is a better distinction between the stages of OSCC. However, Stages I and II still share the same treatment protocol, even if the prognosis is radically different. A retrospective study has been conducted including 70 previously untreated patients with Stage I or II OSCC, treated with tumorectomy and selective neck dissection. The study focuses on the link between pT1/2 and various other factors, particularly histological grading, vascular and perineural invasion, local and cervical recurrence, surgical margins and overall survival. These data reveal significant differences between pT1 and pT2 in histological grade, perineural invasion, cervical recurrence, surgical margins, and overall survival, emphasizing the necessity of different treatment protocols for T1 and T2 OSCC. Distinct strategies should be proposed to treat Stage I and II OSCC, with Stage II patients possibly benefitting from more aggressive treatments: following these data, a wait-and-see strategy should only be considered in Stage I, while certain treatments at the cervical level - such as prophylactic neck dissection and sentinel node biopsy - should always be considered for Stage II tumors.
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Affiliation(s)
| | - Paolo Cariati
- Maxillofacial Surgeon, Virgen de las Nieves University Hospital, Granada, Spain
| | - Imanol Zubiate
- Resident in Oral and Maxillofacial Surgery, Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | | | - Silvano Ferrari
- Professor, Department of Maxillofacial Surgery, University of Parma, Italy
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19
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Noor A, Mair MD, Gupta R, Elliott MS, Wykes J, Palme CE, Clark JR, Low THH. When should patients with T1N0 oral squamous cell carcinoma be considered for elective neck dissection? ANZ J Surg 2024. [PMID: 38291013 DOI: 10.1111/ans.18884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
AIMS To identify adverse pathological features (APF) predicting nodal failure in clinically node negative T1 oral squamous cell carcinoma (OSCC). METHODOLOGY This study evaluated patients with T1N0 (≤5 mm depth of invasion (DOI) and ≤2 cm diameter) oral cancers from a prospectively maintained database between 1988 and 2020. All patients underwent surgical excision of the primary lesion without neck dissection. Patients underwent three monthly clinical surveillance and salvage neck dissection was performed if nodal relapse was diagnosed. RESULTS Overall, 141 patients were included. Nodal relapse was reported in 16/141 (11.3%) patients. Factors impacting regional recurrence-free survival were DOI ≥3 mm (HR: 2.4, P < 0.001), maximum tumour diameter ≥12 mm (HR: 1.1, P = 0.009), perineural invasion (PNI) (HR 7.5, P = 0.002) and poor differentiation (HR 5.3, P = 0.01). Rates of nodal relapse increased from 2% amongst patients with no APFs to 100% for those with four APFs. Patients with two or more APFs had significantly poorer 5-year regional recurrence-free survival (94.8% vs. 56.3%, P < 0.001). CONCLUSION Patients with T1N0 OSCC with two or more APFs (DOI ≥3 mm, diameter ≥12 mm, PNI or poor differentiations) should be considered for elective neck dissection.
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Affiliation(s)
- Anthony Noor
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Manish D Mair
- Department of Head and Neck Surgery, University Hospital of Leicester NHS trust, Leicester, UK
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology, NSW Health Pathology, Camperdown, Australia
| | - Michael S Elliott
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Medicine, Sydney Local Health District, Syndey, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Medicine, Sydney Local Health District, Syndey, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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20
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Lévay B, Tóth E, Péter I, Kiss A, Fröhlich G, Dohán O, Boér A, Oberna F. [Results of surgical treatment of papillary thyroid cancer with lymph node metastasis - review of our data in a 5-year period]. Orv Hetil 2024; 165:83-88. [PMID: 38245878 DOI: 10.1556/650.2024.32960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/23/2024]
Abstract
A papillaris pajzsmirigyrák prognózisát a gyakori nyaki nyirokcsomóáttét-képzés
befolyásolja. Sebészi kezelésük minősége a betegek túlélését és a recidíva
előfordulási gyakoriságát is meghatározza. Az Országos Onkológiai Intézet
Fej-Nyaki Daganatok Multidiszciplináris Központjában a fej-nyak sebész szerzők
által 2013 és 2018 között operált, nyaki áttétet adó papillaris carcinomás
betegek adatait vizsgáltuk. 130, nyaki áttétet adó papillaris
pajzsmirgy-carcinomás beteg esetében az ATA (American Thyroid Association) 2015.
évi irányelvei alapján teljes pajzsmirigy-eltávolítást és nyaki
nyirokcsomó-dissectiót végeztünk. Az eltávolított anyagokat szövettani
feldolgozásra küldtük, vizsgáltuk a nyirokcsomóáttét(ek) arányát az életkor, a
nem, a tumor-multifokalitás, a kétoldaliság, a tokon kívüli terjedés, a nyirok-,
érinvázió függvényében. Elemeztük a műtét után fellépő szövődményeket is. 43
betegnél thyreoidectomia, totális és centrális nyaki dissectio (VI. régió), 87
esetben centrális (VI. régió) és laterális (II–V. régió) nyaki dissectio
történt. Átmeneti (6 hónapon belül normalizálódó) hypocalcaemia 30 betegnél
(23%), permanens hypocalcaemia 4 betegnél (3%) fordult elő. Átmeneti nervus
recurrens bénulás 12 esetben (9,2%), permanens bénulás 3 (2,3%) esetben történt.
A szövettani értékeléskor érbetörés és tokinvázió 75 betegnél (57,7%),
nyirokér-invázió 63 betegnél (48,5%), Hashimoto-thyreoiditis 51 betegnél (39,2%)
igazolódott. Microcarcinoma (1 cm-nél kisebb daganat) 43 esetben fordult elő
(33%). Az eltávolított nyirokcsomók átlagosan 48%-a volt áttétes. Ez csak a
tumormérettel mutatott szignifikáns korrelációt, az életkorral nem találtunk
összefüggést. Az oldaliság, a többgócúság, valamint a tok-, nyirokér- és
érinvázió, a Hashimoto-status és a beteg neme nem mutatott összefüggést az
áttétes nyirokcsomók számával. A túlélést befolyásolta a tok-, ér- és
nyirokér-invázió, valamint a tumorméret is. A nyaki áttétet adó, differenciált
pajzsmirigyrákos beteganyagunk kezelésében a kivizsgálási protokollt követően a
teljes pajzsmirigy-eltávolítás és a megfelelő régiókat tartalmazó nyaki
dissectio döntő fontosságú, a radiojód-terápiával kiegészítve az irányelveknek
megfelelő kezelési modul. A pajzsmirigydaganat a leggyakoribb endokrin daganatos
megbetegedés, melynek sebészi kezelése a multidiszciplináris terápia
legfontosabb eleme. 5 év alatt operált, nyaki áttétet is adó, differenciált
pajzsmirigyrákos beteganyagunkat feldolgozva ismertetjük eredményeinket az
olvasóval. Orv Hetil. 2024; 165(3): 83–88.
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Affiliation(s)
- Bernadett Lévay
- 1 Országos Onkológiai Intézet, Fej-Nyaki Daganatok Multidiszciplináris Központ Budapest, Ráth Gy. u. 7-9., 1124 Magyarország
| | - Erika Tóth
- 2 Országos Onkológiai Intézet, Daganatpatológiai Központ, Sebészeti és Molekuláris Patológiai Osztály Budapest Magyarország
| | - Ilona Péter
- 2 Országos Onkológiai Intézet, Daganatpatológiai Központ, Sebészeti és Molekuláris Patológiai Osztály Budapest Magyarország
| | - Alexandra Kiss
- 1 Országos Onkológiai Intézet, Fej-Nyaki Daganatok Multidiszciplináris Központ Budapest, Ráth Gy. u. 7-9., 1124 Magyarország
| | - Georgina Fröhlich
- 3 Országos Onkológiai Intézet, Sugárterápiás Központ Budapest Magyarország
- 4 ELTE Eötvös Loránd Tudományegyetem Budapest Magyarország
| | - Orsolya Dohán
- 5 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Sz. Belgyógyászati Klinika Budapest Magyarország
| | - András Boér
- 1 Országos Onkológiai Intézet, Fej-Nyaki Daganatok Multidiszciplináris Központ Budapest, Ráth Gy. u. 7-9., 1124 Magyarország
| | - Ferenc Oberna
- 1 Országos Onkológiai Intézet, Fej-Nyaki Daganatok Multidiszciplináris Központ Budapest, Ráth Gy. u. 7-9., 1124 Magyarország
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Pagedar NA, Hoffman HT. Anatomic Variability of the Accessory Nerve: Implications for Dissection of Level IIB. Laryngoscope 2024; 134:154-159. [PMID: 37289066 PMCID: PMC10703995 DOI: 10.1002/lary.30758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES During neck dissection, level IIB lymphadenectomy necessitates manipulation of the spinal accessory nerve that might be avoided and might cause postoperative disability. Current literature does not describe the effect of variation in the spinal accessory nerve in the upper neck. We sought to measure the effect of the dimensions of level IIB on nodal yield in level IIB and on patient reported neck symptoms. METHODS We measured the boundaries of level IIB of 150 patients undergoing neck dissection. Level II was dissected and separated into levels IIA and IIB intraoperatively. Patient-reported symptoms were assessed in 50 patients using the Neck Dissection Impairment Inventory. We computed descriptive statistics, and sought to identify correlation with the number and proportion of level IIB nodes and the number of metastatic nodes. Level IIB dimensions were analyzed as predictors of postoperative symptoms. RESULTS We measured 184 sides, with 37.7% of level II nodes found in level IIB. Mean accessory nerve length across level II was 2.5 cm. Every additional 1 cm in accessory nerve length was associated with two more level IIB nodes. At all accessory nerve lengths, meaningful numbers of nodes were present in level IIB. Accessory nerve length and other factors did not correlate with NDII scores. CONCLUSIONS Longer lengths of accessory nerve across level IIB correlated with greater nodal yield. However, data did not point to an accessory nerve length cutoff below which level IIB dissection could be avoided. In addition, the dimensions of level IIB did not correlate with postoperative neck symptoms. LEVEL OF EVIDENCE 2 Laryngoscope, 134:154-159, 2024.
