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Gompel JJV, Janus JR, Hughes JD, Stokken JK, Moore EJ, Ryan T, Price DL, Link MJ. Esthesioneuroblastoma and Olfactory Preservation: Is it Reasonable to Attempt Smell Preservation? J Neurol Surg B Skull Base 2017; 79:184-188. [PMID: 29868325 DOI: 10.1055/s-0037-1606307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022] Open
Abstract
Objective Olfactory preservation after resection of esthesioneuroblastoma (ENB) has been reported, however, the ability to predict tumor involvement of the olfactory system is critical to this surgical strategy. This study aims to answer the question: Can a surgeon predict, based on preoperative imaging, whether there is unilateral involvement of the olfactory system allowing for safe attempt of olfactory preservation? Methods This is a retrospective review of post-resection ENB meeting inclusion criteria of having bilateral olfactory tracts and bulbs submitted at the time of primary resection for pathologic margins. Five board-certified skull base surgeons blinded to the pathology individually reviewed the preoperative MRI scans to predict degree of tumor involvement. Results Olfactory bulb involvement occurred in both bulbs in 35% of cases and unilateral in 39% of cases, and there was no involvement in 26% of cases sampled. When comparing physician prediction of involved tracts or bulbs, involvement was appropriate or over-called (i.e., called positive when pathology was in fact negative) in 96% of cases. Conclusion This study demonstrates unilateral or no pathologic olfactory involvement of the olfactory system in 65% of cases. Our ability to predict this involvement, which may allow for a management strategy that attempts to preserve olfactory function, was accurate at 96%. Therefore, interpretation of imaging and proceeding with smell preservation in ENB appears reasonable in this cohort. LEVEL OF EVIDENCE Level 2b.
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Affiliation(s)
- Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Joshua D Hughes
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Janalee K Stokken
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Tarek Ryan
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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102
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Marinelli JP, Van Gompel JJ, Link MJ, Moore EJ, Price DL, Lees KA, Kaczor MW, Janus JR. Volumetric analysis of olfactory neuroblastoma skull base laterality and implications on neck disease. Laryngoscope 2017; 128:864-870. [PMID: 28833165 DOI: 10.1002/lary.26843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/15/2017] [Accepted: 07/17/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if the laterality of primary tumors in patients with olfactory neuroblastoma (ONB) influenced the pattern and development of neck disease. METHODS Using a retrospective cohort study design from 1994 to 2015, the primary tumors of patients who either presented with or developed neck disease were volumetrically analyzed using iPlan software (version 3.0.0, BrainLAB, Feldkirchen, Germany) by two independent observers. Agreement of volume-derived sidedness was assessed with a kappa statistic, whereas agreement in volume-derived degree of tumor laterality was evaluated with an intraclass correlation coefficient. A one-sample t test was used to assess the difference in dominant percentage between the two observers. RESULTS Sixty-one patients with histological diagnosis and treatment of ONB at our institution were identified. Twenty-four patients exhibited neck involvement, 13 of whom could be volumetrically analyzed. Tumors that were greater than 75% eccentric to one side all exhibited contralateral disease, whereas the majority of unilateral neck disease was associated with relatively midline masses. Within the entire cohort, ipsilateral level 2 lymph nodes displayed the highest involvement (83%, 20 of 24), followed by ipsilateral level 1 (54%, 13 of 24), contralateral level 2 (46%, 11 of 24), contralateral level 1 (21%, 5 of 24), and ipsilateral level 3 (21%, 5 of 24). CONCLUSION Ipsilateral neck involvement frequently was observed; however, the degree of ONB primary site laterality did not appear to have implications on the development of contralateral neck disease. Therefore, when considering elective therapy to the neck, ONB laterality should not be used to justify unilateral neck treatment. LEVEL OF EVIDENCE 4. Laryngoscope, 128:864-870, 2018.
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Affiliation(s)
| | - Jamie J Van Gompel
- Department of Neurosurgery, Rochester, Minnesota, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mark W Kaczor
- Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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103
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Sreenilayam G, Moore EJ, Steck V, Fasan R. Metal Substitution Modulates the Reactivity and Extends the Reaction Scope of Myoglobin Carbene Transfer Catalysts. Adv Synth Catal 2017; 359:2076-2089. [PMID: 29606929 DOI: 10.1002/adsc.201700202] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Engineered myoglobins have recently emerged as promising scaffolds for catalyzing carbene-mediated transformations. In this work, we investigated the effect of altering the metal center and its first-sphere coordination environment on the carbene transfer reactivity of myoglobin. To this end, we first established an efficient protocol for the recombinant expression of myoglobin variants incorporating metalloporphyrins with non-native metals, including second- and third-row transition metals (ruthenium, rhodium, iridium). Characterization of the cofactor-substituted myoglobin variants across three different carbene transfer reactions (cyclopropanation, N-H insertion, S-H insertion) revealed a major influence of the nature of metal center, its oxidation state and first-sphere coordination environment on the catalytic activity, stereoselectivity, and/or oxygen tolerance of these artificial metalloenzymes. In addition, myoglobin variants incorporating manganese- or cobalt-porphyrins were found capable of catalyzing an intermolecular carbene C-H insertion reaction involving phthalan and ethyl α-diazoacetate, a reaction not supported by iron-based myoglobins and previously accessed only using iridium-based (bio)catalysts. These studies demonstrate how modification of the metalloporphyrin cofactor environment provides a viable and promising strategy to enhance the catalytic properties and extend the reaction scope of myoglobin-based carbene transfer catalysts.
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Affiliation(s)
| | - Eric J Moore
- Department of Chemistry, University of Rochester, Rochester, New York 14627, USA
| | - Viktoria Steck
- Department of Chemistry, University of Rochester, Rochester, New York 14627, USA
| | - Rudi Fasan
- Department of Chemistry, University of Rochester, Rochester, New York 14627, USA
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104
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Sims JR, Van Abel K, Martin EJ, Lohse CM, Price DL, Olsen KD, Moore EJ. Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2017; 157:69-76. [DOI: 10.1177/0194599817696304] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery–based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days–6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery–based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.
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Affiliation(s)
- John R. Sims
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eliot J. Martin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L. Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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105
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Carlstrom LP, Van Abel KM, Carlson ML, Moore EJ, Stokken JK. Occult infratemporal fossa neurofibroma presenting with persistent unilateral tinnitus and middle ear effusion: More than meets the eye. Am J Otolaryngol 2017; 38:251-253. [PMID: 27913068 DOI: 10.1016/j.amjoto.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/30/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022]
Abstract
Herein, we present the case of a previously healthy 54year-old female who developed several weeks of unilateral tinnitus and aural fullness. She subsequently underwent unilateral pressure equalization tube placement at an outside institution after exam demonstrated a middle ear effusion, conductive hearing loss and normal nasopharyngoscopy. Ultimately, an MRI revealed an occult mass in the infratemporal fossa (ITF), which was successfully removed via an endoscopic transnasal ITF approach. Following resection of a histopathologically confirmed benign neurofibroma, she reported complete resolution of her symptoms. The antiquated diagnostic algorithm of unilateral effusion suggests that normal nasopharyngscopy successfully "rules out" a causative neoplastic process; however, Eustachian tube occlusion by occult skull base lesions may be missed without further investigation. This case highlights the need for additional radiological investigation of unexplained unilateral persistent middle ear effusion in the setting of normal nasopharyngoscopy.
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Affiliation(s)
| | | | | | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
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106
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Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL. Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques. Otolaryngol Head Neck Surg 2017; 156:906-911. [DOI: 10.1177/0194599817691955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages. Results Sixteen patients (48%) underwent a single-stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1-3 days). Seventeen patients (52%) underwent a double-staged approach with a median time to decannulation of 35 days (range, 13-100 days). Twenty-four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0-3 days), with a median hospital stay of 4 days (range, 2-7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow-up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%). Conclusions Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long-term follow-up. Patients should be counseled about the potential for worsening voice quality with the open approach.
