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Green L, McDowell L, Ip F, Tapia M, Zhou M, Fahey MT, Dixon B, Magarey M. Early return to work is possible after transoral robotic surgery (TORS) in carefully selected patients with oropharyngeal squamous cell carcinoma. Oral Oncol 2024; 159:107032. [PMID: 39293101 DOI: 10.1016/j.oraloncology.2024.107032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/26/2024] [Accepted: 09/09/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION The aims of this study were to investigate the rate and time to return to work (RTW) after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) and to explore the impact of disease or work-related factors leading to variations in RTW outcomes. METHODS Cross-sectional survey of disease, socioeconomic, work-related and health-related quality of life (HR-QOL). Qualitative analysis of responses for facilitators and barriers to RTW. RESULTS A total of 47 participants employed at diagnosis were included in the study, with an average age 56 years. Median survey time 3.2 years. 22 participants underwent TORS only with 25 undergoing TORS with adjuvant therapy. 93.6 % had stage 1 disease. 95.7 % of participants RTW after TORS with a mean time of 13.6 weeks. Patients returned earlier after TORS alone compared to those requiring adjuvant treatment (10 weeks vs. 17 weeks; p = 0.13) Overall high HR-QOL metrics for all patients, with those undergoing adjuvant having significantly poorer outcomes for the dry mouth/sticky saliva (9.1 vs 41.3, p=<0.001) items. Qualitative analysis of free text responses showed facilitators and barriers to RTW fell under four main categories: physical, phycological/emotional, financial and workplace. CONCLUSION High rate of RTW amongst patients after TORS, which is the highest reported amongst head and neck cancer literature to date. Participants returned earlier after surgery only compared to adjuvant treatment, but both groups reported high HR-QOL metrics. Physical effects of treatment, including fatigue and oral dysfunction were some of the main barriers to RTW; whereas flexible working arrangements and support from employer/colleagues were major facilitators.
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Affiliation(s)
- Lorne Green
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lachlan McDowell
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Fiona Ip
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia
| | - Mario Tapia
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Hospital Clinico Regional de Concepcion Dr. Guillermo Grant Benavente, Concepcion, Chile
| | - Meiling Zhou
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael T Fahey
- Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials (BaCT), Melbourne, VIC, Australia
| | - Benjamin Dixon
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia; Department of ENT Head & Neck Surgery, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Magarey
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia; Department of Medical Education, University of Melbourne, Melbourne, VIC, Australia
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2
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van der Scheer FA, Jansen F, Eerenstein SEJ, Vergeer MR, Leemans CR, Verdonck-de Leeuw IM, Hendrickx JJ. Swallowing outcomes after transoral robotic surgery and adjuvant treatment in unknown primary. Oral Dis 2024. [PMID: 38988121 DOI: 10.1111/odi.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Robotic transoral mucosectomy of the base of tongue was introduced as a diagnostic procedure in patients treated for head and neck cancer with unknown primary (CUP), increasing the identification rate of the primary tumour. For the treatment of CUP, a considerable percentage of patients require adjuvant (chemo)radiation. The aim of this study was to investigate swallowing outcomes among CUP patients after TORS and adjuvant treatment. SUBJECTS AND METHODS A systematic review was carried out on studies investigating the impact of TORS and adjuvant treatment on swallowing-related outcomes among CUP patients In addition, a cross-sectional study was carried out on swallowing problems (measured using the SWAL-QOL questionnaire) among CUP patients in routine care who visited the outpatient clinic 1-5 years after TORS and adjuvant treatment. RESULTS The systematic review (6 studies; n = 98) showed that most patients returned to a full oral diet. The cross-sectional study (n = 12) showed that all patients were able to return to a full oral diet, nevertheless, 50% reported swallowing problems in daily life (SWAL-QOL total score ≥14). CONCLUSION Although after TORS and adjuvant treatment for CUP a full oral diet can be resumed, patients still experience problems with eating and drinking in daily life.