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Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Henry T Hoffman
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
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22
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Penston V, White S, Safar M, Groom P. Emergency front of neck access in the management of acute airway obstruction secondary to postoperative neck haematoma. Anaesth Rep 2024; 12:e12273. [PMID: 38222107 PMCID: PMC10783831 DOI: 10.1002/anr3.12273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/16/2024] Open
Abstract
Airway compromise is the most significant complication of a postoperative neck haematoma. Here, we report the management of a case of complete airway obstruction secondary to an acute neck haematoma arising after radical neck dissection, partial glossectomy and a free flap reconstruction. The patient deteriorated precipitously and required immediate emergency surgical front of neck access to secure the airway. Drawing on our experience of this case, we propose a mental model to inform the emergency airway management of postoperative neck haematoma following all types of surgery.
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Affiliation(s)
- V. Penston
- Department of AnaesthesiaLiverpool University Foundation TrustLiverpoolUK
| | - S. White
- Department of AnaesthesiaLiverpool University Foundation TrustLiverpoolUK
| | - M. Safar
- Department of AnaesthesiaLiverpool University Foundation TrustLiverpoolUK
| | - P. Groom
- Department of AnaesthesiaLiverpool University Foundation TrustLiverpoolUK
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Koliarakis I, Manatakis DK, Tsitsipanis C, Drakonaki E, Tsamandouras I, Tsiaoussis J. Spinal accessory nerve anatomy in the posterior cervical triangle: A systematic review with meta-analysis. Clin Anat 2024; 37:130-139. [PMID: 37767816 DOI: 10.1002/ca.24119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/10/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
This study aimed to investigate the anatomy of the spinal accessory nerve (SAN) in the posterior cervical triangle, especially in relation to adjacent anatomical landmarks, along with a systematic review of the current literature with a meta-analysis of the data. Overall, 22 cadaveric and three prospective intraoperative studies, with a total of 1346 heminecks, were included in the analysis. The major landmarks relevant to the entry of the SAN at the posterior border of the SCM muscle (PBSCM) were found to be the mastoid apex, the great auricular point (GAP), the nerve point (NP), and the point where the PBSCM meets the upper border of the clavicle. The SAN was reported to enter the posterior cervical triangle above GAP in 100% of cases and above NP in most cases (97.5%). The mean length of the SAN along its course from the entry point to its exit point from the posterior triangle of the neck was 4.07 ± 1.13 cm. The SAN mainly gave off 1 or 2 branches (32.5% and 31%, respectively) and received either no branches or one branch in most cases (58% and 23%, respectively) from the cervical plexus during its course in the posterior cervical triangle. The major landmarks relevant to the entry of the SAN at the anterior border of the TPZ muscle (ABTPZ) were found to be the point where the ABTPZ meets the upper border of the clavicle and the midpoint of the clavicle, along with the mastoid apex, the acromion, and the transverse distance of the SAN exit point to the PBSCM. The results of the present meta-analysis will be helpful to surgeons operating in the posterior cervical triangle, aiding the avoidance of the iatrogenic injury of the SAN.
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Affiliation(s)
- Ioannis Koliarakis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Christos Tsitsipanis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Elena Drakonaki
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioannis Tsamandouras
- Department of Otorhinolaryngology - Head and Neck Surgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - John Tsiaoussis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Saha BK, Jena S, Singodia P, Lenka JK, Sinha N, Mishra M. Surgical Management of Oral Cavity Cancer: Experience at a Tertiary Care Centre in Jamshedpur. Cureus 2024; 16:e51727. [PMID: 38318587 PMCID: PMC10839743 DOI: 10.7759/cureus.51727] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Background Cancer of the oral cavity is very common in Eastern India. This is due to the lack of awareness that chewing tobacco causes oral cancer. Because of poor economic condition and lack of access to healthcare, patients in this region often present at an advanced stage of the disease when they become symptomatic. A retrospective study was conducted at Tata Main Hospital, Jamshedpur, India, to know the epidemiology and recurrence of oral cavity cancer in this region. Materials and methods We conducted a retrospective study of oral cavity cancer patients operated at Tata Main Hospital, Jamshedpur, from January 2018 to June 2023. Data were collected from the surgical register, operation theatre notes, case sheets and hospital online data. The following parameters were observed in this study: a) age, b) gender, c) site of cancer, d) histology, e) stage of disease at presentation, f) type of neck dissection, g) margin status on the final histopathology report, h) node positivity, i) presence of perineural invasion or lymphovascular invasion and j) recurrence. Results A total of 218 patients were operated between January 2018 and June 2023. The most common site for oral cavity cancer was the buccal mucosa with the involvement of the lower alveolus (168 patients, 77.06%), followed by the tongue (27 patients, 12.38%). Two-hundred seventeen patients were diagnosed with squamous cell carcinoma (SCC), and one patient had epithelioid sarcoma on the biopsy report. The most common stage of presentation was stage IVa (180 patients, 82.56%), followed by stage III (16 patients, 7.34%). The most frequent neck dissection performed was modified radical neck dissection (MRND) sacrificing the sternocleidomastoid muscle (SCM) and preserving the internal juglar vein (IJV) and spinal accessory nerve (SAN) (176 patients, 80%). The margin was positive for 10 patients. Node positivity on the final histopathology report grouped according to the clinical stage are as follows: stage I (33.33%), stage II (60%), stage III (75%) and stage IV (86.67%). Similarly, the presence of lymphovascular or perineural invasion on the final histopathology report grouped according to the clinical stage is as follows: stage I (0%), stage II (20%), stage III (25%) and stage IV (55.55 %). Fifteen patients lost to follow-up. Recurrence was noted in 11 patients (5.04%). Patients presenting with stages I and II had no recurrence, whereas three out of 16 patients in stage III (1.1%) and eight out of 180 patients in stage IV (4.44%) had recurrence. Conclusion SCC is the most common type of oral cavity cancer in Eastern India. It is strongly related to tobacco chewing habit. Since most of the patients in this part of the country present with an advanced stage of the disease, awareness regarding cessation of tobacco use and screening can be beneficial to the general population.
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Affiliation(s)
- Bijan K Saha
- Surgical Oncology, Tata Main Hospital, Jamshedpur, IND
| | | | - Pankaj Singodia
- Plastic and Reconstructive Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Jayant K Lenka
- Plastic and Reconstructive Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Neetesh Sinha
- Surgical Oncology, Tata Main Hospital, Jamshedpur, IND
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Huang NS, Chen JY, Ma B, Guo KP, Wang GR, Guan Q, Zhao ZH, Wang WJ, Zhang JS, Wang YJ, Wei WJ, Lu ZW, Xiang J, Ji QH, Liu YF, Wang Y. A multicenter prospective study of lateral neck lymph node mapping in papillary thyroid cancer. Gland Surg 2023; 12:1500-1507. [PMID: 38107486 PMCID: PMC10721555 DOI: 10.21037/gs-23-222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Abstract
Background Despite the high incidence of lateral neck lymph node (LN) metastasis in papillary thyroid cancer (PTC), the management of the lateral neck remains controversial. We aimed to map the draining LNs in the lateral neck using carbon nanoparticles and explore its potential in neck evaluation. Methods We conducted a multicenter, prospective study in PTC patients who had non-palpable yet suspicious metastatic lateral LNs on ultrasound and/or computed tomography (CT) but could not be confirmed by fine needle aspiration. Carbon nanoparticle suspension was injected peritumorally into the thyroid and modified lateral neck dissection was subsequently performed. Results A total of 154 patients were enrolled for analysis. And 5,070 lateral LNs were removed, of which 1,079 (21.3%) were dyed. The median of dyed LNs was 6 per case (range, 1-33). The distribution of dyed LNs in neck compartments was IV > III > IIA > IIB/V, independent of tumor size, location, multifocality or microscopic extra-thyroidal extension (ETE). Compared with undyed LNs, the probabilities of metastasis in dyed LNs were significantly increased in compartment III, IV, V, and II-V (III: 29.3% vs. 15.4%, P<0.001; IV: 26.3% vs. 14.5%, P<0.001; V: 16.7% vs. 3.3%, P=0.005; II-V: 26.3% vs. 10.0%, P<0.001). The relative risks of metastasis in dyed LNs compared with undyed LNs were 1.90, 1.82, 5.04 and 2.62 in compartment III, IV, V, and II-V, respectively. Conclusions It was the first prospective multicenter study to map the lateral neck LNs with carbon nanoparticles, which could help surgeons visualize the suspicious LNs during surgery. Instead of unguided LN biopsy, this method has a potential role in lateral neck assessment for indeterminate lateral LNs in PTC.