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Affiliation(s)
- Deanna C. Menapace
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Mara C. Modest
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Dale C. Ekbom
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric S. Edell
- Department of Pulmonology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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107
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Zenga J, Haughey BH, Jackson RS, Adkins DR, Aranake-Chrisinger J, Bhatt N, Gay HA, Kallogjeri D, Martin EJ, Moore EJ, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease. Laryngoscope 2016; 127:2033-2037. [PMID: 28008626 DOI: 10.1002/lary.26455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
- Head and Neck Surgery Center of Florida; Celebration Hospital, Celebration; Florida U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Douglas R. Adkins
- Department of Medical Oncology; Washington University; St. Louis Missouri U.S.A
| | | | - Neel Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
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108
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Pryor SG, Moore EJ, Maragos NE, Boahene KDO. Mucosal Flap Approximation in Microlaryngeal Surgery: Fibrin Glue As a Viable Alternative. Otolaryngol Head Neck Surg 2016. [DOI: 10.1016/j.otohns.2004.06.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Eric J Moore
- Rochester MN; Rochester MN; Rochester MN; Rochester MN
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109
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Carlson ML, Osetinsky LM, Alon EE, Inwards CY, Lane JI, Moore EJ. Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base: Review of 11 cases. Laryngoscope 2016; 127:2340-2346. [PMID: 27888510 DOI: 10.1002/lary.26435] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. STUDY DESIGN Retrospective case series with histopathologic review. METHODS A retrospective chart review was performed identifying and collecting data from all cases of TGCT involving the TMJ and adjacent temporal bone that were treated at the authors' center between January 1960 and December 2015. RESULTS Eleven histopathologically confirmed cases met inclusion criteria. The median age at diagnosis was 49 years, eight patients were men, and the median follow-up was 116 months. Computed tomographic (CT) imaging revealed a lytic expansile mass centered on the TMJ. Magnetic resonance imaging (MRI) most commonly exhibited hypointense signal on precontrast T1- and T2-weighted sequences and variable postcontrast enhancement. The median delay in diagnosis was 24 months, and the most common presenting symptoms were hearing loss and pain. All patients underwent surgical resection, eight receiving gross total removal, one receiving near total removal, and two patients from early in the series receiving subtotal resection with neoadjuvant or adjuvant radiation. Histopathological review of surgical specimens revealed chondroid metaplasia in seven tumors. Eight of nine cases receiving gross total or near total resection have no evidence of recurrence to date. CONCLUSIONS TGCT of the TMJ and temporal bone are rare and locally aggressive tumors that commonly present with nonspecific symptoms. A careful review of CT and MRI followed by early biopsy is critical in establishing an accurate diagnosis and facilitating appropriate treatment. TGCT of the TMJ more commonly contain chondroid metaplasia when compared to TGCT at other anatomic locations. Gross total resection is achievable in most cases and offers long-term cure. Radiation may be considered for recurrent disease or adjuvant therapy following subtotal resection. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2340-2346, 2017.
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Affiliation(s)
- Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - L Mariel Osetinsky
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Eran E Alon
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center at Tel Hashomer, Tel Aviv, Israel
| | - Carrie Y Inwards
- Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - John I Lane
- Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
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110
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Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
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Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
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111
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Modest MC, Moore EJ, Abel KMV, Janus JR, Sims JR, Price DL, Olsen KD. Scapular flap for maxillectomy defect reconstruction and preliminary results using three-dimensional modeling. Laryngoscope 2016; 127:E8-E14. [DOI: 10.1002/lary.26351] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mara C. Modest
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Kathryn M. Van Abel
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Jeffrey R. Janus
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - John R. Sims
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel L. Price
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Kerry D. Olsen
- Department of Otorhinolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
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Zenga J, Jackson RS, Graboyes EM, Sinha P, Lindberg M, Martin EJ, Ma D, Thorstad WL, Rich JT, Moore EJ, Haughey BH. Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope 2016; 127:623-630. [DOI: 10.1002/lary.26272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Miranda Lindberg
- Washington University School of Medicine; Saint Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel Ma
- Department of Radiation Oncology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; Saint Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Bruce H. Haughey
- Head and Neck Surgery Center of Florida; Celebration Hospital; Celebration Florida U.S.A
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
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Cockerill CC, Gross BC, Contag S, Rein S, Moore EJ, Olsen KD, Orvidas LJ. Pediatric malignant salivary gland tumors: 60 year follow up. Int J Pediatr Otorhinolaryngol 2016; 88:1-6. [PMID: 27497376 DOI: 10.1016/j.ijporl.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the presentation, treatments and outcomes in pediatric patients with salivary gland malignancies. STUDY DESIGN Retrospective chart review (1950-2012), Prospective phone interview. METHODS Patients ≤18 years old with a salivary gland malignancy treated at our institution were identified. Patients were also contacted by phone for a follow up survey. RESULTS Fifty-six patients were identified. Tumor origin was 88% parotid (n = 49), 5% (n = 3) submandibular and 7% (n = 4) minor salivary glands. Time from onset of symptoms to diagnosis was over one year (mean = 14.4 years). Fifteen out of 52 patients with major gland malignancy had a locoregional recurrence and local recurrences were almost all after initial enucleation. Two of these patients died of disease (overall disease specific survival = 96%). Three out of 4 patients with minor gland malignancy had a local recurrence and two patients with high grade pathology developed metastases and died of their disease (overall survival = 50%). On long term follow up survey in 13 patients (25%), 100% reported normal facial movement and 54% described symptoms of Frey's syndrome, which is higher than other reported series in children. Recurrence was noted up to 45 years after initial treatment. CONCLUSIONS The majority of malignant pediatric salivary gland tumors are low grade and have excellent survival, especially if found at an early stage. Minor salivary gland malignancies, particularly high grade, have a worse prognosis. Long term mild Frey's syndrome can be expected in approximately half of patients. We advocate a need for long term follow up and increased awareness among providers to diagnose these patients earlier.
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Affiliation(s)
- Cara C Cockerill
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
| | - Brian C Gross
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
| | - Stephanie Contag
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
| | - Sarah Rein
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
| | - Eric J Moore
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
| | - Kerry D Olsen
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
| | - Laura J Orvidas
- Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA.
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Arce K, Moore EJ, Lohse CM, Reiland MD, Yetzer JG, Ettinger KS. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Does Not Accurately Predict Risk of 30-Day Complications Among Patients Undergoing Microvascular Head and Neck Reconstruction. J Oral Maxillofac Surg 2016; 74:1850-8. [DOI: 10.1016/j.joms.2016.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/02/2016] [Accepted: 02/22/2016] [Indexed: 12/21/2022]
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Cockerill CC, Orvidas LJ, Moore EJ, Binnicker MJ, Duresko BJ, Espy MJ, Cockerill FR, Tombers NM, Pritt BS. Detection of high-risk human papillomavirus infection in tonsillar specimens using 2 commercially available assays. Diagn Microbiol Infect Dis 2016; 86:365-368. [PMID: 27638349 DOI: 10.1016/j.diagmicrobio.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/30/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 01/24/2023]
Abstract
THE OBJECTIVE OF THE STUDY IS TO DETERMINE THE PREVALENCE OF HIGH-RISK HUMAN PAPILLOMAVIRUS (HRHPV) INFECTION IN TONSILLAR SWABS AND TISSUE: Patients undergoing tonsillectomy for nonmalignant causes were enrolled. A flocked swab and fresh tissue were collected from the left and right tonsil of each patient. Specimens were tested for hrHPV DNA using the Roche cobas test and for the presence of E6/E7 messenger RNA using the Hologic Aptima hrHPV test. Of the 193 patients enrolled, 129 were in the pediatric group (ages 1-12years; median, 5years), and 64 were in the adult group (ages 13-55; median, 22years). All swab and tissue specimens were negative for hrHPV by both methods. Positive, negative, and internal controls performed as expected. We found a 0% rate of infection indicating that detectable hrHPV infection in tonsillar tissue appears to be uncommon in the children and adults in the population sampled.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- DNA, Viral/analysis
- DNA, Viral/genetics
- DNA, Viral/isolation & purification
- Female
- Genotype
- Humans
- Infant
- Male
- Middle Aged
- Palatine Tonsil/virology
- Papillomaviridae/classification
- Papillomaviridae/genetics
- Papillomaviridae/isolation & purification
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/virology
- Prevalence
- RNA, Messenger/analysis
- RNA, Messenger/genetics
- RNA, Messenger/isolation & purification
- RNA, Viral/analysis
- RNA, Viral/genetics
- RNA, Viral/isolation & purification
- Young Adult
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Affiliation(s)
- Cara C Cockerill
- The Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Laura J Orvidas
- The Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Eric J Moore
- The Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Matthew J Binnicker
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Brian J Duresko
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Mark J Espy
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Franklin R Cockerill
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Nicole M Tombers
- The Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Bobbi S Pritt
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Moore EJ, Van Abel KM, Olsen KD. Transoral robotic surgery in the seated position: Rethinking our operative approach. Laryngoscope 2016; 127:122-126. [DOI: 10.1002/lary.26148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/05/2016] [Accepted: 06/01/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Eric J. Moore
- Department of Otolaryngology/Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Kathryn M. Van Abel
- Department of Otolaryngology/Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Kerry D. Olsen
- Department of Otolaryngology/Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
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117
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Pryor SG, Moore EJ, Kasperbauer JL. Implantable Doppler flow system: Experience with 24 microvascular free-flap operations. Otolaryngol Head Neck Surg 2016; 135:714-8. [PMID: 17071300 DOI: 10.1016/j.otohns.2006.05.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Indexed: 10/24/2022]
Abstract
Objective Microvascular reconstruction requires postoperative monitoring to prevent vascular occlusion and flap failure. These methods require skilled personnel and can delay diagnosis and treatment of threatened flap failures. The Cook-Swartz implantable Doppler flow system provides continual feedback on vascular pedicle status, which in turn provides rapid assessment of minute-to-minute changes in flap vasculature that may allow intervention before total vascular occlusion and expeditious reexploration for threatened flap failure, possibly improving flap salvage. Study Design and Setting Charts of 24 patients with microvascular free-flap reconstruction and implantation of Doppler flow system at Mayo Clinic Rochester were retrospectively reviewed. Surgical technique and flap outcomes were evaluated. Results Microvascular reconstruction and implantation of Doppler flow system were successful in all patients. Complications were minimal, and postoperative monitoring system facilitated rapid reexploration when necessary. Flap viability was 96%. Conclusion Doppler flow system is reliable for monitoring minute-to-minute changes in microvascular flap vascular status postoperatively, and allows rapid recognition of complications and facilitating reexploration. This is a valuable, easily mastered tool for microvascular reconstructive surgery. Significance May alter postoperative monitoring techniques of microvascular surgeons.