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Affiliation(s)
- Fennetta A van der Scheer
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan-Jaap Hendrickx
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Awad L, Reed B, Bollen E, Langridge BJ, Jasionowska S, Butler PEM, Ponniah A. The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:254. [PMID: 38878229 PMCID: PMC11180031 DOI: 10.1007/s11701-024-01987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/19/2024] [Indexed: 06/19/2024]
Abstract
The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK.
- Department of Plastic Surgery, Royal Free Hospital, London, UK.
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK.
| | - Benedict Reed
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Edward Bollen
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
| | - Benjamin J Langridge
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Sara Jasionowska
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Peter E M Butler
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Allan Ponniah
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Patfield A, Wykes J, Venchiarutti R, Dunn M, Clark J, Froggatt C. How age affects health-related-quality-of-life outcomes in maxillomandibular reconstructive surgery. ANZ J Surg 2024; 94:148-155. [PMID: 38156723 DOI: 10.1111/ans.18826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Maxillomandibular reconstruction has various functional, aesthetic, and psychosocial effects that can decrease patients' health-related quality of life (HRQOL). The aim of this study was to compare HRQOL outcomes in older and younger patients undergoing maxillomandibular reconstruction. METHODS A cross-sectional study of patients undergoing maxillomandibular reconstruction surgery between November 2008 and January 2021 was conducted. Participants completed the FACE-Q Head and Neck Cancer Module, M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Results from these instruments were used to compare HRQOL outcomes in old (≥70 years) and young (<70 years) patients. RESULTS Ninety-nine patients who underwent maxillomandibular reconstruction completed the instruments (response rate 50%), of which 33 (33%) were aged ≥70 years. Older age was associated with improved FACE-Q speaking (+11.3, P = 0.045), FACE-Q cancer worry (-9.97, P = 0.050), and SHI score (-16.6, P = 0.013). After adjusting for the effect of radiotherapy, age was associated with improved FACE-Q speaking (+16.8, P = 0.012), FACE-Q smiling distress (+12.6, P = 0.040), FACE-Q worry (-11.0, P = 0.032), and SHI scores (-18.4, P = 0.004). Older age was associated with an increased likelihood of postoperative complications (odds ratio (OR) = 2.9, P = 0.02) and medical complications (OR = 4.6, P = 0.012). CONCLUSION In patients undergoing maxillomandibular reconstruction, older age (≥70 years) was associated with better HRQOL outcomes in domains relating to speech and cancer worry. In all other HRQOL outcomes, the two age groups performed similarly.
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Affiliation(s)
- Alexander Patfield
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rebecca Venchiarutti
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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Olaleye O, Nassif R, Fleming B, Burrows S. Laser tongue base mucosectomy is a useful diagnostic tool in the management of unknown primary cancers of the head and neck region. J Laryngol Otol 2023; 137:438-441. [PMID: 35674061 DOI: 10.1017/s0022215122001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Tongue base mucosectomy identified cancer in 78 per cent of cancers of unknown primary in a recent meta-analysis. The carbon dioxide laser is an alternative technique if there is no access to a robot. This study aimed to describe the steps for undertaking tongue base mucosectomy using the carbon dioxide laser and its diagnostic utility in cancers of unknown primary. METHOD This was a prospective feasibility study utilising carbon dioxide laser for tongue base mucosectomy in cancers of unknown primary. Data collected included demographic data and p16 status. RESULTS There were 14 cancers of unknown primary with 86 per cent p16 positivity on immunohistochemistry. Laser tongue base mucosectomy alone identified the cancer primary in 7 of 12 (58 per cent) cancers of unknown primary among p16 positive tumours and 0 of 2 (0 per cent) among p16 negative tumours. Combining bilateral tonsillectomy with laser tongue base mucosectomy resulted in identification of the primary cancer in 8 of 12 (67 per cent) p16 positive tumours. CONCLUSION In centres without a robot, tongue base mucosectomy using the carbon dioxide laser is a viable alternative, especially in combination with bilateral tonsillectomy in p16 positive cases.
