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Vermoet NCW, Weijs WLJ, van Bilsen MWT, Honings J. Pharyngo-cervicospinal fistula with destructive osteomyelitis after laryngopharyngectomy and radiotherapy, managed successfully with a vascularized fibula free flap. Int J Oral Maxillofac Surg 2024; 53:282-285. [PMID: 37813806 DOI: 10.1016/j.ijom.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
Total laryngectomy is an operation mainly employed in recurrent laryngeal and hypopharyngeal carcinoma after previous radiotherapy. The most feared complication after this procedure is a pharyngocutaneous fistula. An extremely rare complication is the development of osteomyelitis of the cervical spine, which is associated with high rates of neurological impairment and epidural empyema, often requiring surgical treatment. This report describes the case of a patient with neck and shoulder pain and progressive motor weakness of the left deltoid and biceps muscle, caused by a pharyngo-cervicospinal fistula with spinal empyema. This condition resulted in destructive osteomyelitis of the cervical spine. A successful reconstruction of the cervical spine and neopharynx was performed using a free vascularized fibula bone and skin graft in a complex area because of previous treatments. It appears that no similar case has been described previously.
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Affiliation(s)
- N C W Vermoet
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - W L J Weijs
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M W T van Bilsen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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Heirman AN, Dirven R, van der Molen L, Schreuder WH, Hoebers F, Honings J, Al-Mamgani A, de Bree R, Eerenstein SEJ, Halmos GB, van den Brekel MWM. The development of a decision aid for patients with operable oropharyngeal carcinoma in the Netherlands - A mixed methods study. Oral Oncol 2024; 149:106677. [PMID: 38142550 DOI: 10.1016/j.oraloncology.2023.106677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The aim of this project is to create an interactive online patient decision aid (PDA) for oropharyngeal cancer (OPSCC) patients, eligible for transoral (robotic) surgery with an ultimate goal to assist both physicians and patients in making treatment choices. MATERIALS AND METHODS Following the International Patient Decision Aid Standards, a mixed-methods approach was employed. The study involved semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and study-specific questionnaires. Thematic coding and analysis were conducted on verbatim transcriptions of audio-recorded interviews. RESULTS The PDA drafts were evaluated by twenty OPSCC survivors and twenty multidisciplinary specialists. Significant revisions were made after phase 1 to enhance readability and reduce text, whilst incorporating videos and graphics. Following all phases, both patients and specialists rated the PDA as comprehensible, feasible, and a valuable addition to regular counseling. CONCLUSION This study showcases the development of a PDA for early stage oropharyngeal cancer patients considering surgery and radiotherapy options. The decision aid emphasizes the disparities in short- and long-term side effects between the two treatments. Patients and physicians found the decision aid to be understandable, user-friendly, and helpful for future patients. The PDA is available on https://beslissamen.nl/.
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Affiliation(s)
- Anne N Heirman
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Richard Dirven
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Willem H Schreuder
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of MaxilloFacial Surgery, Amsterdam University Medical Center. Amsterdam, the Netherlands; Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, the Netherlands.
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3
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Leemans M, Longobardi Y, Dirven R, Honings J, D'Alatri L, Galli J, van den Brekel M, Parrilla C, van Sluis KE. Improving Hands-Free Speech Rehabilitation in Laryngectomized Patients with a Moldable Adhesive. Laryngoscope 2023; 133:2965-2970. [PMID: 36883657 DOI: 10.1002/lary.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients. METHODS Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study-specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands-free speech, use and duration of hands-free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability. RESULTS The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants' baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline. The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8-144 h) and improved comfort, fit, and ease of speech. CONCLUSION The moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands-free speech more regularly. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2965-2970, 2023.