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Affiliation(s)
- Shepherd G Pryor
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Chintakuntlawar AV, Shon W, Erickson-Johnson M, Bilodeau E, Jenkins SM, Davidson JA, Keeney MG, Rivera M, Price DL, Moore EJ, Olsen KD, Kasperbauer JL, Foote RL, Price KA, García JJ. High-grade transformation of acinic cell carcinoma: an inadequately treated entity? Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:542-549.e1. [DOI: 10.1016/j.oooo.2016.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
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Jackson RS, Price DL, Arce K, Moore EJ. Evaluation of Clinical Outcomes of Osseointegrated Dental Implantation of Fibula Free Flaps for Mandibular Reconstruction. JAMA FACIAL PLAST SU 2016; 18:201-6. [DOI: 10.1001/jamafacial.2015.2271] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ryan S. Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Daniel L. Price
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin Arce
- Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Graffeo CS, Van Abel KM, Morris JM, Carlson ML, Van Gompel JJ, Moore EJ, Price DL, Kasperbauer JL, Janus JR, Olsen KD, Link MJ. Preoperative diagnosis of vagal and sympathetic cervical schwannomas based on radiographic findings. J Neurosurg 2016; 126:690-697. [PMID: 27104848 DOI: 10.3171/2016.1.jns151763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Vagus nerve and sympathetic chain cervical schwannomas (VNCSs and SCCSs) are benign nerve sheath tumors that arise in the head and neck. Despite similar presentations that make accurate preoperative diagnosis more difficult, the potential for morbidity following resection is significantly higher for patients with VNCS. Therefore, the authors analyzed a retrospective case series and performed a comparative analysis of the literature to establish diagnostic criteria to facilitate more accurate preoperative diagnoses. METHODS The authors conducted a blinded review of imaging studies from retrospectively collected, operatively confirmed cases of VNCS and SCCS. They also performed a systematic review of published series that reported patient-specific preoperative imaging findings in VNCS or SCCS. RESULTS Nine patients with VNCS and 11 with SCCS were identified. In the study cohort, splaying of the internal carotid artery (ICA) and internal jugular vein (IJV) did not significantly predict the nerve of origin (p = 0.06); however, medial and lateral ICA displacement were significantly associated with VNCS and SCCS, respectively (p = 0.01 and p = 0.003, respectively). Multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carried an 86% probability of VNCS (p = 0.001), while the absence of splaying with lateral ICA displacement carried a 91% probability of SCCS (p = 0.006). The presence of vocal cord symptoms or peripheral enhancement significantly augmented the predictive probability of VNCS, as did Horner's syndrome or homogeneous enhancement for SCCS. A review of the literature produced 25 publications that incorporated a total of 106 patients, including the present series. Splaying of the ICA and IJV was significantly, but not uniquely, associated with VNCS (p < 0.0001); multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carries a 75% probability of VNCS (p < 0.0001), while the absence of such splaying with lateral ICA displacement carries an 87% probability of SCCS (p = 0.0003). CONCLUSIONS ICA and IJV splaying frequently predicts VNCS; however, this finding is also commonly observed in SCCS and, among the 9 cases in the present study, was observed more often than previously reported. When congruent with splaying, medial or lateral ICA displacement significantly enhances the reliability of preoperative predictions, empowering more accurate prognostication.
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121
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Gross ND, Holsinger FC, Magnuson JS, Duvvuri U, Genden EM, Ghanem TA, Yaremchuk KL, Goldenberg D, Miller MC, Moore EJ, Morris LG, Netterville J, Weinstein GS, Richmon J. Robotics in otolaryngology and head and neck surgery: Recommendations for training and credentialing: A report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee. Head Neck 2016; 38 Suppl 1:E151-8. [PMID: 26950771 DOI: 10.1002/hed.24207] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/09/2015] [Indexed: 01/08/2023] Open
Abstract
Training and credentialing for robotic surgery in otolaryngology - head and neck surgery is currently not standardized, but rather relies heavily on industry guidance. This manuscript represents a comprehensive review of this increasingly important topic and outlines clear recommendations to better standardize the practice. The recommendations provided can be used as a reference by individuals and institutions alike, and are expected to evolve over time. © 2016 Wiley Periodicals, Inc. Head Neck 38: E151-E158.
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Affiliation(s)
- Neil D Gross
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California
| | - J Scott Magnuson
- Department of Otolaryngology - Head and Neck Surgery, Division of Surgery, Florida Hospital Group, Celebration, Florida
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Veterans Administration Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Tamer Ah Ghanem
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Kathleen L Yaremchuk
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
| | - David Goldenberg
- Division of Otolaryngology - Head and Neck Surgery, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Matthew C Miller
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Luc Gt Morris
- Department of Head and Neck Surgery, Division of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - James Netterville
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Ingram Cancer Center, Nashville, Tennessee
| | - Gregory S Weinstein
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Richmon
- Department of Otolaryngology - Head and Neck Surgery, Division of Surgery, Johns Hopkins University, Baltimore, Maryland
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Ettinger KS, Moore EJ, Lohse CM, Reiland MD, Yetzer JG, Arce K. Application of the Surgical Apgar Score to Microvascular Head and Neck Reconstruction. J Oral Maxillofac Surg 2016; 74:1668-77. [PMID: 26997211 DOI: 10.1016/j.joms.2016.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The surgical Apgar score (SAS) is a recently devised risk-stratifying metric that relies on 3 intraoperative parameters to predict postoperative complications in surgical patients. The purpose of this study was to validate the SAS externally in a cohort of patients undergoing microvascular head and neck reconstruction with fibular free flaps. MATERIALS AND METHODS A retrospective cohort study of patients undergoing head and neck microvascular reconstruction with fibular free flaps was completed. The primary predictor variable was the calculated SAS. The primary outcome variable was the presence of medical and surgical complications occurring within 30 days of surgery. Basic demographic information, comorbidity indices, and perioperative parameters were abstracted as covariates. Medical and surgical complications were categorized as minor or major depending on severity level. Univariable and multivariable logistic regression models were used to evaluate associations with 30-day postoperative complications. RESULTS In 154 patients, the partial flap failure rate was 3% and there were no complete flap failures. There were 110 patients (71%) who developed at least 1 30-day postoperative complication and 51 (33%) who developed a major complication. The median SAS was 7. The SAS was not significantly associated with the presence of any 30-day postoperative complication (odds ratio [OR] = 1.02; 95% confidence interval [CI], 0.74-1.42; P = .89) or the presence of any major postoperative complication (OR = 0.08; 95% CI, 0.59-1.09; P = .16) in a univariable setting. The SAS did not achieve statistical significance after multivariable adjustment. CONCLUSION Despite validation in numerous other surgical specialties, the SAS might not be useful as a metric for risk stratification among patients undergoing major head and neck reconstruction with fibular free flaps.
