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Chanda A, Krisciunas GP, Grillone GA. Correlating muscle resection with functional swallow outcomes: An anatomic framework informed systematic review of the literature. Am J Otolaryngol 2022; 43:103386. [PMID: 35158265 DOI: 10.1016/j.amjoto.2022.103386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To perform a systematic review of studies reporting swallow-associated outcomes in patients who received surgery for head and neck cancer (HNC), informed by an anatomic and physiologic framework of pharyngeal phase of swallowing (Pearson's dual-sling model). METHODS PUBMED and Google Scholar databases were searched for peer-reviewed papers published between 1990 and 2019 using relevant MeSH terms. Exclusion criteria were 1) discussions comparing reconstruction techniques, 2) case-report/series (n < 10), 3) perspective articles, 4) papers comparing objective instrumental methods of swallowing evaluation, 5) animal/cadaver studies, 6) no instrumental or validated swallow assessment tools used, 7) papers that discuss/include radiotherapy treatment, 8) systematic reviews, 9) papers that discuss swallow training or rehabilitation methods. Two investigators reviewed papers meeting inclusion/exclusions criteria. Muscles resected, anatomic resection site, swallow outcomes, and patient treatment variables were collected. RESULTS A total of 115,020 peer-reviewed papers were identified. 74 papers were relevant to this review, 18 met inclusion and exclusion criteria, and none discussed surgical impact on the pharyngeal phase of swallowing using Pearson's dual-sling model. Most papers discussed the effect of tongue-base, supraglottic, or regional anatomic resection. Post-surgical resection Follow-up times ranged from 1 to 13 months. 67% of studies used objective instrumental swallow studies; 22% used patient reported outcome measures. Follow up time since surgical resection, time to feeding tube removal, feeding tube present/absent, aspiration severity were used to define dysphagia endpoints. CONCLUSIONS To date, no surgical HNC studies have used the dual-sling mechanism to guide study design, and dysphagia assessment has been inconsistent. To counsel patients on the effects of surgery on pharyngeal phase of swallow function, specialists need physiologically grounded research that correlates muscles resected with consistent measures of swallow function.
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Affiliation(s)
- Anindita Chanda
- Touro College of Osteopathic Medicine, 60 Prospect Avenue, Middletown, NY 10940, United States.
| | - Gintas P Krisciunas
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States.
| | - Gregory A Grillone
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States.
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Maschio F, Lejuste P, Ilankovan V. Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years. Br J Oral Maxillofac Surg 2019; 57:101-115. [PMID: 30665664 DOI: 10.1016/j.bjoms.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. Only one was a randomised controlled trial, all the rest were prospective or retrospective case series. The heterogeneities in their characteristics made meta-analysis impossible and only qualitative analysis was feasible. We found no conclusive evidence to suggest the advantage of one therapeutic approach over another, so we still cannot offer patients the "ideal" treatment. We have, however, raised the possibility of there being two different entities: human papillomavirus (HPV)-positive and HPV-negative disease.
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Affiliation(s)
- F Maschio
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK; Department of Maxillofacial and Reconstructive Surgery, GHdC-Site Notre Dame, Grand'Rue 3, 6000 Charleroi, Belgium.
| | - P Lejuste
- Department of Maxillofacial and Reconstructive Surgery, GHdC-Site Notre Dame, Grand'Rue 3, 6000 Charleroi, Belgium.
| | - V Ilankovan
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK.
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Marzouki HZ, Biron VL, Dziegielewski PT, Ma A, Vaz J, Constantinescu G, Harris J, O'Connell D, Seikaly H. The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction. J Otolaryngol Head Neck Surg 2018; 47:58. [PMID: 30231911 PMCID: PMC6146510 DOI: 10.1186/s40463-018-0301-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/26/2018] [Indexed: 12/19/2022] Open
Abstract
Background To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC). Methods A retrospective review of a prospectively collected database of all patients with OPSCC diagnosed and treated from 1998 to 2009. Speech, swallowing, and quality of life data were gathered at 3 different evaluation points. HPV status was determined using p16 positivity as a surrogate marker. Univariate and multivariate statistical analyses were performed to identify whether p16 status is a significant predictor of functional outcome and QOL. Results One hundred twelve patients with OPSCC and known p16 status were treated with primary surgery between 1998 and 2009, with mean age of 56 years. Out of those patients 63 (56%) were p16 positive. Speech intelligibility remained high at 1-year post operation (95.4%). Only 11.5% of the patients required a feeding tube at 1 year after surgery to maintain their daily caloric requirements and the risk of aspiration after surgery was not significant (p = 0.097). There was no statistically or clinically significant difference in speech, swallowing ability, swallowing safety and QOL outcomes between p16-positive and negative OPSCC. Conclusions Surgically treated OPSCC patients demonstrate excellent swallowing function and can achieve excellent speech perception. P16 status may not be predictive of functional outcomes or QOL in surgically treated OPSCC.
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Affiliation(s)
- Hani Z Marzouki
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Otolaryngology, University of Florida, Florida, USA
| | - Andrew Ma
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Jason Vaz
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Gabriela Constantinescu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Daniel O'Connell
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and Alberta Health Services, 1E4.34, WMC 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
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Backes C, Bier H, Knopf A. Therapeutic implications of tumor free margins in head and neck squamous cell carcinoma. Oncotarget 2017; 8:84320-84328. [PMID: 29137426 PMCID: PMC5663598 DOI: 10.18632/oncotarget.21035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/05/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The resection status is one of the most important prognostic factors for patients with head and neck squamous cell carcinoma (HNSCC) concerning overall survival (OS) and recurrence free interval (RFI). To assess whether therapy concepts changed depending on different resection margins and extracapsular extension, OS and RFI data were set into clinical context. METHODS All HNSCC patients who underwent head and neck surgery with/without adjuvant therapy (n=534) were selected over a ten-year period (2001-2011). Clinical parameters and survival data were collected retrospectively and histopathological analysis of tumor free margins and extracapsular extension were done. RESULTS Patients with microscopic in-sano resection showed mean OS/RFI of 95/96 months. OS/RFI decreased in microscopic non-in-sano and macroscopic non-in-sano (56/58 and 35/39 months) as well as in unclear resection margins (63/60 months). Patients with extracapsular extension, microscopic non-in-sano resection as well as patients with in-sano resection after follow up resection demonstrated therapy escalation by adjuvant (chemo-) radiation. CONCLUSIONS Insufficient surgical margins and extracapsular extension are main risks for a reduced overall and recurrence free survival. Although there is no measure to prevent positive extracapsular extension, clear margins at first pass protect patients from adjuvant therapy escalation.
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Affiliation(s)
- Clara Backes
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
| | - Henning Bier
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
| | - Andreas Knopf
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
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