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Affiliation(s)
- Nai-Si Huang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia-Ying Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ben Ma
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kun-Peng Guo
- Department of General Surgery, Shanghai Electric Power Hospital, Shanghai, China
| | - Guo-Rui Wang
- Department of General Surgery, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi-Hong Zhao
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Wei-Jian Wang
- Department of General Surgery, Shanghai Electric Power Hospital, Shanghai, China
| | - Jin-Song Zhang
- Department of General Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Yun-Jun Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhong-Wu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan-Fei Liu
- Office of Clinical Research, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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De Luca P, Di Stadio A, de Campora L, De Bonis E, Fermi M, Petruzzi G, Atturo F, Colangeli R, Scarpa A, Lo Manto A, Colizza A, Cintoli G, Togo G, Salzano G, Crescenzi D, Ralli M, Abbate V, Ricciardiello F, Magaldi L, D’Ecclesia A, di Massa G, Costarelli L, Merenda E, Corsi A, Covello R, Di Crescenzo RM, Duda L, Dimitri LM, Caputo A, Ferrara G, Lucante T, Longo F, Tassone D, Iemma M, Cassano M, Salzano FA, Califano L, Marchioni D, Pellini R, de Vincentiis M, Presutti L, Ionna F, de Campora E, Radici M, Camaioni A. A Retrospective Multicenter Italian Analysis of Epidemiological, Clinical and Histopathological Features in a Sample of Patients with Acinic Cell Carcinoma of the Parotid Gland. Cancers (Basel) 2023; 15:5456. [PMID: 38001716 PMCID: PMC10669973 DOI: 10.3390/cancers15225456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The acinic cell carcinoma (AciCC) of the parotid gland is a rare tumor with an indolent behavior; however, a subgroup of this tumor presents an aggressive behavior with a tendency to recur. The aim of this multicenter study was to identify and stratify those patients with AciCC at high risk of tumor recurrence. METHODS A retrospective study was carried out involving 77 patients treated with surgery between January 2000 and September 2022, in different Italian referral centers. Data about tumor characteristics and its recurrence were collected. The histological specimens and slides were independently reviewed by a senior pathologist coordinator (L.C.) and the institution's local head and neck pathologist. RESULTS The patients' age average was 53.6 years, with a female prevalence in the group. The mean follow-up was 67.4 months (1-258, SD 59.39). The five-year overall survival (OS) was 83.2%. The 5-year disease-free survival (DFS) was 60% (95% CI 58.2-61.7). A high incidence of necrosis, extraglandular spread, lymphovascular invasion (LVI), atypical mitosis, and cellular pleomorphism was observed in the high-risk tumors compared to the low-risk ones. CONCLUSION AciCC generally had an indolent behavior, optimal OS, DFS with few cervical node metastases, and rare distant relapses. This multicenter retrospective case series provides evidence of the need for clinical-epidemiological-histological stratification for patients at risk of poor outcomes. Our results suggest that the correct definition of high-risk AciCC should include tumor size, the presence of necrosis, extraglandular spread, LVI, atypical mitosis, and cellular pleomorphism.
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Affiliation(s)
- Pietro De Luca
- Otolaryngology Department, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy; (D.C.); (M.R.)
| | | | - Luca de Campora
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
| | - Egidio De Bonis
- Otolaryngology Unit, San Giovanni di Dio e Ruggi D’Aragona Hospital, 84131 Salerno, Italy; (E.D.B.); (M.I.)
| | - Matteo Fermi
- Department of Otorhinolaryngology—Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.P.)
| | - Gerardo Petruzzi
- Department Otolaryngology Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), 00144 Rome, Italy; (G.P.); (R.P.)
| | - Francesca Atturo
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
| | - Roberta Colangeli
- Otolaryngology Department, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (A.S.); (F.A.S.)
| | - Alfredo Lo Manto
- Otolaryngology Department, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.L.M.); (D.M.)
| | - Andrea Colizza
- Department of Sense Organs, University Sapienza, 00161 Rome, Italy; (A.C.); (M.R.); (M.d.V.)
| | - Giulia Cintoli
- Otolaryngology Unit, University of Foggia, 71122 Foggia, Italy; (G.C.); (L.M.); (M.C.)
| | - Giulia Togo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | - Giovanni Salzano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | - Domenico Crescenzi
- Otolaryngology Department, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy; (D.C.); (M.R.)
| | - Massimo Ralli
- Department of Sense Organs, University Sapienza, 00161 Rome, Italy; (A.C.); (M.R.); (M.d.V.)
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | | | - Luciano Magaldi
- Otolaryngology Unit, University of Foggia, 71122 Foggia, Italy; (G.C.); (L.M.); (M.C.)
| | - Aurelio D’Ecclesia
- Maxillofacial and Otolaryngology Unit, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, 71013 Foggia, Italy; (A.D.); (F.L.)
| | - Gianluca di Massa
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Leopoldo Costarelli
- Department of Pathology, San Giovanni Addolorata-Hospital, 00184 Rome, Italy;
| | - Elisabetta Merenda
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (E.M.); (A.C.)
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (E.M.); (A.C.)
| | - Renato Covello
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Rosa Maria Di Crescenzo
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, 80131 Naples, Italy;
| | - Loren Duda
- Pathology Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Lucia Maria Dimitri
- Department of Pathology, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Alessandro Caputo
- Pathology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, 84131 Salerno, Italy;
| | - Gerardo Ferrara
- Department of Pathology, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | - Teresina Lucante
- Department of Pathology, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy;
| | - Francesco Longo
- Maxillofacial and Otolaryngology Unit, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, 71013 Foggia, Italy; (A.D.); (F.L.)
| | - Domenico Tassone
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
| | - Maurizio Iemma
- Otolaryngology Unit, San Giovanni di Dio e Ruggi D’Aragona Hospital, 84131 Salerno, Italy; (E.D.B.); (M.I.)
| | - Michele Cassano
- Otolaryngology Unit, University of Foggia, 71122 Foggia, Italy; (G.C.); (L.M.); (M.C.)
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (A.S.); (F.A.S.)
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (G.T.); (G.S.); (V.A.); (L.C.)
| | - Daniele Marchioni
- Otolaryngology Department, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.L.M.); (D.M.)
| | - Raul Pellini
- Department Otolaryngology Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), 00144 Rome, Italy; (G.P.); (R.P.)
| | - Marco de Vincentiis
- Department of Sense Organs, University Sapienza, 00161 Rome, Italy; (A.C.); (M.R.); (M.d.V.)
| | - Livio Presutti
- Department of Otorhinolaryngology—Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.P.)
| | - Franco Ionna
- Maxillofacial Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | - Enrico de Campora
- Associazione Ospedaliera Italia Centro-Meridionale Otorinolaringoiatrica (AOICO), 00100 Rome, Italy;
| | - Marco Radici
- Otolaryngology Department, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy; (D.C.); (M.R.)
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, 00100 Rome, Italy (F.A.); (D.T.); (A.C.)