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Affiliation(s)
- O Olaleye
- ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
| | - R Nassif
- ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
| | - B Fleming
- Anaesthesia, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
| | - S Burrows
- ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
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Alzahrani F, Sahovaler A, Mundi N, Rammal A, Fnais N, MacNeil SD, Mendez A, Yoo J, Fung K, Laxague F, Warner A, Palma DA, Nichols A. Transoral robotic surgery for the identification of unknown primary head and neck squamous cell carcinomas: Its effect on the wait and the weight. Head Neck 2022; 44:1206-1212. [PMID: 35224796 DOI: 10.1002/hed.27023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Neck carcinoma of unknown primary (CUP) is a frequent scenario. Transoral robotic mucosectomies (TORM) of pharynx have increased rate of primary identification, but come with cost of treatment delay. METHODS We reviewed patients who underwent CUP protocol from 2014 to 2020. Patients with cervical nodes carcinoma and failure to localize a primary source were classified as CUP. We determined primary identification rate and postoperative complications. RESULTS We included 65 patients underwent TORM. Surgical approach consisted of lingual and/or palatine tonsillectomies. The primary detection rate was 49.2%. Average weight reduction was 2.5 ± 4.3 kg. The average number of days from consultation to definitive treatment was 52.2 ± 18.3. CONCLUSION A systematic approach to patients with CUP showed a promising primary identification rate compared to panendoscopy alone. TORM carries a small risk of complications. The benefits of primary identification must be weighed with the morbidity and delay to definitive treatment.
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Affiliation(s)
- Faisal Alzahrani
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Department Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Axel Sahovaler
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Neil Mundi
- Department of Otolaryngology, Southern Illinois University, Springfield, Illinois, USA
| | - Almoaidbellah Rammal
- Department Otolaryngology-Head and Neck Surgery, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Naif Fnais
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Department Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - S Danielle MacNeil
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Francisco Laxague
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Anthony Nichols
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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Larsen MHH, Scott SI, Channir HI, Madsen AKØ, Charabi BW, Rubek N, Tvedskov JF, Kehlet H, von Buchwald C. Days alive and out of hospital following transoral robotic surgery: Cohort study of 262 patients with head and neck cancer. Head Neck 2021; 43:3866-3874. [PMID: 34605110 DOI: 10.1002/hed.26880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Days alive and out of hospital (DAOH) is a validated outcome in clinical trials, since it reflects procedure-associated morbidity and mortality. Transoral robotic surgery (TORS) has become a widely adopted procedure with increasing demand for knowledge and data on morbidity. METHODS Retrospective single-center assessment of a prospective TORS database comprising patients treated for malignancy between 2013 and 2018 using DAOH to describe procedure- and disease-related morbidity the first 12-postoperative months. RESULTS For 262 patients, median DAOH365 was 357 days (IQR 351-360). Indications for TORS were (i) primary curative resection (61%), (ii) salvage resection (15%), and (iii) diagnostic work-up of cancer of unknown primary in the head and neck (24%). Median DAOH365 was 359 days (IQR 351-361 days), 348 days (IQR 233-355), and 357 days (351-361), respectively. Pneumonia had the highest impact in DAOH365 reduction. CONCLUSION Total median DAOH365 after TORS was 357 days. The main cause leading to DAOH365 reduction was pneumonia.