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Affiliation(s)
- Kyle S Ettinger
- Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
| | - Eric J Moore
- Professor of Otolaryngology, Division of Head and Neck Surgery, Department of Otorhinolaryngology, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Christine M Lohse
- Biostatistician, Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN
| | - Matthew D Reiland
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Jacob G Yetzer
- Instructor in Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Kevin Arce
- Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
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Sparrow S, Manning JR, Cartier J, Anblagan D, Bastin ME, Piyasena C, Pataky R, Moore EJ, Semple SI, Wilkinson AG, Evans M, Drake AJ, Boardman JP. Epigenomic profiling of preterm infants reveals DNA methylation differences at sites associated with neural function. Transl Psychiatry 2016; 6:e716. [PMID: 26784970 PMCID: PMC5068883 DOI: 10.1038/tp.2015.210] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 12/13/2022] Open
Abstract
DNA methylation (DNAm) plays a determining role in neural cell fate and provides a molecular link between early-life stress and neuropsychiatric disease. Preterm birth is a profound environmental stressor that is closely associated with alterations in connectivity of neural systems and long-term neuropsychiatric impairment. The aims of this study were to examine the relationship between preterm birth and DNAm, and to investigate factors that contribute to variance in DNAm. DNA was collected from preterm infants (birth<33 weeks gestation) and healthy controls (birth>37 weeks), and a genome-wide analysis of DNAm was performed; diffusion magnetic resonance imaging (dMRI) data were acquired from the preterm group. The major fasciculi were segmented, and fractional anisotropy, mean diffusivity and tract shape were calculated. Principal components (PC) analysis was used to investigate the contribution of MRI features and clinical variables to variance in DNAm. Differential methylation was found within 25 gene bodies and 58 promoters of protein-coding genes in preterm infants compared with controls; 10 of these have neural functions. Differences detected in the array were validated with pyrosequencing. Ninety-five percent of the variance in DNAm in preterm infants was explained by 23 PCs; corticospinal tract shape associated with 6th PC, and gender and early nutritional exposure associated with the 7th PC. Preterm birth is associated with alterations in the methylome at sites that influence neural development and function. Differential methylation analysis has identified several promising candidate genes for understanding the genetic/epigenetic basis of preterm brain injury.
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Affiliation(s)
- S Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - J R Manning
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - J Cartier
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - D Anblagan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - C Piyasena
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - R Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - E J Moore
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - S I Semple
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | | | - M Evans
- Department of Pathology, NHS Lothian, Edinburgh, UK
| | - A J Drake
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - J P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Room W1.26, Edinburgh EH16 4TJ, UK. E-mail:
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Sims JR, Robinson NL, Moore EJ, Janus JR. Transoral robotic medial hypopharyngectomy: Surgical technique. Head Neck 2015; 38 Suppl 1:E2127-9. [DOI: 10.1002/hed.24360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 09/14/2015] [Accepted: 11/04/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- John R. Sims
- Department of Otorhinolaryngology - Head and Neck Surgery; Mayo Clinic; Rochester Minnesota
| | - Nathaniel L. Robinson
- Department of Otorhinolaryngology - Head and Neck Surgery; Mayo Clinic; Rochester Minnesota
| | - Eric J. Moore
- Department of Otorhinolaryngology - Head and Neck Surgery; Mayo Clinic; Rochester Minnesota
| | - Jeffrey R. Janus
- Department of Otorhinolaryngology - Head and Neck Surgery; Mayo Clinic; Rochester Minnesota
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Funk RK, Moore EJ, García JJ, Harmsen WS, Stoddard DG, Vencio EF, Foote RL, Price KA, Ma DJ. Risk factors for locoregional relapse after transoral robotic surgery for human papillomavirus-related oropharyngeal squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E1674-9. [DOI: 10.1002/hed.24298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ryan K. Funk
- Department of Radiation Oncology; Mayo Clinic; Rochester Minnesota
| | - Eric J. Moore
- Department of Otolaryngology; Mayo Clinic; Rochester Minnesota
| | - Joaquín J. García
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - W. Scott Harmsen
- Department of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | | | - Eneida F. Vencio
- Department of Oral Pathology, School of Dentistry; Federal University Goiás; Goiás Brazil
| | - Robert L. Foote
- Department of Radiation Oncology; Mayo Clinic; Rochester Minnesota
| | | | - Daniel J. Ma
- Department of Radiation Oncology; Mayo Clinic; Rochester Minnesota
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Van Abel KM, Tombers NM, Krein KA, Moore EJ, Price DL, Kasperbauer JL, Hinni ML, Lott DG, Ekbom DC. Short-term Quality-of-Life Outcomes following Transoral Diverticulotomy for Zenker’s Diverticulum. Otolaryngol Head Neck Surg 2015; 154:322-7. [DOI: 10.1177/0194599815616078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/16/2015] [Indexed: 11/15/2022]
Abstract
Objective To prospectively analyze quality-of-life outcomes following transoral diverticulotomy with cricopharyngeal myotomy (DCPM) for Zenker’s diverticulum (ZD). Study Design Prospective single-group study. Settings Tertiary academic institution. Subjects and Methods A prospective multicenter study performed from January 1, 2012, to July 1, 2014, included 18 patients presenting with ZD undergoing DCPM. Standardized questionnaires—including the 10-item Eating Assessment Tool (EAT-10), Functional Outcome of Swallowing Scale (FOSS), and the Reflux Symptom Index (RSI)—were completed preoperatively and at 3 and 6 months postoperatively. Videofluoroscopic studies were obtained and analyzed by our senior speech-language pathologist, who was blinded to the clinical outcomes. Results Eighteen patients were included (11 women; mean age, 72.6 years; range, 53-86 years). All patients had ZD on preoperative videofluoroscopic swallowing studies. The most common comorbidities included hypertension (10 of 18, 55.6%), dyslipidemia (8 of 18, 44.4%), hiatal hernia (6 of 18, 33.3%), and gastroesophageal reflux disease (5 of 18, 27.8%). Median preoperative RSI was 27 (interquartile range [IQR], 22.5-31.5); FOSS, 2 (IQR, 2-3); and EAT-10, 21.5 (IQR, 13.5-27.5). The 3-month questionnaire (88.9% completion) demonstrated an improved median RSI of 5 (IQR, 1-7.5; P < .001), FOSS of 0 (IQR, 0; P < .001), and EAT-10 of 0 (IQR, 0-3; P < .001). Fourteen patients (77.8%) completed the 6-month questionnaire, demonstrating a median RSI of 4 (IQR, 0-8), FOSS of 0 (IQR, 0-0.5), and EAT-10 of 1 (IQR, 0-3). While regurgitation decreased following surgery ( P = .007), nighttime cough did not ( P = .25). Conclusion This study supports an improvement in functional outcome and quality of life in patients with ZD undergoing DCPM.
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Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Nicole M. Tombers
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Kari A. Krein
- Department of Speech and Language Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Daniel L. Price
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Michael L. Hinni
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - David G. Lott
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Dale C. Ekbom
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Olson MD, Moore EJ, Price DL. Removal of the split thickness skin graft from the skin paddle of the donor site: A single institution's experience. Am J Otolaryngol 2015; 36:820-2. [PMID: 26545479 DOI: 10.1016/j.amjoto.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/07/2015] [Accepted: 07/18/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Radial forearm free flaps (RFFFs) and fibular osteocutaneous flaps (FOFs) are mainstays of head and neck reconstruction. Removal of the donor tissue often leaves a soft tissue defect requiring a split thickness skin graft (STSG) for coverage. The purpose of this study is to evaluate the potential to reduce the morbidity of removal of the STSG from a second site. MATERIALS AND METHODS We report a series of 9 patients who had the STSG taken from the free flap donor skin paddle as an alternative to removal from the standard distant sight. RESULTS 9/9 (100%) flaps were successfully transferred with no primary or secondary loss of the flap. 8/9 (89%) of STSGs were successfully harvested from the donor skin paddle. Postoperative complications included infection and partial STSG loss (2/9, 22%). CONCLUSIONS This study demonstrates the feasibility and reduced morbidity associated with removal of the STSG from the donor flap skin paddle in addition to the placement of a de-epithelialized free flap in head and neck reconstruction patients. Given this research, which supports the previously published research on this topic, this technique could be considered in an effort to reduce morbidity in patients undergoing head and neck reconstruction using the RFFF and FOF.