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Tadokoro Y, Takeda D, Saito I, Yatagai N, Kakei Y, Akashi M, Hasegawa T. The Efficacy of Carbon Dioxide Paste in Alleviating Pain in Patients After Neck Dissection: Protocol for a Double-Blinded, Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50500. [PMID: 37955944 PMCID: PMC10682928 DOI: 10.2196/50500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Head and neck cancers that cause severe aesthetic and functional disorders normally metastasize to the cervical lymph nodes. Patients with cervical lymph node metastasis are undergoing neck dissection. Shoulder complaints are common after neck dissection, with patients reporting symptoms such as pain, weakness, shoulder droop, and disability. However, no safe and effective treatment is available for this condition at present. We will conduct a double-blinded, randomized controlled trial to evaluate the efficacy of carbon dioxide (CO2) paste in relieving pain in patients after neck dissection. OBJECTIVE This will be the first clinical study to compare the efficacy of CO2 paste with placebo in relieving postoperative pain in patients who underwent neck dissection. METHODS We will perform this trial at the Kobe University Hospital in Japan. Patients will be randomized 1:1 into the CO2 paste and control groups. Patients in the CO2 paste group will have the CO2 paste applied to the cervical surface skin for 10 minutes once per day for 14 consecutive days. The primary end point of the study is a change in the visual analog scale (VAS) scores of neck pain from baseline on day 1 (preapplication) to the end of drug application (day 15). Secondary end points include changes in the following parameters from baseline on day 1 to the end of drug application (day 15) or the study (day 29): neck pain VAS score (days 1-29), grip strength (days 1-15 and 1-29), VAS scores for subjective symptoms (the feeling of strangulation, numbness, swelling, and warmth in the neck and shoulder region) for days 1-15 and 1-29, whether the VAS score improved more than 30% (days 1-15), the arm abduction test (days 1-15 and 1-29), shoulder range of motion (abduction and flexion) for days 1-15 and 1-29, occurrence of skin disorders, and occurrence of serious side effects. Periodic monitoring will be conducted for participants during the trial. This study was approved by the certified review board of Kobe University. RESULTS The intervention commenced in May 2021 and will continue until March 2024. The collected data will provide information on the efficacy of the CO2 paste treatment. The primary end point will be compared using the Wilcoxon test, with the 1-sided significance level set at 5%. Each evaluation item will be summarized. Secondary efficacy end points will be analyzed to provide additional insights into the primary analysis. Findings based on the treatment effects are expected to be submitted for publication in 2025. CONCLUSIONS This trial will provide exploratory evidence of the efficacy and safety of CO2 paste in relieving pain in patients after neck dissection. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT) identifier: jRCTs051210028; https://jrct.niph.go.jp/en-latest-detail/jRCTs051210028. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50500.
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Affiliation(s)
- Yoshiaki Tadokoro
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nanae Yatagai
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Liu S, Xu W, Liu L, Zhu Y, Wu Y, Lu H, Yang W, Zhang C. Prognostic factors and treatment considerations of submandibular gland carcinomas: A population-based study. Oral Dis 2023; 29:3298-3305. [PMID: 35821655 DOI: 10.1111/odi.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The therapeutic regimen of submandibular gland carcinoma (SGC) has not reached consensus, especially for the neck treatment of patients with cN0. MATERIALS AND METHODS Patients with SGC were identified from the medical database of Shanghai Ninth People's Hospital. Kaplan-Meier analysis, univariate and multivariate Cox regression were employed to evaluate the survival and independent prognostic factors. RESULTS Two hundred and fifteen patients with SGC were retrospectively reviewed. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 71.5% and 77.8%, respectively. Multivariate analysis revealed that histological grade, cT classification, cN classification, and perineural invasion (PNI) were independent prognostic factors for DFS, while histological grade, cT classification, cN classification, and age were those for OS. The neck dissection showed no significant survival benefit for patients with cN0. Lung was the most common site of distant metastasis (16.7%). CONCLUSIONS Histological grade, cT classification, cN classification, age, and PNI were independent prognostic factors of patient with SGC, which should be the main considerations for making therapeutic regimens. Our study also verifies the neck dissection of patient with cN0 is unnecessary, and postoperative radiotherapy (PORT) is vital for patients with pN+.
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Affiliation(s)
- Shengwen Liu
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanlin Xu
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Liu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Zhu
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifan Wu
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Lu
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjun Yang
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenping Zhang
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral and Maxillofacial-Head and Neck Oncology, National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kanemoto H, Obata K, Umemori K, Hasegawa K, Ono S, Ono K, Yutori H, Ibaragi S. Multimodal Prediction of Cervical Lymph Node Metastasis and Recurrence in Oral Squamous Cell Carcinoma. Anticancer Res 2023; 43:4993-5001. [PMID: 37909954 DOI: 10.21873/anticanres.16698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Oral squamous cell carcinoma (OSCC) is the most common malignancy in the head/neck region, and cervical lymph node (CLN) metastasis is a strong poor-prognosis factor. In addition, many patients with OSCC experience recurrence despite multidisciplinary treatment. We sought to identify factors associated with CLN metastasis and recurrence in patients with OSCC. PATIENTS AND METHODS We evaluated a total of 45 patients and 233 target CLNs. The longest diameter of the target CLN, the shortest diameter of the target CLN (LS), the area of the target CLN, and the relative computed tomography (CT) values of the target CLNs calculated based on the CT values of the internal jugular vein (LCT) were obtained from preoperative CT images, and the maximum standardized uptake values of the primary tumor (pSUV) and target CLN (nSUV) were obtained from preoperative 18F-fluorodeoxyglucose-positron emission tomography/CT images. We performed immunohistochemical staining for cytokeratin 13 (CK13) and 17 (CK17) on neck dissection tissues. RESULTS A discrimination equation was used that can predict CLN metastasis with a 92.2% discrimination rate using LS, LCT, pSUV, and nSUV. The CLNs were divided into discrimination and non-discrimination groups based on discriminant equations and CK13 and CK17 were used as the objective variables. A significantly higher recurrence rate was observed in the non-discrimination group (CK13: 5-year recurrence rate 28.6% vs. 64.3%, p<0.01; CK17: 5-year recurrence rate 28.0% vs. 76.0%, p<0.01). CONCLUSION CLN metastases in OSCC can be assessed by combining preoperative imaging. The combined use of CK13 and CK17 expression with imaging findings offers an integrated approach to predict OSCC recurrence.
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Affiliation(s)
- Hideka Kanemoto
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;
| | - Koki Umemori
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuaki Hasegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Sawako Ono
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kisho Ono
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirokazu Yutori
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Baker A, Tassone P, Dooley LM, Galloway TI, Zitsch RP. Postoperative Chyle Leak Rate Following Neck Dissection for Squamous Cell Carcinoma Versus Papillary Thyroid Cancer. Laryngoscope 2023; 133:2959-2964. [PMID: 36825523 DOI: 10.1002/lary.30627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Compare the rates of post-operative chyle leak following therapeutic lateral neck dissection during treatment of papillary thyroid carcinoma (PTC) versus squamous cell carcinoma (SCC) of the head and neck. METHODS A retrospective analysis of 226 consecutive neck dissections in 201 patients who underwent therapeutic neck dissection involving at least levels II-IV with a final pathologic diagnosis of mucosal SCC of the head and neck or PTC from 2010 to 2020. Specific cases of chyle leak were reviewed. Surgical factors associated with chyle leak were analyzed using logistic regression analysis. Duration of chyle leak was assessed by the Kaplan-Meier curve, and time-to-resolution was analyzed by Cox proportional hazard analysis. RESULTS Postoperative chyle leak was encountered in 15 (6.6%) neck dissections, eight (12.3%) in PTC, and seven (4.3%) in SCC. High-volume chyle leak and chyle leak requiring operative intervention were only encountered in neck dissections performed for PTC. Chyle leak was significantly associated with PTC on univariable analysis (OR 3.08, p = 0.037), but not on multivariable analysis (OR 1.35, p = 0.711). High-volume chyle leak and the need for operative intervention were associated only with PTC patients (OR 23.6, p = 0.006; OR 18.09, p = 0.023 respectively). Median duration of chyle leak was 12.1 days among patients with SCC, and 20.5 days among patients with PTC (p = 0.089). CONCLUSIONS Among 201 patients undergoing therapeutic neck dissection, chyle leak was associated with PTC pathology on univariable but not multivariable analysis. However, high-volume leaks and leaks requiring operative intervention only occurred among patients with PTC. LEVEL OF EVIDENCE level III Laryngoscope, 133:2959-2964, 2023.