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Affiliation(s)
- Mikkel H H Larsen
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne I Scott
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hani I Channir
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne K Ø Madsen
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte W Charabi
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper F Tvedskov
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology - Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Human Papillomavirus and Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region: A Comprehensive Review on Clinical Implications. Viruses 2021; 13:v13071297. [PMID: 34372502 PMCID: PMC8310239 DOI: 10.3390/v13071297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/02/2023] Open
Abstract
Squamous cell carcinoma of unknown primary (SCCUP) is a challenging diagnostic subgroup of oropharyngeal squamous cell carcinoma (OPSCC). The incidence of SCCUP is increasing in parallel with the well-documented increase in OPSCC and is likewise driven by the increase in human papillomavirus (HPV). The SCCUP patient often presents with a cystic lymph node metastasis and undergoes an aggressive diagnostic and treatment program. Detection of HPV in cytologic specimens indicates an oropharyngeal primary tumor origin and can guide the further diagnostic strategy. Advances in diagnostic modalities, e.g., transoral robotic surgery and transoral laser microsurgery, have increased the successful identification of the primary tumor site in HPV-induced SCCUP, and this harbors a potential for de-escalation treatment and increased survival. This review provides an overview of HPV-induced SCCUP, diagnostic modalities, and treatment options.
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Hussain T, Mattheis S, Lang S. [The role of surgery and salvage surgery in the era of HPV-associated oropharyngeal carcinomas]. HNO 2020; 68:688-694. [PMID: 32638060 DOI: 10.1007/s00106-020-00900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of human papillomavirus (HPV)-positive oropharyngeal carcinomas is increasing worldwide. Due to a markedly different response to treatment compared to HPV-negative oropharyngeal carcinomas, determining the ideal therapeutic approach can be challenging. Particularly in never-smokers, HPV-positive oropharyngeal carcinomas respond well to primary radiation therapy; at the same time recent studies indicate comparable survival after primary surgery. For stage I tumors according to TNM‑8, retrospective analyses show very good oncologic outcomes after surgery alone, and no added benefit of adjuvant radio- or chemotherapy. Results of prospective treatment deintensification trials are expected in the coming years. Minimally invasive transoral surgical approaches for selected oropharyngeal cancers can improve preservation of postoperative function and quality of life. For both HPV-positive and HPV-negative oropharyngeal carcinomas, salvage surgery is the treatment of choice for resectable recurrent locoregional disease and resectable distant metastases.
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Affiliation(s)
- T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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11
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Kubik MW, Channir HI, Rubek N, Kim S, Ferris RL, von Buchwald C, Duvvuri U. TORS Base-of-Tongue Mucosectomy in Human Papilloma Virus-Negative Carcinoma of Unknown Primary. Laryngoscope 2020; 131:78-81. [PMID: 32239774 DOI: 10.1002/lary.28617] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/11/2020] [Accepted: 03/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the role of transoral robotic base-of-tongue mucosectomy in a cohort of patients with human papilloma virus negative unknown primary carcinoma. STUDY DESIGN Retrospective database analysis. METHODS A retrospective database review from 2012 to 2018 was performed at two large tertiary centers to study patients with human papilloma virus (HPV)-negative unknown primary carcinoma who underwent transoral robotic base-of-tongue mucosectomy. P16 testing was used as a surrogate for HPV status. Patients were included that had squamous cell carcinoma metastatic to the lateral neck based on fine needle aspiration or open biopsy. Preoperatively, all patients were classified as having an unknown primary based on normal clinical and flexible endoscopic exam, normal operative endoscopy, nonlocalizing imaging, and tonsillectomy. All patients underwent robotic base-of-tongue mucosectomy. The primary outcome measure was the incidence of pathologic identification of a mucosal primary. RESULTS Twenty-three patients with p16-negative unknown primary carcinoma were identified and studied. All patients underwent transoral robotic base-of-tongue mucosectomy. Median age was 60 years at the time of diagnosis, and 18 of 23 (78.2%) were male. Pathologic analysis of the base-of-tongue specimens showed a primary tumor in only three of 23 (13.0%) of patients. CONCLUSION Despite prior evidence suggesting a high rate of primary site identification in HPV-related disease, robotic base-of-tongue mucosectomy may not be indicated for HPV-negative unknown primary carcinoma based on a low likelihood of finding the primary. LEVEL OF EVIDENCE 4 Laryngoscope, 131:78-81, 2021.