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Affiliation(s)
- Maartje Leemans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Ylenia Longobardi
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucia D'Alatri
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Galli
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michiel van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
| | - Claudio Parrilla
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Klaske E van Sluis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Reerds STH, Honings J, van Engen ACH, Marres HAM, Takes RP, van den Hoogen FJA. Prioritizing parotid gland surgery: A call for the implementation of the MSRSGC classification. Cancer Cytopathol 2023; 131:701-707. [PMID: 37519238 DOI: 10.1002/cncy.22747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is developed to aid diagnosis and management of salivary gland tumors. This study evaluates the time-to-treatment initiation (TTI) for parotid gland tumors in the Netherlands and relates these to the MSRSGC classification. Subsequently, the use of the MSRSGC in the Netherlands is evaluated. METHODS Data regarding fine-needle aspiration cytology (FNAC) and histopathological resections of the parotid were gathered from the Dutch nationwide pathology data bank (PALGA). The TTI was calculated for each MSRSGC category and type of treating center. FNACs performed from 2018 to 2021 were gathered from PALGA to estimate how frequently the MSRSGC classification was applied. RESULTS Median TTI in days were 86 for nondiagnostic (MSRSGC I), 75 for nonneoplastic (MSRSGC II), 65 for atypia of unknown significance (AUS) (MSRSGC III), 89 for benign (MSRSGC IVa), 52 for salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), 31 for suspected malignant (MSRSGC V), and 30 for malignant (MSRSGC VI) categories. Significant variation in the TTI between the types of treating centers was found for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. In the first 3 years after the introduction of the MSRSGC, the pathologist stated the MSRSGC classification in 6.4% of all reports. CONCLUSIONS The median TTI for most categories is long, and there is significant interhospital variation in TTI. Preoperative risk stratification and treatment prioritization in parotid gland surgery in the Netherlands should be improved. The MSRSGC could contribute to this. Until 2021, the MSRSGS classification was implemented on a limited scale in the Netherlands.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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Driessen DAJJ, Arens AIJ, Dijkema T, Weijs WLJ, Draaijer LC, van den Broek GB, Takes RP, Honings J, Kaanders JHAM. Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy-guided tracer injection under topical anesthesia: A feasibility study. Head Neck 2023; 45:1359-1366. [PMID: 36942817 DOI: 10.1002/hed.27347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. METHODS Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra- and peritumoral [99m Tc]Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT-CT scans were performed at two time points. RESULTS Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4-16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT-CT. Most SLNs were visualized in neck levels II and III. CONCLUSIONS Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.
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Affiliation(s)
- Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne I J Arens
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem L J Weijs
- Department of Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lisette C Draaijer
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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Ebbers T, Takes RP, Honings J, Smeele LE, Kool RB, van den Broek GB. Development and validation of automated electronic health record data reuse for a multidisciplinary quality dashboard. Digit Health 2023; 9:20552076231191007. [PMID: 37529541 PMCID: PMC10388626 DOI: 10.1177/20552076231191007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective To describe the development and validation of automated electronic health record data reuse for a multidisciplinary quality dashboard. Materials and methods Comparative study analyzing a manually extracted and an automatically extracted dataset with 262 patients treated for HNC cancer in a tertiary oncology center in the Netherlands in 2020. The primary outcome measures were the percentage of agreement on data elements required for calculating quality indicators and the difference between indicators results calculated using manually collected and indicators that used automatically extracted data. Results The results of this study demonstrate high agreement between manual and automatically collected variables, reaching up to 99.0% agreement. However, some variables demonstrate lower levels of agreement, with one variable showing only a 20.0% agreement rate. The indicator results obtained through manual collection and automatic extraction show high agreement in most cases, with discrepancy rates ranging from 0.3% to 3.5%. One indicator is identified as a negative outlier, with a discrepancy rate of nearly 25%. Conclusions This study shows that it is possible to use routinely collected structured data to reliably measure the quality of care in real-time, which could render manual data collection for quality measurement obsolete. To achieve reliable data reuse, it is important that relevant data is recorded as structured data during the care process. Furthermore, the results also imply that data validation is conditional to development of a reliable dashboard.