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Affiliation(s)
- Austin Baker
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Laura M Dooley
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Tabitha I Galloway
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
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Patel AM, Vedula S, Haleem A, Choudhry HS, Tseng CC, Park RCW. Elective Neck Dissection for cT1-4 N0M0 Head and Neck Verrucous Carcinoma. Otolaryngol Head Neck Surg 2023; 169:1187-1199. [PMID: 37278222 DOI: 10.1002/ohn.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in cT1-4 N0M0 head and neck verrucous carcinoma (HNVC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNVC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were utilized. RESULTS Of 1015 patients satisfying inclusion criteria, 223 (22.0%) underwent END. The majority of patients were male (55.4%) and white (91.0%) with disease of the oral cavity (67.6%) classified as low grade (90.0%) and cT1-2 (81.8%). The minority of ENDs (4.0%) detected occult nodal metastases. The rate of END increased from 2006 to 2017 for both cT1-2 (16.3% vs 22.0%, p = .126, R2 = 0.405) and cT3-4 (41.7% vs 70.0%, p = .424, R2 = 0.232) disease but these trends were not statistically significant. Independent predictors of undergoing END included treatment at an academic facility (adjusted odds ratio [aOR]: 1.75, 95% confidence interval [CI]: 1.19-2.55), cT3-4 disease (aOR: 3.31, 95% CI: 2.16-5.07), and tumor diameter (aOR: 1.09, 95% CI: 1.01-1.19) (p < 0.05). The 5-year overall survival (OS) of patients treated with and without END was 71.3% and 70.6%, respectively (p = .661). END did not significantly reduce the 5-year hazard of death (adjusted hazard ratio: 1.25, 95% CI: 0.91-1.71, p = .172). END did not significantly improve 5-year OS in univariate and multivariate analyses stratified by several patient, facility, tumor, and treatment characteristics. CONCLUSION END does not confer an appreciable survival benefit in HNVC, even after stratifying univariate and multivariate analyses by several patient, facility, tumor, and treatment characteristics. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sudeepti Vedula
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Bajwa MS, Jackson R, Dhanda J, Tudur Smith C, Shaw RJ, Schache AG. Determining the Effectiveness of Fibrin Sealants in Reducing Complications in Patients Undergoing Lateral Neck Dissection (DEFeND): A Randomised External Pilot Trial. Cancers (Basel) 2023; 15:5073. [PMID: 37894440 PMCID: PMC10605578 DOI: 10.3390/cancers15205073] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES High-quality randomised controlled trials (RCT) to support the use of Fibrin Sealants (FS) in neck dissection (ND) are lacking. The DEFeND trial assessed critical pilot/feasibility questions and signals from clinical outcomes to inform a future definitive trial. PATIENTS AND METHODS The study design piloted was a blinded surgical RCT. All participants underwent unilateral ND for head and neck cancer. Interventional arm: ND with application of FS. CONTROL ARM ND alone. Feasibility outcomes included recruitment, effectiveness of blinding, protocol adherence and evaluating administrative processes. Clinical outcomes included surgical complications (primary outcome), drainage volume, time to drain removal, length of hospital stay, pain and the Neck Dissection Impairment Index. RESULTS Recruitment completed ahead of time. Fifty-three patients were recruited, and 48 were randomised at a rate of 5.3 patients/month. Blinding of patients, research nurses and outcome assessors was effective. Two protocol deviations occurred. Two patients were lost to follow-up. The mean (SD) Comprehensive Complication Index in the interventional arm was 6.5 (12.8), and it was 9.9 (14.2) in the control arm. The median (IQR) time to drain removal (days) was shorter in the interventional arm (2.67 (2.42, 3.58) vs. 3.40 (2.50, 4.27)). However, this did not translate to a clinically significant reduction in median (IQR) length of hospital stay in days (intervention: 3.48 (2.64, 4.54), control: 3.74 (3.11, 4.62)). CONCLUSION The proposed trial design was effective, and a definitive surgical trial is feasible. Whilst there was a tendency for FS to improve clinical outcomes, the effect size did not reach clinical or statistical significance. (ISRCTN99181100).
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Affiliation(s)
- Mandeep S. Bajwa
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool L69 3BX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
| | - Richard Jackson
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool L69 3BX, UK
| | - Jagtar Dhanda
- Head & Neck Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK
| | - Catrin Tudur Smith
- Institute of Population Health, The University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool L69 3GF, UK
| | - Richard J. Shaw
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
| | - Andrew G. Schache
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
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Kaufman-Goldberg T, Flynn JP, Banks CA, Varvares MA, Hadlock TA. Lower Facial Nerve Nomenclature Clarification: Cervical Branch Controls Smile-Associated Lower Lip Depression and Dental Display. Otolaryngol Head Neck Surg 2023; 169:837-842. [PMID: 37021911 DOI: 10.1002/ohn.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE In head and neck ablative surgery, traditional teaching is that the key facial nerve branch to preserve along the plane of the lower border of the mandible is the marginal mandibular branch (MMb), which is considered to control all lower lip musculature. The depressor labii inferioris (DLI) is the muscle responsible for pleasing lower lip displacement and lower dental display during natural emotive smiling. STUDY DESIGN To understand the structure/function relationships of the distal lower facial nerve branches and lower lip musculature. SETTING In vivo extensive facial nerve dissections under general anesthesia. METHODS Intraoperative mapping was performed in 60 cases, using branch stimulation and simultaneous movement videography. RESULTS In nearly all cases, the MMb innervated the depressor anguli oris, lower orbicularis oris, and mentalis muscles. The nerve branches controlling DLI function were identified 2 ± 0.5 cm below the angle of the mandible, originating from a cervical branch, separately and inferior to MMb. In half of the cases, we identified at least 2 independent branches activating the DLI, both within the cervical region. CONCLUSION An appreciation of this anatomical finding may help prevent lower lip weakness following neck surgery. Avoiding the functional and cosmetic consequences that accompany loss of DLI function would have a significant impact on the burden of potentially preventable sequelae that the head and neck surgical patient frequently carries.
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Affiliation(s)
- Tal Kaufman-Goldberg
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Caroline A Banks
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Pinto JV, Sousa MM, Silveira H, Vales F, Moura CP. Comparison of Clinical and Pathological Staging in Patients with Head and Neck Cancer After Neck Dissection. Int Arch Otorhinolaryngol 2023; 27:e571-e578. [PMID: 37876699 PMCID: PMC10593535 DOI: 10.1055/s-0042-1758208] [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: 11/14/2021] [Accepted: 06/30/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. Objective The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Methods Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. Results A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging ( p = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality ( p = 0.016), clinical T staging ( p = 0.049), and histology ( p = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age ( p = 0.013), clinical N staging ( p < 0.001), and presence of extranodal invasion ( p < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Conclusion Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.
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Affiliation(s)
- João Viana Pinto
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto University, Portugal
| | - Mafalda Martins Sousa
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - Helena Silveira
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - Fernando Vales
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - Carla Pinto Moura
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Department of Medical Genetics, Centro Hospitalar Universitário S. João, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
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Ozawa T, Oze I, Matsuzuka T, Sasaki E, Yokoyama J, Sano Y, Tomifuji M, Araki K, Kogashiwa Y, Tateya I, Agena S, Sakashita T, Tsuzuki H, Terada H, Suzuki H, Nishikawa D, Beppu S, Matoba T, Mukoyama N, Oguri K, Hasegawa Y. Indications for sentinel lymph node biopsy in node-negative oral cancers. Head Neck 2023; 45:2533-2543. [PMID: 37552157 DOI: 10.1002/hed.27477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/24/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND We aimed to define the indications for sentinel lymph node biopsy (SLNB), the third option for cervical treatment in oral cancer with negative cervical lymph nodes. METHODS The greatest depth of invasion (DOI) and long diameter (LD) of the primary site were used as exposures. SLN metastasis was considered the outcome. RESULTS In three trials conducted between 2009 and 2016, 158 patients were eligible and reassigned to this study group. The scatterplot based on the respective values of DOI and LD would eventually be divided into three sections. In cases of sections T1, T2, and T3, the proportions of SLN metastasis positivity were 21.3%, 35.3%, and 51.2%, respectively. In certain cases of T1 with 2 mm < DOI ≤ 5 mm and 8 mm < LD ≤ 20 mm, the proportion of SLN metastasis positivity was 40.9%. CONCLUSIONS SLNB-navigated or assisted neck dissection can be added as an effective procedure for N0 neck control.