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Affiliation(s)
- Mark W Kubik
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Hani I Channir
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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12
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Kainulainen S, Koivusalo AM, Roine RP, Wilkman T, Sintonen H, Törnwall J, Thorén H, Lassus P. Long-term quality of life after surgery of head and neck cancer with microvascular reconstruction: a prospective study with 4.9-years follow-up. Oral Maxillofac Surg 2019; 24:11-17. [PMID: 31691048 PMCID: PMC7010629 DOI: 10.1007/s10006-019-00806-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Abstract
Purpose The aim of this study was to evaluate the long-term health-related quality of life (HRQoL) of head and neck cancer patients with microvascular surgery. Surgical treatment causes great changes in patient HRQoL. Studies focusing on long-term HRQoL after microvascular reconstruction for head and neck cancer patients are scarce. Methods We conducted a prospective study of 93 patients with head and neck cancer and microvascular reconstruction in Helsinki University Hospital Finland. HRQoL was measured using the 15D instrument at baseline and after a mean 4.9-years follow up. Results were compared with those of an age-standardized general population. Results Of the 93 patients, 61 (66%) were alive after follow-up; of these, 42 (69%) answered the follow-up questionnaire. The median time between surgery and HRQoL assessment was 4.9 years (range 3.7–7.8 years). The mean 15D score of all patients (n = 42) at the 4.9-years follow up was statistically significantly (p = 0.010) and clinically importantly lower than at baseline. The dimensions of “speech” and “usual activities” were significantly impaired at the end of follow up. There was a significant difference at the 4.9-years follow-up in the mean 15D score between patients and the general population (p = 0.014). After follow up, patients were significantly (p < 0.05) worse off on the dimensions of “speech,” “eating,” and “usual activities.” Conclusions Long-term HRQoL was significantly reduced in the whole patient cohort. Speech and usual activities were the most affected dimensions in head and neck cancer patients with microvascular reconstruction at the end of the 4.9-years follow up.
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Affiliation(s)
- Satu Kainulainen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, P.O. Box 220, FI-00029 HUS, Helsinki, Finland.
| | - A M Koivusalo
- Department of Anesthesia and Intensive Care Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - R P Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Group Administration, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - T Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, P.O. Box 220, FI-00029 HUS, Helsinki, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Törnwall
- University of Helsinki, Helsinki, Finland
| | - H Thorén
- Department of Oral and Maxillofacial Diseases, Institute of Dentistry, University of Turku and Turku University Hospital, Turku, Finland
| | - P Lassus
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
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13
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Systematic Review of Validated Quality of Life and Swallow Outcomes after Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2019; 161:561-567. [DOI: 10.1177/0194599819844755] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the available evidence on the effects of transoral robotic surgery (TORS) on the posttreatment quality of life (QOL) and swallow function of patients with head and neck cancer. Data Sources PubMed and Ovid electronic databases were searched from inception to July 6, 2016. Specific database functions were applied to maximize the search. Review Methods Articles in the database were reviewed for inclusion by 2 independent reviewers according to predetermined eligibility criteria. The references of relevant articles were then hand-searched to identify additional manuscripts. For included articles, the study characteristics and relevant data were extracted. Results Of 103 articles screened, 20 reporting validated measures of QOL and/or swallow outcomes for 659 patients were eligible for inclusion. Fourteen were observational studies or case series and did not compare the TORS group with another intervention. Two were prospective nonrandomized clinical trials that compared outcomes between TORS and primary chemoradiation. Four were cohort studies comparing TORS with other treatment approaches and modalities, including open surgical approaches and transoral laser microsurgery. Overall, most patients who underwent TORS ± adjuvant therapy reported a return to baseline QOL and swallow function by 6 to 12 months posttreatment. Several studies demonstrated superior QOL and swallowing outcomes when compared with primary chemoradiation or open approaches. Conclusions Available evidence suggests that patients who undergo TORS for head and neck cancer have good QOL and swallowing outcomes after treatment, but outcomes are dependent on baseline function, T stage, and adjuvant treatment status.