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Patel NS, Modest MC, Brobst TD, Carlson ML, Price DL, Moore EJ, Janus JR. Surgical management of lateral skull base defects. Laryngoscope 2015; 126:1911-7. [DOI: 10.1002/lary.25717] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/01/2015] [Accepted: 09/10/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Neil S. Patel
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Mara C. Modest
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Tyler D. Brobst
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Matthew L. Carlson
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel L. Price
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Jeffrey R. Janus
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
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Ma DJ, Price KA, Moore EJ, Garcia JJ, Okuno SH, Price DL, Sloan JA, Foster NR, Foote RL. Abstract CT227: MC1273: Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiation in HPV associated oropharynx cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-ct227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Traditional adjuvant therapy for oropharyngeal squamous cell carcinoma (OPSCC) consists of 60-66 Gy of radiation therapy (XRT) given in 2 Gy daily fractions along with high dose cisplatin if the patient has high risk factors. Despite the excellent cure rates for HPV+ OPSCC, one in three patients treated with conventional treatment will develop grade >3 long-term sequelae from therapy. There is intense interest in de-intensifying adjuvant therapy for this patient population in order to maximize quality of life while maintaining excellent historical rates of disease control.
Methods: MC1273 is a phase II non-randomized trial open at Mayo Clinic Rochester testing a novel course of aggressive therapy de-escalation following surgery for HPV+ OPSCC. The primary endpoint is local/regional control at 2 years while secondary endpoints include toxicity and quality of life (QOL). The eligibility criteria include all patients with p16-positive OPSCC with less than a ten pack-year smoking history who have had a complete surgical resection. Exclusion criteria include positive surgical margins, prior history of malignancy, and history of connective tissue disorders. Patients are divided into two prospective cohorts depending upon risk factors found at surgery. Patients with intermediate risk disease (≥T3, ≥N2, lymphovascular invasion, or perineural invasion) are enrolled in MC1273A while patients with extracapsular extension (ECE) are enrolled in MC1273B. Patients on MC1273A receive 30 Gy of radiation delivered in 1.5 Gy twice-daily fractions over the course of two weeks along with weekly docetaxel (15 mg/m2) given on day 1 and day 8. Patients on MC1273B receive a similar treatment regimen but also have the nodal level with positive ECE concurrently boosted to 36 Gy in 1.8 Gy twice-daily fractions. In addition to standard of care follow-up, patients receive a swallowing assessment with speech therapy immediately before XRT, one month post-XRT, and one year post-XRT. Patients also have QOL assessment consisting of the XeQOLS, Eq-5D, FACT H&N (Vers 4) and Dermatology Life Quality Index assessed at pre-XRT and 3, 12, and 24 months post-XRT.
Results: Each cohort of MC1273 is powered to detect a 10% local/regional failure rate with 85% confidence. Each cohort will accrue 35 evaluable patients and 5 additional patients to account for ineligibilities and violations (40 patients total per cohort.) MC1273A began accrual in September 2013. The first five patients were monitored for grade ≥4 acute toxicities before proceeding to open accrual. MC1273B began accrual in May 2014 and has also proceeded to open accrual. Accrual will also begin in Mayo Clinic Scottsdale in the first quarter of 2015.
Conclusions: MC1273 is meeting its accrual targets and should finish accrual by 2016. We anticipate that preliminary results for toxicity will be available by 2017 and local/regional data will be available by 2018.
Citation Format: Daniel J. Ma, Katharine A. Price, Eric J. Moore, Joaquin J. Garcia, Scott H. Okuno, Daniel L. Price, Jeff A. Sloan, Nathan R. Foster, Robert L. Foote. MC1273: Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiation in HPV associated oropharynx cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT227. doi:10.1158/1538-7445.AM2015-CT227
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Jackson RS, Martin EJ, Moore EJ. Prefabricated auricular cartilage radial forearm free flap reconstruction for cricoid chondrosarcoma. Laryngoscope 2015; 125:2514-7. [DOI: 10.1002/lary.25510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
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Jackson RS, Voss SG, Wilson ZC, Remmes NB, Stalboerger PG, Keeney MG, Moore EJ, Janus JR. An Athymic Rat Model for Mandibular Osteoradionecrosis Allowing for Direct Translation of Regenerative Treatments. Otolaryngol Head Neck Surg 2015; 153:526-31. [DOI: 10.1177/0194599815593278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
Objective We aim to create a model of mandibular osteoradionecrosis in athymic rats. Athymic rats provide an immunosuppressed environment whereby human stem cells and biomaterials can be used to investigate regenerative solutions for osteoradionecrosis, bridging the gap between in vivo testing and clinical application. Study Design Prospective animal study. Setting Academic otolaryngology department laboratory. Subjects and Methods After Institutional Animal Care and Use Committee approval, 10 athymic nude rats were divided into 2 groups. The experimental group (n = 6) underwent irradiation (20 Gy), while the control group (n = 4) underwent sham irradiation catheter placement only. All 10 rats underwent extraction of the second mandibular molar 7 days later. The rats were sacrificed 28 days after dental extraction, and their mandibles were harvested. The mandibles were examined with histologic analysis and bone volume analysis based on 3-dimensional micro–computed tomography. Results All 10 rats survived the experiment period. Radiographic and histologic analysis revealed decreased bone formation in the experimental group compared with the control group. Jaw region volume ratio was 0.83 for the experimental group versus 0.97 in the control group ( P = .003). The region-of-interest volume ratio was 0.75 in the experimental group and 0.97 in the control group ( P = .005). Histologically, there were increased osteoclasts ( P = .02) and decreased osteoblasts ( P = .001) as well as increased fibrosis in the experimental group versus the control group. Conclusion Mandibular osteoradionecrosis can be effectively and reproducibly produced in an athymic rat model. This will allow further research to study regenerative medicine in an athymic rat model.
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Affiliation(s)
- Ryan S. Jackson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen G. Voss
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zachary C. Wilson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas B. Remmes
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael G. Keeney
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Carlson ML, Patel NS, Modest MC, Moore EJ, Janus JR, Olsen KD. Occult Temporal Bone Facial Nerve Involvement by Parotid Malignancies with Perineural Spread. Otolaryngol Head Neck Surg 2015; 153:385-91. [DOI: 10.1177/0194599815591160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/22/2015] [Indexed: 11/17/2022]
Abstract
Objective To characterize disease presentation and outcomes following surgical treatment of parotid malignancies with occult temporal bone facial nerve (FN) involvement. Study Design Case series with chart review. Setting Tertiary academic referral center. Subjects and Methods Thirty consecutive patients (mean age 58 years; 77% men) who underwent surgery for parotid malignancies with occult perineural involvement of the intratemporal FN were included. Primary outcome measures included margin status and recurrence. Results The mean duration of clinical follow-up was 49 months, and the most common presenting symptom was FN paresis (n = 23; 77%) followed by pain (n = 15; 50%). To obtain a proximal FN margin, 27 patients (90%) underwent mastoidectomy, and 3 patients (10%) had lateral temporal bone resection. The intratemporal FN margin was cleared in 26 patients (87%), most commonly in the mastoid segment (60%). Adjuvant therapy was given in 25 patients (83%). Ten patients (33%) experienced locoregional (4; 13%) and/or distant (8; 27%) recurrence at a median of 19 months (mean 26, 2–54 months) following surgery. Locoregional failure was significantly more common in cases with a positive intratemporal FN margin (66% vs 8%; P = .045). Overall 1-, 3-, and 5-year disease-specific survival rates were 83%, 79%, and 72%, respectively. Conclusions Perineural invasion of the intratemporal FN by parotid malignancy is uncommon. Normal preoperative FN function does not preclude histopathologic involvement. Temporal bone FN exploration should be considered when a positive margin is encountered at the stylomastoid foramen, as failure to do so is associated with an increased rate of locoregional recurrence.