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Affiliation(s)
- Taijiro Ozawa
- Department of Otolaryngology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Takashi Matsuzuka
- Department of Head and Neck Surgery - Otolaryngology, Asahi University Hospital, Gifu, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology - Head and Neck Surgery, Nadogaya Hospital, Kashiwa, Japan
| | - Yoshie Sano
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical Collage, Tokorozawa, Japan
| | - Koji Araki
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical Collage, Tokorozawa, Japan
| | - Yasunao Kogashiwa
- Department of Otorhinolaryngology, Head and Neck Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Ichiro Tateya
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinya Agena
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomohiro Sakashita
- Department of Otorhinolaryngology / Head and Neck Surgery, Kushiro City General Hospital, Kushiro, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Okazaki City Hospital, Okazaki, Japan
| | - Hoshino Terada
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shintarou Beppu
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuma Matoba
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Oguri
- Department of Otorhinolaryngology, Konan Kosei Hospital, Konan, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery - Otolaryngology, Asahi University Hospital, Gifu, Japan
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Depboylu B, Eryilmaz A, Basak HS, Kirbac V, Basal Y, Omurlu IK, Gok M. Comparison of Arterial Stiffness and Strain Measured with Speckle Tracking Carotid Strain Ultrasonography after Radiation and Surgical Treatment for Head and Neck Cancer-A Clinical Trial. Diagnostics (Basel) 2023; 13:3090. [PMID: 37835836 PMCID: PMC10572110 DOI: 10.3390/diagnostics13193090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
This study assessed arterial stiffness in head and neck cancer patients using speckle tracking carotid strain ultrasonography (STCS-US). It investigated the impacts of neck irradiation and neck dissection on the arterial stiffness of these patients by comparing their stiffness parameters with those of healthy controls. A total of 101 participants (67 patients and 34 healthy controls) were enrolled in this study. Fifty-two patients received definitive radiation therapy (TD: 60-72 Gy in 30 days) at least two years ago. Participants were grouped into four according to their states of neck irradiation (IR) and neck dissection (ND): Group (IR+/ND-) had 28 patients, Group (IR+/ND+) had 24 patients, Group (IR-/ND+) had 15 patients, and Group (IR-/ND-) had 34 healthy controls. All the participants underwent STCS-US. Arterial stiffness parameters relating to arterial compliance (AC) and elastic modulus (EM) were significantly changed in Group (IR+/ND-) and Group (IR+/ND+) in the transverse plane (p < 0.001, p < 0.001) and in the longitudinal plane (p < 0.001, p < 0.001); the change in β-stiffness index (β-SI) was more significant in the transverse plane (p = 0.002). Group (IR+/ND+) had significant transverse circumferential (p = 0.001) and radial strain parameters (p = 0.001). The carotid intimal medial thickness (CIMT) significantly changed in Group (IR+/ND+) compared to controls (p = 0.001). Our findings indicate that neck irradiation and neck dissection increase arterial stiffness as single treatments; however, double treatment is associated with a higher increase. Neck irradiation affects strain parameters more than neck dissection alone. The study demonstrated the feasibility and clinical value of the STCS method in assessing arterial stiffness and its potential use in cardiovascular risk assessment for patients with head and neck cancer.
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Affiliation(s)
- Bengu Depboylu
- Department of Radiation Oncology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye;
| | - Aylin Eryilmaz
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Hatice Sema Basak
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Veli Kirbac
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Yesim Basal
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Imran Kurt Omurlu
- Department of Biostatistics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye;
| | - Mustafa Gok
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye
- Department of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
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Inan CH, Yanasma HO, Aslier M, Saraydaroglu O, Sahin I, Basut O, Kasapoglu F, Ozmen AO, Demir UL, Coskun H. Role of the neck dissection in early-stage lower lip cancers. Niger J Clin Pract 2023; 26:1303-1308. [PMID: 37794543 DOI: 10.4103/njcp.njcp_36_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background In early-stage lip cancer, spread to cervical lymph nodes is extremely rare. Elective neck treatment options include suprahyoid or supraomohyoid neck dissection, sentinel lymph node biopsy, or close follow-up. Aim: In this study, our aim was to investigate the effect of elective surgery on survival in patients operated for early-stage lip cancer. Methods Patients who underwent surgical treatment for lower lip squamous cell carcinoma between 2005 and 2020 were retrospectively analyzed. Age, gender, neck dissection status (yes/no), clinical and pathological T stage of the tumor, grade, and perineural invasion were recorded and 3-year and 5-year overall (OS) and disease-free survival (DFS) rates were estimated. Results Thirty patients were included: 20 patients had pT1 and 10 patients had pT2 tumors. Neck dissection was performed in 13 patients. The 5-year OS rate was 90.9% and 87.8% with and without dissection, respectively. Neck dissection did not appear to affect OS (P = 0.534) in these patients. The 5-year DFS rate was 96.4% in the overall group, while it was 91.7% and 100% in patients who did or did not undergo neck dissection, respectively (P = 0.756). Discussion Patients with or without neck dissection did not differ significantly in terms of OS and DFS. Watchful waiting with regular ultrasound imaging of the neck in patients with T1 and T2 lip tumors may be an appropriate therapeutic option.
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Affiliation(s)
- C H Inan
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - H O Yanasma
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - M Aslier
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - O Saraydaroglu
- Department of Pathology, Bursa Uludağ University, Bursa, Turkey
| | - I Sahin
- Department of Biostatistics, Bursa Uludağ University, Bursa, Turkey
| | - O Basut
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - F Kasapoglu
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - A O Ozmen
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - U L Demir
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - H Coskun
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
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Zhao Q, Bian X. Two cases of concurrent carcinoma showing thymus-like differentiation (CASTLE) coexisting with papillary thyroid carcinoma. J Surg Case Rep 2023; 2023:rjad527. [PMID: 37771882 PMCID: PMC10532264 DOI: 10.1093/jscr/rjad527] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
Carcinoma showing thymus-like differentiation (CASTLE), which emerges within the thyroid gland or the adjacent soft tissues of the neck, is a rare malignant neoplasm found globally. The occurrence of CASTLE in conjunction with papillary thyroid carcinoma is an even more infrequent phenomenon. The ensuing sections elaborate upon the clinical attributes characteristic of CASTLE.
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Affiliation(s)
- Qi Zhao
- Department of Thyroid Surgery, China–Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China
| | - Xuehai Bian
- Department of Thyroid Surgery, China–Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China
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Prasad A, Carey RM, Panara K, Rajasekaran K, Cannady SB, Newman JG, Brant JA, Brody RM. Nodal metastasis in surgically treated laryngeal squamous cell carcinoma. Head Neck 2023; 45:2303-2312. [PMID: 37403903 DOI: 10.1002/hed.27437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Management of the neck in laryngeal squamous cell carcinoma (LSCC) is essential to oncologic control and survival. We aim to describe patterns and rates of clinical/pathologic lymph node disease, elective neck dissection (END), and occult lymph node metastasis (LNM) in patients with surgically-managed LSCC. METHODS Retrospective cohort study of patients in the National Cancer Database (NCDB) diagnosed with LSCC between January 2004 and December 2016 who underwent primary surgery. RESULTS Seven thousand eight hundred and seventy-six patients met inclusion criteria. For cN0 patients, the rates of END and occult LNM both increased with tumor stage and were highest for supraglottic tumors. Predictors of occult LNM included supraglottic site, pathologic T3 and T4 stage, positive margins, and presence of lymphovascular invasion (p < 0.05). CONCLUSIONS The propensity for cervical LNM in surgically-managed LSCC varies based on primary tumor site and stage, and a variety of disease factors increase risk of occult LNM.
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Affiliation(s)
- Aman Prasad
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kush Panara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newman
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sakai A, Nonaka T, Furuya H, Ebisumoto K, Sugimoto R, Maki D, Iijima H, Hanayama K, Okami K. Shoulder function after neck dissection with level IIb preservation: a prospective observational study. Acta Otolaryngol 2023; 143:814-822. [PMID: 37772758 DOI: 10.1080/00016489.2023.2261985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Shoulder syndrome can be reduced by preserving the spinal accessory nerve (SAN). However, it is unclear whether performing level IIb preservation will decrease the risk of SAN injury and shoulder syndrome. AIMS/OBJECTIVES We investigated whether neck dissection with level IIb preservation can reduce shoulder dysfunction and postoperative quality of life (QOL) in head and neck cancer patients. MATERIAL AND METHODS This prospective observational study enrolled patients who underwent neck dissection from 2011 to 2014. Patients were divided into three groups (level IIb preservation group [group 1], IIb dissection group [group 2], and IIb and V dissection group [group 3]). Postoperative shoulder function and QOL were evaluated among the three groups. RESULTS There were a total of 35 neck sides in three groups, with nine neck sides in group 1, 16 neck sides in group 2, and 10 neck sides in group 3. Although the results showed less shoulder dysfunction in group 1 at early postoperative period. The QOL in group 1 was preserved in the early postoperative period. CONCLUSIONS AND SIGNIFICANCE Neck dissection with level IIb preservation may help reduce shoulder syndrome and maintain QOL in the early postoperative period.