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14
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Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: A comparative analysis of a prospective registry. Oral Oncol 2019; 91:13-20. [DOI: 10.1016/j.oraloncology.2019.01.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/22/2022]
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15
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Transoral tongue base mucosectomy for the identification of the primary site in the work-up of cancers of unknown origin: Systematic review and meta-analysis. Oral Oncol 2019; 91:97-106. [PMID: 30926070 DOI: 10.1016/j.oraloncology.2019.02.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of transoral robotic surgery (TORS) and laser microsurgery (TLM) in the diagnosis and identification of the site of the unknown primary has become increasingly common. This systematic review and meta-analysis aims to assess the use and efficacy of TORS and TLM for this indication. METHOD Systematic review and meta-analysis of studies employing TORS or TLM in diagnosis of the unknown primary tumor site in patients with cervical nodal metastases of squamous cell origin. MEDLINE, EMBASE and CINHAL were searched from inception to July 2018 for all studies that used TORS and or TLM in identifying the unknown primary. RESULTS 251 studies were identified, of which 21 were eligible for inclusion. The primary tumour was identified by TORS/TLM in 78% of patients (433 out of 556). Tongue base mucosectomy (TBM) identified the primary in 222 of 427 cases (53%). In patients with negative physical examination, diagnostic imaging and PETCT, TBM identified the primary in 64% (95% CI 50, 79) cases. In patients who had negative CT/MRI imaging, negative PETCT and negative EUA and tonsillectomy, TBM identified a tongue base primary in 78% (95% CI 41, 92) cases. Haemorrhage, the commonest complication, was reported in 4.9% cases. Mean length of stay varied between 1.4 and 6.3 days. CONCLUSION Tongue base mucosectomy, performed by TORS or TLM, is highly efficacious in identifying the unknown primary in the head and neck region.
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16
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A cost effective custom dental guard for transoral robotic surgery. J Robot Surg 2019; 14:91-94. [DOI: 10.1007/s11701-019-00942-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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17
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Liu HH, Li LJ, Shi B, Xu CW, Luo E. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci 2017; 9:63-73. [PMID: 28660906 PMCID: PMC5518975 DOI: 10.1038/ijos.2017.24] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
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Affiliation(s)
- Hang-Hang Liu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Long-Jiang Li
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Bin Shi
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Chun-Wei Xu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - En Luo
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
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18
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Hamilton D, Paleri V. Role of transoral robotic surgery in current head & neck practice. Surgeon 2017; 15:147-154. [DOI: 10.1016/j.surge.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
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19
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Ozbay I, Yumusakhuylu AC, Sethia R, Wei L, Old M, Agrawal A, Teknos T, Ozer E. One-year quality of life and functional outcomes of transoral robotic surgery for carcinoma of unknown primary. Head Neck 2017; 39:1596-1602. [PMID: 28513895 DOI: 10.1002/hed.24801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 02/08/2017] [Accepted: 02/23/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the quality of life (QOL) outcomes in patients who underwent transoral robotic surgery (TORS) for carcinoma of unknown primary (CUP). METHODS Twenty-nine patients with CUP were administered the Head and Neck Cancer Inventory (HNCI) prospectively to evaluate QOL preoperatively and postoperatively. RESULTS There was statistically and clinically significant deterioration in 2 of 4 domains (eating and social disruption) in the immediate aftermath of TORS. There was statistically and clinically meaningful deterioration in all 4 domains at 3 months relative to baseline, and there remained statistically and clinically meaningful deterioration in 2 of 4 domains at 6 months compared to baseline. These 2 domains remained statistically and clinically worse than baseline at 12 months. Speech and aesthetics domain scores were comparable at baseline and 12 months. CONCLUSION Patients reported difficulties with eating and social disruption over the course of 1 year, but problems with speech and appearance abated.