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Affiliation(s)
- Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Neil S. Patel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mara C. Modest
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Kerry D. Olsen
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Van Abel KM, Mallory GW, Kasperbauer JL, M D, Moore EJ, Price DL, O'Brien EK, Olsen KD, Krauss WE, Clarke MJ, Jentoft ME, Van Gompel JJ. Transnasal odontoid resection: is there an anatomic explanation for differing swallowing outcomes? Neurosurg Focus 2015; 37:E16. [PMID: 25270135 DOI: 10.3171/2014.7.focus14338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Swallowing dysfunction is common following transoral (TO) odontoidectomy. Preliminary experience with newer endoscopic transnasal (TN) approaches suggests that dysphagia may be reduced with this alternative. However, the reasons for this are unclear. The authors hypothesized that the TN approach results in less disruption of the pharyngeal plexus and anatomical structures associated with swallowing. The authors investigate the histological and gross surgical anatomical relationship between pharyngeal plexus innervation of the upper aerodigestive tract and the surgical approaches used (TN and TO). They also review the TN literature to evaluate swallowing outcomes following this approach. METHODS Seven cadaveric specimens were used for histological (n = 3) and gross anatomical (n = 4) examination of the pharyngeal plexus with the TO and TN surgical approaches. Particular attention was given to identifying the location of cranial nerves (CNs) IX and X and the sympathetic chain and their contributions to the pharyngeal plexus. S100 staining was performed to assess for the presence of neural tissue in proximity to the midline, and fiber density counts were performed within 1 cm of midline. The relationship between the pharyngeal plexus, clivus, and upper cervical spine (C1-3) was defined. RESULTS Histological analysis revealed the presence of pharyngeal plexus fibers in the midline and a significant reduction in paramedian fiber density from C-2 to the lower clivus (p < 0.001). None of these paramedian fibers, however, could be visualized with gross inspection or layer-by-layer dissection. Laterally based primary pharyngeal plexus nerves were identified by tracing their origins from CNs IX and X and the sympathetic chain at the skull base and following them to the pharyngeal musculature. In addition, the authors found 15 studies presenting 52 patients undergoing TN odontoidectomy. Of these patients, only 48 had been swallowing preoperatively. When looking only at this population, 83% (40 of 48) were swallowing by Day 3 and 92% (44 of 48) were swallowing by Day 7. CONCLUSIONS Despite the midline approach, both TO and TN approaches may injure a portion of the pharyngeal plexus. By limiting the TN incision to above the palatal plane, the surgeon avoids the high-density neural plexus found in the oropharyngeal wall and limits injury to oropharyngeal musculature involved in swallowing. This may explain the decreased incidence of postoperative dysphagia seen in TN approaches. However, further clinical investigation is warranted.
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Affiliation(s)
- Kathryn M Van Abel
- Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Moore EJ, Schelling A. Postsecondary inclusion for individuals with an intellectual disability and its effects on employment. J Intellect Disabil 2015; 19:130-148. [PMID: 25567096 DOI: 10.1177/1744629514564448] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Abstract
Postsecondary education (PSE) programs for individuals with intellectual disabilities (IDs) have emerged exponentially in the United States over the last decade. Research regarding these postsecondary programs has largely been descriptive, and thus, there exists a need for qualitative, outcome-based research. In this comparative case report, graduates from two types of PSE programs for individuals with IDs are surveyed regarding employment outcomes and other personal developments. The results from each postsecondary program are compared with one another and also with a comparison group of individuals with IDs who did not attend a postsecondary program (utilizing the 2009 National Longitudinal Transition Study 2). This case demonstrates significant positive employment outcomes for individuals with IDs who attend postsecondary programs compared to those who do not attend such programs and highlights similarities and differences regarding outcomes of the two program types under consideration.
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Patel AB, Hinni ML, Pollei TR, Hayden RE, Moore EJ. Severe prolonged dysphagia following transoral resection of bilateral synchronous tonsillar carcinoma. Eur Arch Otorhinolaryngol 2015; 272:3585-91. [DOI: 10.1007/s00405-015-3540-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
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Van Abel KM, Moore EJ, Kasperbauer JL, Hinni ML, Lott DG, Baron TH, Ekbom DC. Functional Outcomes and Quality of Life Associated with Cricopharyngeal Myotomy for Cricopharyngeal Dysfunction: A Prospective Study. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: (1) Evaluate cricopharyngeal myotomy (CPM) for cricopharyngeal dysfunction (CPD) including Zenkers diverticulum (ZD) and cricopharyngeal bar/hypertrophy (CPB). (2) Analyze functional outcomes and quality of life associated with CPD following CPM. Methods: A prospective multicenter study performed from January 1, 2012, to July 1, 2014, included patients presenting with CPD undergoing CPM. Standardized questionnaires including the 10-item Eating Assessment Tool (EAT-10), Functional Outcome of Swallowing Scale (FOSS), and the Reflux Symptom Index (RSI) were completed preoperatively, at 3 and 6 months postoperatively. Results: Thirty-two patients were included (18F; mean 71 years; range, 53-86 years). Primary CPD included ZD (17/32; 53.1%), CPB (6/32; 18.8%), and ZD+CPB (9/32; 28.1%). The most common comorbidities included GERD (11/32; 34.4%), hiatal hernia (6/32; 18.8%), and an underlying neurologic disease (5/32; 15.6%). Twenty-six patients (81.3%) underwent rigid-endoscopic, 3 (9.4%) underwent flexible-endoscopic, and 3 (9.4%) underwent open-transcervical CPM. One patient developed a leak on postoperative day 3. There were no deaths. Three patients experienced treatment failure at 7, 14, and 14 months postoperatively, requiring revision surgery. Mean preoperative RSI was 24.7 (range, 10-40), FOSS was 2.2 (range, 0-4), and EAT-10 was 20.7 (range, 2-34). The 3-month questionnaire (32/32, 100%) demonstrated an improved mean RSI of 7.2 (range, 0-30), FOSS of 0.6 (range, 0-3), and EAT-10 of 4.6 (range, 0-24). A total of 63% (20/32) completed the 6-month questionnaire, demonstrating a stable/improved mean RSI of 4.95 (range, 0-17), FOSS of 0.55 (range, 0-2), and EAT-10 of 3.1 (range, 0-15). Conclusions: This represents one of the first prospective studies to demonstrate a significant improvement in functional outcome and quality of life in patients with CPD undergoing CPM.
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Genden EM, Moore EJ, Pfister DP, Brandwein-Gensler M, O’Sullivan B. Controversies in Robotic Surgery. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Program Description: Transoral robotic surgery (TORS) has become a popular approach for management of oropharyngeal carcinoma. The miniseminar will be organized as a tumor board panel staffed with a head and neck surgeon, radiation oncologist, medical oncologist, and pathologist. Two cases will be presented to highlight 3 controversial topics: (1) What are acceptable surgical margins and does human papillomavirus (HPV) status affect margin status? (2) Following TORS with negative margins, does the primary site require radiotherapy and does HPV status affect that decision? (3) How do “poor prognostic factors” affect decisions regarding adjuvant therapy, radiation dose, and treatment fields? Educational Objectives: (1) Differentiate the pathologic characters of HPV-positive and HPV-negative tumors and demonstrate how this finding affects treatment margins. (2) Explain the indication for treating the primary site after TORS resection. (3) Recognize impact of poor prognostic factors of adjuvant therapy decisions, including treatment dose.
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Modest MC, Van Abel KM, Moore EJ, Janus JR, Price DL, Kasperbauer JL, Olsen KD. Parapharyngeal Space Neoplasms: A 50-Year Experience. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: (1) Describe the presentation, histopathology, and workup for parapharyngeal space (PPS) neoplasms. (2) Analyze management and long-term oncologic outcomes. Methods: A chart review was performed from 1960-2010 on patients with primary PPS neoplasms treated at a tertiary center with intent-to-cure. Results: A total of 381 patients were included (160 males; mean, 50.9 years; range, 2 days-89 years). The most common symptom was a neck mass (182/381, 48%). Of the patients, 78.7% (300/381) had preoperative imaging: 44% (167/381) had computed tomography and 41% (156/381) had magnetic resonance imaging. Of the patients, 20.2% (77/381) underwent fine-needle aspiration biopsy. A total of 299 tumors were benign (78.5%), pleomorphic adenomas comprising the majority (151/299, 50.5%). Eighty-two were malignant (21.5%), adenocarcinomas (16/82, 19.5%) being the most common. All patients underwent primary surgical management ± adjuvant therapy. The cervical-parotid approach was the most common (253/381, 66.4%), with mandibulotomies required in 4.5% (17/381). Postoperative cranial neuropathies were identified in 18.7% (70/374); 48.5% (34/70) were related to neurogenic tumors. No perioperative mortalities were reported. Mean follow-up was 89.9 months (N = 345; range: 1 month-42 years). The 5-/10-/ 20-year recurrence-free survival was 93.2%/86.3%/77.9% for benign and 48.2%/38.3%/21.3% for malignant lesions ( P < .0001). The 5-/10-/20-year cancer-specific survival was 98.7%/97.9%/96.2% for benign and 59.0%/52.3%/14.0% for malignant lesions ( P < .0001). The 5-/10-/20-year overall survival was 96.4%/89.3% /70.0% for benign and 56.0%/46.0%/7.3% for malignant lesions ( P < .0001). Conclusions: While the rate of recurrence for benign PPS lesions is low, these patients remain at risk for recurrence >20 years following surgery. Long-term surveillance should be considered. Patients with malignant lesions are at higher risk for recurrence and have a poor oncologic prognosis. The cervical-parotid approach remains safe and effective for most PPS neoplasms.