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Affiliation(s)
- Tom Ebbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Rudolf B Kool
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Reerds STH, Hey SY, van den Hoogen FJA, Takes RP, Ganesh V, Marres HAM, Manickavasagam J, Honings J. Outpatient parotidectomy with or without the use of a post-operative drain: A retrospective bi-institutional study. Clin Otolaryngol 2022; 48:430-435. [PMID: 36585381 DOI: 10.1111/coa.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 10/10/2022] [Accepted: 12/10/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes. DESIGN Retrospective cohort study. SETTING Bi-institutional retrospective cohort study. PARTICIPANTS Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement. MAIN OUTCOME MEASURES Complication rates, unplanned post-operative visits, unplanned prolonged stay. RESULTS Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p < .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p = .16). CONCLUSIONS Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Shi Ying Hey
- Department of Otorhinolaryngology and Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Vaishnevy Ganesh
- Department of Otorhinolaryngology and Head and Neck Surgery, Ninewells Hospital, Dundee, UK.,NHS Tayside, University of Dundee, Dundee, UK
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Jaiganesh Manickavasagam
- Department of Otorhinolaryngology and Head and Neck Surgery, Ninewells Hospital, Dundee, UK.,NHS Tayside, University of Dundee, Dundee, UK
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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Kuut MH, Honings J, Marres HAM, Mourisse JMJ, Verhagen AFTM. Controlled mechanical ventilation through a narrow bore lumen during tracheal surgery: A prospective observational study. Eur J Anaesthesiol 2022; 39:835-837. [PMID: 35875915 DOI: 10.1097/eja.0000000000001717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marieke H Kuut
- From the Department of Anesthesia, Pain and Palliative Medicine (MHK, JMJM), the Department of Oto-Rhino-Laryngology and Head and Neck Surgery (JH, HAMM), and the Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands (AFTMV)
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Reerds STH, Uijen MJM, Van Engen-Van Grunsven ACH, Marres HAM, van Herpen CML, Honings J. Results of histopathological revisions of major salivary gland neoplasms in routine clinical practice. J Clin Pathol 2022; 76:374-378. [PMID: 35042756 DOI: 10.1136/jclinpath-2021-208072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/05/2022] [Indexed: 11/03/2022]
Abstract
AIMS Salivary gland neoplasms are rare and are characterised by overlapping histopathological aspects. Therefore, the assessment of the correct histopathological diagnosis can be challenging. This study evaluated the frequency of pathology consultations and revisions for salivary gland neoplasms during routine clinical practice in the Netherlands. Furthermore, the concordance and discordance rates of these revisions are presented. METHODS The Dutch Pathology Registry (PALGA) was searched for patients that underwent a resection of a major salivary gland neoplasm between 2006 and 2016. Frequencies of pathology consultations and revisions are presented and, in order to calculate the rates of concordance and discordance, the results of the initial histopathological review were compared with the results of the revision. RESULTS Between 2006 and 2016, 13 441 major salivary gland neoplasms were resected in the Netherlands. 90% (n=12 082) of these tumours were diagnosed as benign and 10% (n=1359) as malignant. The initial pathologist requested a consultation in 3.3% of resections (n=439). Revision of the histopathological specimen was performed in 2.6% (n=350) of cases. Revisions were discordant in 8.3%; including 5.8% of the initially benign diagnosed lesions reclassified as malignant by the second expert pathologist and 8% of the revised malignant tumours that underwent a subtype change. CONCLUSIONS The number of discordant histopathological revisions (8.3%) emphasises the complexity of the histopathological diagnosis of salivary gland neoplasms. An increase in consultations may improve the accuracy of the initial diagnosis and thus treatment in salivary gland tumours while lowering the need for revisions and the number of discordant revisions.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maike J M Uijen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Reerds STH, van Engen-van Grunsven ACH, van den Hoogen FJA, Takes RP, Marres HAM, Honings J. Validation of the Milan System for Reporting Salivary Gland Cytopathology and the diagnostic accuracy of FNA cytology for submandibular gland lesions. Cancer Cytopathol 2021; 130:189-194. [PMID: 34847276 PMCID: PMC9299941 DOI: 10.1002/cncy.22532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Milan System for Salivary Gland Cytopathology (MSRSGC) is a categorical system for salivary gland fine-needle aspiration cytopathology (FNAC) developed to aid clinicians in the management of salivary gland lesions. This classification is widely studied and validated, especially in cohorts that consist of mostly parotid gland lesions. However, only sparse literature describes the use of this classification for submandibular gland lesions in particular. METHODS All patients in the Netherlands that underwent a submandibular gland resection between January 1, 2006, and January 1, 2017, with a FNAC before resection were identified with the use of the Dutch Pathology Registry database (PALGA). All FNAC results were retrospectively classified according to the MSRSGC. The risk of malignancy was calculated for all the MSRSGC categories. The sensitivity and specificity of the MSRSGC classification were calculated for submandibular gland FNAC. RESULTS A total of 837 patients who underwent 975 FNAC aspirates from the submandibular glands were included in the analysis. Risks of malignancy for each of the MSRSGC categories were 14.4% in nondiagnostic, 4.4% in nonneoplastic, 37.0% in atypia of unknown significance, 3.9% in benign neoplasms, 40.7% in salivary gland neoplasms of unknown malignant potential, 76.2% in suspected malignant, and 91.3% in malignant cytology results. The sensitivity for diagnosing malignant submandibular gland tumors was 71.6% and specificity was 98.4%. CONCLUSIONS The results of the present study validate the use of this classification for submandibular gland lesions. Risks of malignancy vary according to the anatomical subsites of the salivary gland lesions. LAY SUMMARY The risks of malignancy of the various Milan System for Salivary Gland Cytopathology (MSRSGC) categories vary according to the anatomical subsite of the salivary gland lesion. The proposed management techniques of the MSRSGC are valid for use with submandibular gland lesions.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | | | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