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Affiliation(s)
- Isa Ozbay
- Department of Otolaryngology, Dumlupinar University, Kutahya, Turkey.,Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ali Cemal Yumusakhuylu
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Otolaryngology, Marmara University, Istanbul, Turkey
| | - Rishabh Sethia
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Lai Wei
- Department of Biomedical, The Ohio State University, Columbus, Ohio
| | - Matthew Old
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Theodoros Teknos
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
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20
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Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S170-S175. [PMID: 27841129 PMCID: PMC4873921 DOI: 10.1017/s0022215116000591] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the evidence base pertaining to the management of metastatic neck disease in the setting of an unknown primary and provides recommendations on the work up and management for this group of patients receiving cancer care.
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21
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Fu TS, Foreman A, Goldstein DP, de Almeida JR. The role of transoral robotic surgery, transoral laser microsurgery, and lingual tonsillectomy in the identification of head and neck squamous cell carcinoma of unknown primary origin: a systematic review. J Otolaryngol Head Neck Surg 2016; 45:28. [PMID: 27142355 PMCID: PMC4855481 DOI: 10.1186/s40463-016-0142-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma of the head and neck can present as a cervical metastasis from an unknown primary site. Recently, transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) have been incorporated in the workup of unknown primary tumors. METHODS We searched MEDLINE, EMBASE, Cochrane, and CINAHL from inception to June 2015 for all English-language studies that utilized TORS, TLM, or lingual tonsillectomy in the approach to an unknown primary. RESULTS Of 217 identified studies, eight were reviewed. TORS/TLM identified the primary tumor in 111/139 (80 %) patients overall, and 36/54 (67 %) patients with no remarkable findings following physical exam, radiologic imaging, and panendoscopy with directed biopsies. Lingual tonsillectomy identified the primary tumor in 18/25 (72 %) patients with no findings. Hemorrhage (5 %) was the most common perioperative complication. CONCLUSION Lingual tonsillectomy using new approaches such as TORS/TLM may improve the identification of occult primary tumors.
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Affiliation(s)
- Terence S Fu
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Foreman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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22
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Human Papillomavirus and Head and Neck Cancer: Psychosocial Impact in Patients and Knowledge of the Link - A Systematic Review. Clin Oncol (R Coll Radiol) 2016; 28:421-439. [PMID: 26996812 PMCID: PMC4914608 DOI: 10.1016/j.clon.2016.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/22/2016] [Indexed: 12/14/2022]
Abstract
Head and neck cancer (HNC) currently affects approximately 11 200 people in the UK, with an increasing proportion known to be caused by the human papillomavirus (HPV). We undertook a systematic review of studies measuring the psychosocial impact of HPV-related HNC and also studies measuring knowledge about the link between HPV and HNC among different populations. Searches were conducted on MEDLINE, Embase, PsycINFO, CINAHL Plus and Web of Science, with reference and forward citation searches also carried out on included studies. Studies were selected if they (i) were original peer-reviewed research (qualitative or quantitative), (ii) mentioned HPV and HNC, (iii) measured an aspect of the psychosocial impact of the diagnosis of HPV-related HNC as the dependent variable and/or (iv) measured knowledge of the association between HPV and HNC. In total, 51 papers met the inclusion criteria; 10 measuring psychosocial aspects and 41 measuring knowledge of the link between HPV and HNC. Quality of life in those with HPV-positive HNC was found to be higher, lower or equivalent to those with HPV-negative HNC. Longitudinal studies found quality of life in patients was at its lowest 2–3 months after diagnosis and some studies found quality of life almost returned to baseline levels after 12 months. Knowledge of the link between HPV and HNC was measured among different populations, with the lowest knowledge in the general population and highest in medical and dental professionals. Due to the limited studies carried out with patients measuring the psychosocial impact of a diagnosis of HPV-positive HNC, future work is needed with the partners of HPV-positive HNC patients and health professionals caring for these patients. The limited knowledge of the association between HPV and HNC among the general population also indicates the need for research to explore the information that these populations are receiving.