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Cockerill CC, Orvidas LJ, Moore EJ, Duresko BJ, Tombers N, Cockerill FR, Pritt BS. Human Papillomavirus Infection in Benign Tonsil Swabs and Tonsillectomy Specimens. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: (1) Determine incidence of HPV (human papillomavirus) infection in routine tonsillectomy swabs and specimens. (2) Determine if vaccination impacts tonsillar HPV infection. Methods: This was a prospective study conducted from July 2012 to January 2014. Patients ages 1 to 100 years undergoing tonsillectomy for nonmalignant indications were enrolled. Demographic data and immunization status were collected. Specimens collected during surgery included a flocked swab and half of the left and right tonsil. All specimens were tested for HPV DNA using the polymerase chain reaction–based Roche Cobas Amplicor test and for the presence of E6/E7 mRNA using the Gen-Probe Aptima HPV test. Results: Patients were stratified into 2 groups, pediatric (ages 1-12 years) and adults (age 13 years and up) based on age of potential sexual maturity. In the pediatric group (n = 130) mean age was 5.2 years, 42% were female, 58% were male, and only 3 patients were fully vaccinated against HPV. In the adult group (n = 64) mean age was 24 years, 76% female, 24% male, and 47% were either fully or partially vaccinated. All specimens were negative for HPV infection via both testing methods. Internal controls confirmed the tests were functioning properly. Conclusions: This is the first study to examine fresh tonsil swabs and tonsillectomy specimens for HPV infection using a Food and Drug Administration–approved method. Interestingly, both adult and pediatric specimens were negative for HPV infection. The role of vaccination in oropharyngeal HPV infection remains unclear.
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140
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Moore EJ, Price DL, Van Abel KM, Carlson ML. Still under the microscope: Can a surgical aptitude test predict otolaryngology resident performance? Laryngoscope 2014; 125:E57-61. [DOI: 10.1002/lary.24791] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/20/2014] [Accepted: 05/28/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel L. Price
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Kathryn M. Van Abel
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Matthew L. Carlson
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
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141
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Thom JJ, Moore EJ, Price DL, Kasperbauer JL, Starkman SJ, Olsen KD. The Role of Total Parotidectomy for Metastatic Cutaneous Squamous Cell Carcinoma and Malignant Melanoma. JAMA Otolaryngol Head Neck Surg 2014; 140:548-54. [DOI: 10.1001/jamaoto.2014.352] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joshua J. Thom
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Medical School, Rochester, Minnesota
| | - Eric J. Moore
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Medical School, Rochester, Minnesota
| | - Daniel L. Price
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Medical School, Rochester, Minnesota
| | - Jan L. Kasperbauer
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Medical School, Rochester, Minnesota
| | - Sidney J. Starkman
- Department of Otolaryngology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Kerry D. Olsen
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Medical School, Rochester, Minnesota
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142
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Abstract
Objectives: We report the clinical findings, surgical management, and outcomes for lingual thyroidectomy. Methods: We performed a retrospective case review of lingual thyroidectomy performed at 3 tertiary-care academic referral centers between 1994 and 2012. Results: Nine patients underwent lingual thyroidectomy for symptoms including globus sensation (6 patients), dysphagia (5 patients), and airway obstruction (5 patients). Before surgery, 3 patients had attempted medical suppressive therapy. Lingual thyroidectomy was performed by transoral laser microsurgery in 4 patients, transoral robotic surgery in 3 patients, transoral surgery without microscopic assistance in 1 patient, and an open approach with a modified Sistrunk procedure in 1 patient. Total thyroidectomy was attained in 7 patients, and subtotal resection in 2. The follow-up averaged 8 months, and all patients reported significant improvement in their symptoms. One patient had a recurrence. Complications included postoperative bleeding and epiglottic perforation in 1 patient and airway obstruction secondary to angioedema in another patient. There was no significant difference in operative times between transoral laser microsurgery (91 ± 16 minutes) and transoral robotic surgery (109 ± 35 minutes). Transoral surgery without microscopic assistance and open resection had longer operative times (206 and 246 minutes, respectively). Conclusions: Surgical resection of lingual thyroid glands achieves significant improvement in patient symptoms, with low rates of recurrence. We favor a total lingual thyroidectomy approach with use of either a microscope or a robotic endoscope for optical assistance.
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Affiliation(s)
| | - Eric J. Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael L. Hinni
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
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143
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Abstract
IMPORTANCE For parotid lesions, the high accuracy and utility of intraoperative frozen section (FS) pathology, compared with permanent section pathology, facilitates intraoperative decision making about the extent of surgery required. OBJECTIVE To demonstrate the accuracy and utility of FS pathology of parotid lesions as one factor in intraoperative decision making. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of patients undergoing parotidectomy at a tertiary care center. INTERVENTIONS Evaluation of the accuracy of FS pathology for parotid surgery by comparing FS pathology results with those of permanent section. MAIN OUTCOMES AND MEASURES Documented changes from FS to permanent section in 1339 parotidectomy pathology reports conducted from January 1, 2000, through December 31, 2009, included 693 benign and 268 primary and metastatic malignant tumors. RESULTS Changes in diagnosis were found from benign to malignant (n = 11) and malignant to benign (n = 2). Sensitivity and specificity of a malignant diagnosis were 98.5% and 99.0%, respectively. Other changes were for lymphoma vs inflammation or lymphoma typing (n = 89) and for confirmation of or change in tumor type for benign (n = 36) or malignant (n = 69) tumors. No case changed from low- to high-grade malignant tumor. Only 4 cases that changed from FS to permanent section would have affected intraoperative decision making. Three patients underwent additional surgery 2 to 3 weeks later. Overall, only 1 patient was overtreated (lymphoma initially deemed carcinoma). CONCLUSIONS AND RELEVANCE Frozen section pathology for parotid lesions has high accuracy and utility in intraoperative decision making, facilitating timely complete procedures.
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Affiliation(s)
- Kerry D Olsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jean E Lewis
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
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144
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Geiger JL, Lazim AF, Walsh FJ, Foote RL, Moore EJ, Okuno SH, Olsen KD, Kasperbauer JL, Price DL, Garces YI, Ma DJ, Neben-Wittich MA, Molina JR, Garcia JJ, Price KAR. Adjuvant chemoradiation therapy with high-dose versus weekly cisplatin for resected, locally-advanced HPV/p16-positive and negative head and neck squamous cell carcinoma. Oral Oncol 2014; 50:311-8. [PMID: 24467937 DOI: 10.1016/j.oraloncology.2014.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 12/31/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Standard treatment for patients with poor-risk, resected head and neck squamous cell carcinoma (HNSCC) is adjuvant radiation therapy combined with high-dose cisplatin. Many patients are treated with weekly cisplatin; it is not known whether weekly and high-dose cisplatin are equivalent. This study compares the outcomes of patients with locally-advanced HPV-negative HNSCC and HPV/p16-positive oropharynx HNSCC treated with adjuvant chemoradiation therapy with either high-dose or weekly cisplatin. MATERIALS AND METHODS Retrospective review of patients with Stage III/IV HNSCC who had surgery followed by adjuvant chemoradiation therapy at Mayo Clinic, Rochester. HPV and/or p16 status was available for all oropharynx patients. RESULTS 104 Patients (51 high-dose, 53 weekly) were analyzed. The 3-year overall survival was 84% and 75% for patients who received high dose and weekly cisplatin, respectively (p=0.30). The 3-year recurrence free survival was 71% and 74% in the high dose and weekly cisplatin group, respectively (p=0.95). Patients with HPV/p16-positive oropharynx cancer who received adjuvant chemoradiation therapy with high-dose and weekly cisplatin had three-year overall survival rates of 91% and 86% (p=0.56), and 3-year recurrence free survival of 84% and 82% (p=0.93). Extracapsular extension did not affect prognosis in either group. CONCLUSIONS No significant survival difference was seen between patients with locally advanced HNSCC treated with adjuvant chemoradiation therapy with high-dose or weekly cisplatin, although there was a trend for improved survival with high-dose cisplatin. Weekly cisplatin in the adjuvant setting may be a better treatment for patients with HPV-positive oropharynx cancer to preserve survival and minimize toxicity.