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Affiliation(s)
- Akihiro Sakai
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tokai University, Isehara, Japan
| | - Takuma Nonaka
- Department of Rehabilitation Services, Tokai University Hospital, Isehara, Japan
| | - Hiroyuki Furuya
- Basic Clinical Science and Public Health, School of Medicine, Tokai University, Isehara, Japan
| | - Koji Ebisumoto
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tokai University, Isehara, Japan
| | - Ryosuke Sugimoto
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tokai University, Isehara, Japan
| | - Daisuke Maki
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tokai University, Isehara, Japan
| | - Hiroaki Iijima
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tokai University, Isehara, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tokai University, Isehara, Japan
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Lopez J, Reategui ML, Rooper L, Koch W, Fakhry C, Mydlarz W, Tan M, Eisele DW, Mandal R, Vosler P, Gourin CG. Node Count as a Quality Indicator in Surgically Treated Mucosal Head and Neck Squamous Cell Cancer. Laryngoscope 2023; 133:2160-2165. [PMID: 36197005 DOI: 10.1002/lary.30429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION A yield of ≥18 nodes from neck dissection has been shown to be associated with improved locoregional recurrence rates and survival. We sought to determine factors associated with lymph node yields below this threshold. MATERIALS AND METHODS A retrospective review of patients who underwent neck dissection as part of definitive surgical treatment for mucosal head and neck squamous cell carcinoma (SCC) between January 2015 and December 2018 at an academic tertiary referral center was performed. Patients with a history of prior radiation or neck dissection were excluded. RESULTS There were 412 neck dissections performed in 323 patients. Specimens containing <18 nodes decreased from 16.2% in 2015-2016 to 7.4% of neck dissections in 2017-2018. The proportion of neck dissections removing <3 levels decreased from 9.1% of neck dissections in 2015-2016 to 4.0% in 2017-2018. Multivariable regression analysis demonstrated that dissection of ≥3 levels (OR = 0.2 [0.1-0.4]) and neck dissection in 2017-2018 compared to 2015-2016 (OR = 0.4 [0.2-0.8]) were significantly associated with a lower odds of <18 nodes. Stage, site, race, sex, human papillomavirus status, positive nodes, surgeon volume, and pathologist volume were not associated with neck dissection specimens with <18 nodes, after controlling for all other variables. CONCLUSIONS Increased recognition of the importance of node count as a quality indicator, and the extent of neck dissection is associated with increased nodal yield from neck dissection. These data suggest that node count can be used as a quality measure of neck dissection for mucosal SCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2160-2165, 2023.
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Affiliation(s)
- Joseph Lopez
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Maria Laura Reategui
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Wojtech Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Peter Vosler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Civantos F, Helmen ZM, Bradley PJ, Coca-Pelaz A, De Bree R, Guntinas-Lichius O, Kowalski LP, López F, Mäkitie AA, Rinaldo A, Robbins KT, Rodrigo JP, Takes RP, Ferlito A. Lymph Node Metastases from Non-Melanoma Skin Cancer of the Head and Neck. Cancers (Basel) 2023; 15:4201. [PMID: 37686478 PMCID: PMC10486745 DOI: 10.3390/cancers15174201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Non-melanoma skin cancer (NMSC) represents the most common malignancy in the world, comprising exceedingly common lesions such as basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) and rare lesions such as Merkel cell carcinoma. Risk factors are widely recognized and include ultraviolet (UV) light exposure, radiation exposure, immunosuppression, and many others. As a whole, survival and functional outcomes are favorable, but each histopathological subtype of NMSC behaves differently. Treatment regimens for the primary site usually include wide surgical excision and neck dissection in cases of clinically involved metastatic lymph nodes. The elective management of draining nodal basins, however, is a contested topic. Nearly all subtypes, excluding BCC, have a significant risk of lymphatic metastases, and have been studied with regard to sentinel lymph node biopsy (SLNB) and elective neck dissection. To date, no studies have definitively established a true single standard of care, as exists for melanoma, for any of the NMSCs. As a result, the authors have sought to summarize the current literature and identify indications and management options for the management of the cervical lymphatics for each major subtype of NMSC. Further research remains critically necessary in order to develop complete treatment algorithms.
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Affiliation(s)
- Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Zachary M. Helmen
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Patrick J. Bradley
- Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, 07747 Jena, Germany
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo 01509-900, Brazil
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Southern Illinois University Carbondale, Carbondale, IL 62901, USA
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Robert P. Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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Obermeier KT, Wuersching SN, Liokatis P, Smolka W, Poxleitner P, Kleye C, Ehrenfeld M, Kollmuss M, Otto S. Metastases of OSCC Based on Oral Lichen Ruber Planus. Cancers (Basel) 2023; 15:4092. [PMID: 37627120 PMCID: PMC10452896 DOI: 10.3390/cancers15164092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Oral lichen ruber planus (OLP) is a poorly understood chronically inflammatory disease of the oral mucosa. Malignant transformation into oral squamous cell carcinoma (OSCC) is reported in between 1-2% of cases in the literature. After malignant transformation, surgical treatment-meaning tumor resection combined with neck dissection-is recommended. The recommended extent of treatment is controversial in the literature because this kind of OSCC is often a highly differentiated tumor with a lower risk for lymph nodal spreading. This study aims to overview 103 patients treated in our department due to OLP. The primary outcome parameter was the development of metastases in OLP patients compared to a group of OSCC patients without OLP and the comparison of survival in between both groups. Statistical analysis showed a significantly lower risk for patients with OSCC and with OLP for lymph nodal spreading (p = 0.013). Patients with OSCC and without OLP had a 4.76-higher risk for lymph nodal spreading. On the other hand, second metachronous tumor occurred more often in patients with OSCC and OLP. Overall, OSCC based on OLP occurs more often in female patients, is more highly differentiated and comes with a lower risk for metastases but has a higher risk for second metachronous tumors. Therefore, special attention should be paid to patients with OSCC based on OLP when planning adjuvant therapy and clinical follow-up. The indication for postoperative radiation should be made cautiously in this case, and clinical controls should be performed more closely due to the risk of recurrent disease or tumors at different locations.
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Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Goethestrasse 70, 80336 Munich, Germany; (S.N.W.)
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Christin Kleye
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Goethestrasse 70, 80336 Munich, Germany; (S.N.W.)
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
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Dudde F, Giersdorf I, Barbarewicz F, Henkel KO. Squamous cell carcinoma of the oral cavity - follow up treatment and distant metastatic behavior. Oncoscience 2023; 10:30-31. [PMID: 37583553 PMCID: PMC10424877 DOI: 10.18632/oncoscience.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Florian Dudde
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Ina Giersdorf
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Filip Barbarewicz
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Kai-Olaf Henkel
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
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Farrell E, B Speaker R, O'Driscoll D, Skinner L. A Case Report of Wire-localised Excision of Impalpable Recurrent Papillary Thyroid Carcinoma and Discussion of Wire-guided Excision in the Head and Neck Pathology. Curr Med Imaging 2023; 20:CMIR-EPUB-133463. [PMID: 37553764 DOI: 10.2174/1573405620666230808161931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/14/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION/BACKGROUND Wire localisation techniques are used widely for precision surgery in many specialities. This convenient technique has not yet become mainstream in the field of head and neck surgery. With limited space and many vital structures coursing through the head and neck region, pathological nodes that are difficult to palpate can be a challenge for clinicians. CASE PRESENTATION A patient with a history of papillary thyroid cancer treated with surgery and radioactive iodine had a single pathological node detected on ultrasound surveillance. An isolated recurrence of papillary thyroid carcinoma was confirmed. An excisional biopsy was performed using ultrasound wire guidance to successfully remove the diseased node with minimal morbidity. CONCLUSION Wire-guided lymph node excision biopsy is a safe and effective method that can be applied to multiple pathologies. As of yet, it is not routine practice to employ this technique. Larger studies would increase the generalisability and safety profile of this technique in the head and neck region.
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Affiliation(s)
- Eric Farrell
- Specialist Trainee in ORL HNS, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard B Speaker
- Specialist Trainee in ORL HNS, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Liam Skinner
- Department of Otolaryngology, Head & Neck Surgery, University Hospital Waterford, Ireland
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Gu Y, Liu D, Gao X, Zhou H, Song P, Qian X. Primary Surgical Management of Laryngeal Neuroendocrine Neoplasms: A Single Institution Case Series. Ear Nose Throat J 2023:1455613231183882. [PMID: 37522341 DOI: 10.1177/01455613231183882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Objective: Laryngeal neuroendocrine neoplasms (NENs) are rare diseases. A single institution retrospective study was done of the outcome of patients with laryngeal NENs who undergo primary surgery as the first treatment modality. Methods: Retrospective analysis of medical records of patients with laryngeal NENs between 2009 and 2018. Cases were classified by applying the 2022 World Health organization Classification of Head and Neck Tumors (5th edition). Results: Six patients were eligible at our tertiary center: 1 large cell neuroendocrine carcinoma (NEC), 3 small cell NEC, 1 neuroendocrine tumor grade 1, and 1 neuroendocrine tumor grade 2. All admitted patients received upfront surgeries, including 3 transoral CO2 laser surgeries and 3 total laryngectomies with or without elective neck dissection. Four patients underwent subsequent chemoradiotherapy. Although 3 patients had recurrent disease and distal metastasis, the overall survival was generally improved. Conclusion: According to our institutional experience, upfront surgery in the first-line setting of a multi-modality approach with adjuvant chemoradiotherapy plays a very important role in managing laryngeal NECs, and may confer additional survival benefit in some patients of the large cell carcinoma subgroup.