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Reerds STH, Gerdsen M, van den Hoogen FJA, Takes RP, van den Broek GB, Vallen HGGJ, Marres HAM, Honings J. Surgical management of deep lobe parotid tumours with and without involvement of the parapharyngeal space. Int J Oral Maxillofac Surg 2021; 51:762-767. [PMID: 34782202 DOI: 10.1016/j.ijom.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/14/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
The diagnosis and treatment of deep lobe parotid tumours is challenging because of the complex surgical accessibility. There is a lack of studies describing the differences between deep lobe tumours that do and do not occupy the parapharyngeal space (PPS). Patients treated for deep lobe tumours occupying the PPS (PPS group) and not occupying the PPS (non-PPS group) were analysed retrospectively. A total of 227 patients were treated surgically for deep lobe parotid tumours between 1990 and 2019. Sixty patients (26.4%) presented with tumours that involved the PPS (PPS group), while 167 (73.6%) presented with tumours that did not occupy the PPS (non-PPS group). The majority of the PPS group tumours were removed using a transcervical or transcervical-transparotid approach. PPS group tumours were larger (P < 0.001), and tumour spill occurred more frequently in this group (benign tumours: P = 0.002; malignant tumours: P = 0.033). Complication rates did not differ between the PPS and non-PPS groups. A transcervical or transcervical-transparotid approach is the preferred method for the management of deep lobe parotid tumours that occupy the PPS in our practice. Tumour spill occurred more frequently in the PPS group, which is most probably due to the larger tumour size and more complex accessibility.
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Affiliation(s)
- S T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands.
| | - M Gerdsen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - F J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - R P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - G B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - H G G J Vallen
- Department of Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands
| | - H A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - J Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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12
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van der Hout A, van Uden-Kraan C, Holtmaat K, Jansen F, Lissenberg-Witte B, Nieuwenhuijzen G, Hardillo J, Baatenburg de Jong R, Tiren-Verbeet N, Sommeijer D, de Heer K, Schaar C, Sedee R, Bosscha K, van den Brekel M, Petersen J, Westerman M, Honings J, Takes R, Houtenbos I, van den Broek W, de Bree R, Jansen P, Eerenstein S, Leemans C, Zijlstra J, Cuijpers P, van de Poll-Franse L, Verdonck-de Leeuw I. Reasons for not reaching or using web-based self-management applications, and the use and evaluation of Oncokompas among cancer survivors, in the context of a randomised controlled trial. Internet Interv 2021; 25:100429. [PMID: 34401388 PMCID: PMC8350584 DOI: 10.1016/j.invent.2021.100429] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/22/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The web-based self-management application Oncokompas was developed to support cancer survivors to monitor health-related quality of life and symptoms (Measure) and to provide tailored information (Learn) and supportive care options (Act). In a previously reported randomised controlled trial (RCT), 68% of 655 recruited survivors were eligible, and of those 45% participated in the RCT. Among participants of the RCT that were randomised to the intervention group, 52% used Oncokompas as intended. The aim of this study was to explore reasons for not participating in the RCT, and reasons for not using Oncokompas among non-users, and the use and evaluation of Oncokompas among users. METHODS Reasons for not participating were assessed with a study-specific questionnaire among 243 survivors who declined participation. Usage was investigated among 320 participants randomised to the intervention group of the RCT via system data and a study-specific questionnaire that was assessed during the 1 week follow-up (T1) assessment. RESULTS Main reasons for not participating were not interested in participation in scientific research (40%) and not interested in scientific research and Oncokompas (28%). Main reasons for not being interested in Oncokompas were wanting to leave the period of being ill behind (29%), no symptom burden (23%), or lacking internet skills (18%). Out of the 320 participants in the intervention group 167 (52%) used Oncokompas as intended. Among 72 non-users, main reasons for not using Oncokompas were no symptom burden (32%) or lack of time (26%). Among 248 survivors that activated their account, satisfaction and user-friendliness were rated with a 7 (scale 0-10). Within 3 (IQR 1-4) sessions, users selected 32 (IQR 6-37) topics. Main reasons for not using healthcare options in Act were that the information in Learn was already sufficient (44%) or no supportive care needs (32%). DISCUSSION Main reasons for not reaching or using Oncokompas were no symptom burden, no supportive care needs, or lack of time. Users selected many cancer-generic and tumour-specific topics to address, indicating added value of the wide range of available topics.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - C.F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - B.I. Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | | | - J.A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R.J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N.L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - D.W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - C.G. Schaar