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Affiliation(s)
- Jessica L Geiger
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ahmed F Lazim
- Department of Pathology, Al Jumhori Teaching Hospital, Mosul, Iraq
| | - Francis J Walsh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Scott H Okuno
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Kerry D Olsen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Julian R Molina
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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145
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Pollei TR, Hinni ML, Moore EJ, Hayden RE, Olsen KD, Casler JD, Walter LC. Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx. JAMA Otolaryngol Head Neck Surg 2014; 139:1212-8. [PMID: 24113922 DOI: 10.1001/jamaoto.2013.5097] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE With an increasing incidence of oropharyngeal carcinoma and prevalence of transoral surgical techniques, postoperative bleeding, with its associated risk factors, deserves evaluation. OBJECTIVE To classify and review postoropharyngectomy hemorrhage rates and associated risk factors. DESIGN, SETTING, AND PARTICIPANTS Single-institution, multicenter retrospective medical chart review analyzing surgical procedures in 906 patients treated with transoral surgery for oropharyngeal carcinoma at a tertiary care, academic referral center from 1994 to 2012. Tumor stage, previous treatment, resection method, and transcervical external carotid branch ligation were analyzed in relationship to postoperative hemorrhage rate, and severity. A novel classification system was created, grading bleeding episodes as minor, intermediate, major, or severe based on management method and related sequelae. RESULTS Postoperative bleeding occurred in 5.4% of patients (49 of 906) with 67.3% of these (33 of 49) requiring operative intervention. Severe bleeding episodes were very rare (1.1% of patients). Transcervical external carotid system vessel ligation was performed with the primary resection in 15.6% of patients with no overall difference in bleeding rate or severity of bleeding in patients who underwent ligation vs those who did not (P = .21 and P = .66, respectively). Vessel ligation was performed more frequently in patients with a higher T stage (P = .002). In previously treated patients, severity of bleeding was decreased if vessels were ligated (P > .05). Higher T-stage tumors had a higher bleeding rate (P = .02). Bleeding rates were similar between those treated with laser (5.6%) and robotic (5.9%) oropharyngectomy (P = .80); however, patients with significantly higher T-stage tumors were treated with laser vs robot techniques (P < .001). CONCLUSIONS AND RELEVANCE Transoral resection of oropharyngeal carcinoma is safe, and severe life-threatening hemorrhage is rare. Although transcervical vessel ligation did not result in an overall decrease in bleeding rate, there is a trend toward reduced postoropharyngectomy bleeding severity with ligation. We recommend ligation for higher T-stage tumors, primary tonsil tumors, and patients undergoing revision surgery.
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Affiliation(s)
- Taylor R Pollei
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
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146
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Van Abel KM, Moore EJ. The rise of transoral robotic surgery in the head and neck: emerging applications. Expert Rev Anticancer Ther 2014; 12:373-80. [DOI: 10.1586/era.12.7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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147
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Gross JA, Olsen SM, Koch CA, Moore EJ. Severe symptomatic hypocalcemia following total thyroidectomy in a patient with a history of Roux-en-Y gastric bypass surgery. Ear Nose Throat J 2014; 93:E6-E11. [PMID: 24452904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Patients who undergo a Roux-en-Y gastric bypass (RYGB) procedure are at moderate risk for calcium and vitamin D deficiency. Those who subsequently undergo thyroid or parathyroid surgery are at high risk for developing severe symptomatic hypocalcemia if they are not monitored and adequately treated prophylactically. We describe the case of a morbidly obese 40-year-old man who had undergone RYGB surgery 6 months prior to the discovery of metastatic papillary thyroid carcinoma. He subsequently underwent total thyroidectomy with central and bilateral neck dissection. Following surgery, he developed severe symptomatic hypocalcemia, as his calcium level fell to a nadir of 6.0 mg/dl. He required aggressive oral and intravenous repletion therapy with calcium, vitamin D, and magnesium for 10 days before hospital discharge. Providers should institute careful preoperative screening, patient counseling, and prophylactic calcium and vitamin D therapy for all thyroid surgery patients who have previously undergone RYGB surgery to prevent the development of severe and life-threatening hypocalcemia. Only a few reports of patients have been published on the dangers of thyroid and parathyroid surgery in patients who have undergone bariatric surgery. We report a new case to add to the body of literature on this patient population. We also review calcium homeostasis and supplementation as they relate to this situation.
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Affiliation(s)
- Justin A Gross
- Department of Surgery, Mayo School of Graduate Medical Education, 200 First St., SW, Rochester, MN 55905, USA
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148
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Janus JR, Chinnadurai S, Moore EJ. Case report: Paraneoplastic neurologic syndrome associated with squamous cell carcinoma of the tonsil. Ear Nose Throat J 2013; 92:E13. [PMID: 24170469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Paraneoplastic syndromes include a variety of disorders that affect the neurologic, endocrine, mucocutaneous, hematologic, and other systems as a result of neoplastic disease. Although their presentations vary, syndromes occur when tumor antigens exhibit cross-reactivity to similar antigens expressed by these systems. The antigens in the nervous system are called "onconeural" antigens. Although many disorders are associated with a comparatively high incidence of paraneoplastic neurologic syndromes, only a few cases have been associated with squamous cell carcinoma (SCC) of the tonsil. We report the case of a 69-year-old man who initially presented with weakness and spastic gait. He was subsequently found to have a characteristic paraneoplastic tractopathy on thoracic magnetic resonance imaging. The subsequent workup and operative intervention identified a T2N0M0 SCC of the tonsil. Following resection, the patient's overall symptoms were significantly alleviated, and his gait improved. A thorough literature search yielded no other report of a tonsillar SCC with associated paraneoplastic thoracic spine tractopathy.
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Affiliation(s)
- Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, 200 First St., SW, Gonda Bldg., 12th Floor, Rochester, MN 55905, USA.
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149
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Janus JR, Laborde RR, Moore EJ, Olsen KD, Olsen S, Kasperbauer JL, Smith D. Increased Expression Levels of Apoptosis Inhibitor BIRC5 Is Associated with Advanced Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: 1) Describe the role that BIRC5 and related activator genes (AURKB and CDCA8) play in various malignancies, and analyze the role that these genes play in oropharyngeal squamous cell carcinoma. 2) Implement innovative gene analysis technology (mRNA Seq) to determine gene expression and validate using established techniques (nCounter). 3) Analyze gene expression in the setting of human papillomavirus (HPV) status, smoking, and tumor stage. Methods: Tumor and adjacent normal oropharyngeal mucosal samples were obtained for validation studies from 24 patients undergoing surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) from 2010-2012. Transcriptome data (mRNA-Seq) were analyzed from patient matched tumor-normal tissues. Transcript levels of target genes were validated using the nCounter system. Expression levels were correlated with tumor stage, HPV infection status, or smoking status. Results: A statistically significant overexpression was noted in all 3 target genes in tumor versus normal tissue. Statistically significant associations were present between expression levels of target genes and advanced tumor stage. No significant association was found between the 3 genes and etiologic subgroupings (HPV latent versus active infections or smoking status). Conclusions: BIRC5 and related activator genes (AURKB and CDCA8) have an established role in the development and progression of other cancers. Expression of these 3 gene targets is related to tumor stage in oropharyngeal SCC. The significant associations between the expression of these genes and tumor staging suggest that these genes may play a role in tumor progression independent of HPV viral expression patterns.
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150
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Van Abel KM, Moore EJ, Price DL, Oldenburg M, Kasperbauer JL, Olsen KD. T4 Oropharyngeal Squamous Cell Carcinoma: Primary Management Outcomes. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: 1) Describe T4a and T4b oropharyngeal squamous cell carcinoma (OPSCC) and its management. 2) Analyze morbidity, functional and oncologic outcomes, and survival associated with four major treatment strategies. Methods: We retrospectively reviewed functional, clinical, and oncologic outcomes for patients diagnosed with T4 OPSCC at a tertiary institution from 1990-2010. Patients underwent primary 1) surgery + chemoradiation (Group 1), 2) surgery + radiation (Group 2), 3) chemoradiation (Group 3), or 4) chemoradiation + neck dissection (Group 4). Preliminary analysis of ongoing study (N = 120). Results: 47 patients were included (32% female, 68% male; mean age 58.8 years, range 43-82). Groups 3 and 4 had a higher preoperative nodal stage ( P = 0.02). Complications and PEG placement/dependence were similar across groups. Groups 2 and 4 had higher rates of surgical airway dependence at last follow up ( P =0.05). Average follow up was 43 months (median 26, range 2-167). Two/five year overall survival was 83%/54% for Group 1, 60%/40% for Group 2, 64%/32% for Group 3, and 80%/30% for Group 4 ( P =0.82). Disease specific survival at two/five/ten years was 83%/63%/31% for Group 1, 70%/58%/44% for Group 2, 68%/60%/48% for Group 3, and 80%/40 %/40% for Group 4 ( P =0.97). Progression free survival at two/five years was 80%/80% for Group 1, 57%/57% for Group 2, 68%/58% for Group 3, and 40%/40% for Group 4. Conclusions: For a disease in which improved survival and oncologic outcomes are measured in months, primary surgery followed by chemoradiation may achieve this goal without sacrificing morbidity or functional outcomes.
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