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23
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Kang SY, Dziegielewski PT, Old MO, Ozer E. Transoral robotic surgery for carcinoma of unknown primary in the head and neck. J Surg Oncol 2015; 112:697-701. [PMID: 26437845 DOI: 10.1002/jso.24027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/17/2015] [Indexed: 11/09/2022]
Abstract
Multiple diagnostic and treatment paradigms exist for the management of carcinoma of unknown primary (CUP) metastatic to cervical lymph nodes. Transoral robotic surgery (TORS) has emerged as a modality for diagnosis and treatment of CUP, optimizing identification and resection of the primary tumor, although also preventing chemotherapy in a subset of patients. This article presents the authors' treatment paradigm and reviews the literature supporting the use of TORS in the management of CUP.
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Affiliation(s)
- Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Peter T Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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Aro K, Bäck L, Loimu V, Saarilahti K, Rogers S, Sintonen H, Roine R, Mäkitie A. Trends in the 15D health-related quality of life over the first year following diagnosis of head and neck cancer. Eur Arch Otorhinolaryngol 2015. [PMID: 26216625 DOI: 10.1007/s00405-015-3732-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Management of head and neck cancer influences both physical and mental wellbeing. Measuring the health-related quality of life (HRQoL) is important, as various treatment modalities are associated with significant morbidity and mortality. In this prospective cohort study, we tested the feasibility of the generic 15D HRQoL instrument in 214 head and neck cancer patients managed with surgery, definitive (chemo)radiotherapy, or with combined modality treatment. HRQoL was assessed at baseline and three times after treatment onset during 1 year, and compared with that of general population standardized for age and sex. At baseline, the patients' mean 15D score was significantly worse compared with general population. Overall HRQoL was at lowest at 3 months after treatment onset, it gradually improved towards 12 months but never reached baseline levels. The dimensions "vitality", "distress", "depression" and "sexual activity" showed marked deterioration at 3 months after the treatment onset, but improved gradually during 12 months. The 15D instrument seems useful for evaluation of HRQoL of head and neck cancer patients. Dimensions reflecting mental wellbeing improved gradually after 3 months, but they seldom reached baseline levels. The support for patients at the time of diagnosis, during treatment, and recovery is emphasized.
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Affiliation(s)
- K Aro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital (HUH), P.O. Box 220, 00029, Helsinki, Finland
| | - L Bäck
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital (HUH), P.O. Box 220, 00029, Helsinki, Finland
| | - V Loimu
- Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Saarilahti
- Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Rogers
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Liverpool, UK
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - R Roine
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital (HUH), P.O. Box 220, 00029, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden.
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Morisod B, Simon C. Meta-analysis on survival of patients treated with transoral surgery versus radiotherapy for early-stage squamous cell carcinoma of the oropharynx. Head Neck 2015; 38 Suppl 1:E2143-50. [DOI: 10.1002/hed.23995] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Benoît Morisod
- Service d'Oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire Vaudois (CHUV), Université Lausanne (UNIL); Lausanne Switzerland
| | - Christian Simon
- Service d'Oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire Vaudois (CHUV), Université Lausanne (UNIL); Lausanne Switzerland
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Diavolitsis V, Quon H. Treatment De-intensification in HPV-Associated Oropharyngeal Cancer: Evidence, Controversies, and Strategies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Transoral robotic surgery for oropharyngeal squamous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg 2015; 23:127-31. [DOI: 10.1097/moo.0000000000000136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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