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Affiliation(s)
- Yajun Gu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing, China
| | - Dingding Liu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing, China
| | - Xinyu Gao
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing, China
| | - Han Zhou
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing, China
| | - Panpan Song
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing, China
| | - Xiaoyun Qian
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing, China
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Moratin J, Horn D, Semmelmayer K, Ristow O, Engel M, Hoffmann J, Bleymehl M, Held T, Zittel S, Freudlsperger C. Surgical Treatment of Carcinomas of the Oral Minor Salivary Glands-Oncological Outcome in Dependence of Tumor Entity and Therapeutic Strategies. Cancers (Basel) 2023; 15:3895. [PMID: 37568711 PMCID: PMC10417329 DOI: 10.3390/cancers15153895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this study was to analyze the clinical outcomes of three types of minor salivary gland carcinomas (adenoid-cystic carcinomas (ACC), adeno carcinomas not otherwise specified (AC-NOS), and mucoepidermoid carcinomas (MEC)) after primary surgical therapy. A retrospective cohort study was designed and patients with cancer of the minor oral salivary glands treated in our department in the years 2011 to 2022 were included. Clinicopathological data were evaluated to compare overall survival and progression-free survival between the entities. Eighty-one patients were included. The rates of cervical metastases were 38.9% for ACC, 25% for MEC, and 9.1% for AC-NOS. ACC exhibited significantly higher rates of local and systemic disease recurrence (p = 0.02), and the presence of neck node metastases was confirmed as an independent prognostic factor for progression-free survival (p = 0.014). Treatment success in terms of oncological outcome varied significantly between the different entities and implies different treatment regimens for each tumor entity.
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Affiliation(s)
- Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Dominik Horn
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Medical Center, Kirrberger Straße, D-66424 Homburg, Germany;
| | - Karl Semmelmayer
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Michael Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Moritz Bleymehl
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Thomas Held
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany;
- National Center for Tumor Diseases, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Sven Zittel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
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Nakamura H, Ogawa T, Yamanaka S, Inukai D, Maruo T, Takahara T, Satou A, Tsuzuki T, Suzuki S, Ueda R, Fujimoto Y. Immune Status of Cervical Lymph Nodes in Head and Neck Cancer-A Surgical Oncology Perspective. J Pers Med 2023; 13:1174. [PMID: 37511787 PMCID: PMC10381643 DOI: 10.3390/jpm13071174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Neck dissection for cervical lymph node metastasis is an established procedure for head and neck cancer (HNC). However, with the advent of immunotherapy, head and neck surgical oncologists need to rethink removing all lymph nodes, including those with immune function. We investigated the anti-cancer immune response of the cervical lymph nodes in four patients with human papillomavirus type 16 (HPV16)-positive head and neck squamous cell carcinoma. Using lymphocytes extracted from local, metastatic, and non-metastatic lymph nodes and peripheral blood from these patients, we performed an intracellular flow cytometric cytokine assay using anti-IFNγ and anti-TNF-α monoclonal antibodies to detect HPV16 E6- and E7-specific T cells. HPV status and p16 immunostaining were determined by in situ detection using the HPV RNAscope method and immunohistochemistry. In one case, E6-specific and E7-specific CD8+ T cells were detected in proximal metastatic nodes and distal non-metastatic nodes. This finding suggests that non-metastatic nodes should be preserved for their immune function during neck dissection and that the immune function of non-metastatic lymph nodes is important when administering immunotherapy. In this context, head and neck surgical oncologists treating HNC should consider the place of immunotherapy and neck dissection in the treatment of HNC.
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Affiliation(s)
- Hiromu Nakamura
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Tetsuya Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Shunpei Yamanaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Daisuke Inukai
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Susumu Suzuki
- Research Creation Support Center, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
| | - Ryuzo Ueda
- Division of Medical Sciences, Department of Physiological Science, Nagoya University Graduate School of Medicine, Furo-cho, Chikusa-ku, Nagoya-shi 464-8601, Aichi, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
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Boro H, Sharma H, Mittal D, Pareek M, Chugh S, Jakhar MS, Nagar N, Bhatia L, Saini S, Joshi V, Vaid S, Mannar V, Nagendra L, Dalvi M, Bundela V. Parathyroid Carcinoma Presenting as Recurrent Primary Hyperparathyroidism and Neck Mass: A Case Report. touchREV Endocrinol 2023; 19:80-85. [PMID: 38046185 PMCID: PMC10688562 DOI: 10.17925/ee.2023.19.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 12/05/2023]
Abstract
Parathyroid carcinoma is a rare endocrine neoplasm that accounts for <1% of cases of primary hyperparathyroidism. The management of parathyroid carcinoma is a challenge due to the high rate of local recurrence of the tumour. We report the case of a middle-aged north Indian woman who presented with recurrent primary hyperparathyroidism due to parathyroid carcinoma. She presented with a recurrent palpable hard neck mass and underwent radical dissection of the neck six times. At the time of writing this report, she was referred for external beam radiotherapy to the neck. Parathyroid carcinoma is a rare malignancy with an indolent but tenacious course. Complete resection at the time of initial surgery determines the prognosis of the neoplasm. Chemotherapy and radiotherapy are usually ineffective. Hypercalcaemia needs to be aggressively managed. A multidisciplinary team is required to effectively manage parathyroid carcinoma.
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Affiliation(s)
- Hiya Boro
- Department of Endocrinology and Metabolism, Aadhar Health Institute, Hisar, Haryana, India
| | - Harish Sharma
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Deepak Mittal
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Mohit Pareek
- Department of Otorhinolaryngology, Aadhar Health Institute, Hisar, Haryana, India
| | - Shilpa Chugh
- Department of Pathology, Aadhar Health Institute, Hisar, Haryana, India
| | - Mohar Singh Jakhar
- Department of Anaesthesiology and Critical Care, Aadhar Health Institute, Hisar, Haryana, India
| | - Neeraj Nagar
- Department of Anaesthesiology and Critical Care, Aadhar Health Institute, Hisar, Haryana, India
| | - Lovekesh Bhatia
- Department of Radiodiagnosis, Aadhar Health Institute, Hisar, Haryana, India
| | - Sanjay Saini
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Vashishth Joshi
- Department of Surgery, Aadhar Health Institute, Hisar, Haryana, India
| | - Sahil Vaid
- Department of Anaesthesiology and Critical Care, Aadhar Health Institute, Hisar, Haryana, India
| | - Velmurugan Mannar
- Department of Endocrinology, Aster Clinic, Dubai, United Arab Emirates
| | - Lakshmi Nagendra
- Department of Endocrinology, Jagadguru Sri Shivarathreeshwara Medical College, Mysuru, India
| | - Mazhar Dalvi
- Department of Endocrinology, Al Noor Mediclinic, Abu Dhabi, United Arab Emirates
| | - Vikash Bundela
- Department of Gastroenterology, Aadhar Health Institute, Hisar, Haryana, India
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50
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Khan A, Reddy VS, Gangadhara B, Mayur M, Barad A, Munisiddaiah D, Ramakrishnan A, Sadhoo A, Nayak SP. Robotic infraclavicular approach for minimally invasive neck dissection in head-neck cancers. J Minim Access Surg 2023; 19:395-401. [PMID: 36861532 PMCID: PMC10449050 DOI: 10.4103/jmas.jmas_223_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/21/2022] [Indexed: 02/16/2023] Open
Abstract
Background In the recent years, there has been a rapid increase in the use of robot assisted neck dissection (RAND) as an alternative method for conventional neck dissection. Several recent reports have emphasized upon the feasibility and effectiveness of this technique. However, substantial technical and technological innovation is still essential in spite of the availability of multiple approaches for RAND. Materials and Methods The present study describes a novel technique, i.e., Robotic Infraclavicular Approach for Minimally Invasive Neck Dissection (RIA MIND) used in head and neck cancers with the help of Intuitive da Vinci Xi Surgical System. Results After RIA MIND procedure, the patient was discharged on the third post operative day. Also, the total wound size was less than 3.5 cm which enhanced the patient recovery time and required minimal post operative care. The patient was further reviewed 10 days after the procedure for the removal of sutures. Conclusion RIA MIND technique was effective and safe for performing neck dissection for oral, head and neck cancers. However, additional detailed studies will be required for establishing this technique.
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Affiliation(s)
- Ameenuddin Khan
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - V. Sreekanth Reddy
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Bharath Gangadhara
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - M. Mayur
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Arunkumar Barad
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | | | - Athira Ramakrishnan
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Abhilasha Sadhoo
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Sandeep P. Nayak
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
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