- Department of Internal Medicine, Gelre ziekenhuis, Apeldoorn, the Netherlands
| | - R.J.E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, the Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - M.W.M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J.F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, the Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R.P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - S.E.J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - C.R. Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - J.M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - L.V. van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, the Netherlands
- CoRPS - Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - I.M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
- Corresponding author at: Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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13
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Reerds STH, Van Engen-Van Grunsven ACH, van den Hoogen FJA, Takes RP, Marres HAM, Honings J. Accuracy of parotid gland FNA cytology and reliability of the Milan System for Reporting Salivary Gland Cytopathology in clinical practice. Cancer Cytopathol 2021; 129:719-728. [PMID: 33908189 PMCID: PMC8453933 DOI: 10.1002/cncy.22435] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Background Differentiating between malignant and benign salivary gland tumors with fine‐needle aspiration cytology (FNAC) can be challenging. This study was aimed at testing the validity of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and at assessing possible differences in the sensitivity and specificity of parotid gland FNAC between dedicated head and neck (H&N) centers, subdivided into head and neck oncology centers (HNOCs) and head and neck oncology affiliated centers (HNOACs), and general hospitals (GHs). Methods The Dutch Pathology Registry (PALGA) database was searched for patients who had undergone a salivary gland resection between January 1, 2006, and January 1, 2017, and had a preoperative FNAC result. The FNAC reports were retrospectively assigned to MSRSGC categories. The risk of malignancy (ROM) was calculated for each category. The sensitivity and specificity for diagnosing malignancy were calculated and compared among HNOCs, HNOACs, and GHs. Results In all, 12,898 FNAC aspirates were evaluated. The ROMs for each category were as follows: 12.5% in MSRSGC I, 10.3% in MSRSGC II, 29% in MSRSGC III, 2.3% in MSRSGC IVa, 28.6% in MSRSGC IVb, 83% in MSRSGC V, and 99.3% in MSRSGC VI. The sensitivity of FNAC was highest in HNOCs (88.1%), HNOACs scored lower (79.7%), and GHs had a sensitivity of 75.0%. Conclusions The MSRSGC is a valid tool for reporting parotid gland FNAC; therefore, these results strongly advocate its use. On the basis of the higher sensitivity of FNAC in dedicated H&N centers, the authors recommend that GHs use the presented management strategies to help to minimize the chances of a preoperative misdiagnosis. The Milan System for Reporting Salivary Gland Cytopathology is a valid tool for reporting parotid gland fine‐needle aspiration cytology. The sensitivity of fine‐needle aspiration cytology is higher at dedicated head and neck centers.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | | | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, the Netherlands
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14
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Jansen F, Coupé VMH, Eerenstein SEJ, Cnossen IC, van Uden-Kraan CF, de Bree R, Doornaert P, Halmos GB, Hardillo JAU, van Hinte G, Honings J, Leemans CR, Verdonck-de Leeuw IM. Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. Oral Oncol 2021; 117:105306. [PMID: 33905913 DOI: 10.1016/j.oraloncology.2021.105306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC. MATERIALS AND METHODS Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping. RESULTS Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0-100 scale). CONCLUSION ITwC is likely to be effective, but possibly at higher expenses. TRIAL REGISTRATION NTR5255.
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Affiliation(s)
- Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Clinical Psychology, Amsterdam Public Health, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - José A U Hardillo
- Department of Otorhinolaryngology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Gerben van Hinte
- Department of Rehabilitation, Radboud University Medical Center Nijmegen, Netherlands, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Clinical Psychology, Amsterdam Public Health, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
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15
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van der Hout A, Holtmaat K, Jansen F, Lissenberg-Witte BI, van Uden-Kraan CF, Nieuwenhuijzen GAP, Hardillo JA, Baatenburg de Jong RJ, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. The eHealth self-management application 'Oncokompas' that supports cancer survivors to improve health-related quality of life and reduce symptoms: which groups benefit most? Acta Oncol 2021; 60:403-411. [PMID: 33345659 DOI: 10.1080/0284186x.2020.1851764] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oncokompas is a web-based self-management application that supports cancer survivors to monitor their health-related quality of life (HRQOL) and symptoms, and to obtain personalised feedback and tailored options for supportive care. In a large randomised controlled trial among survivors of head and neck cancer, colorectal cancer, and breast cancer and (non-)Hodgkin lymphoma, Oncokompas proved to improve HRQOL, and to reduce several tumour-specific symptoms. Effect sizes were however small, and no effect was observed on the primary outcome patient activation. Therefore, this study aims to explore which subgroups of cancer survivors may especially benefit from Oncokompas. MATERIALS AND METHODS Cancer survivors (n = 625) were randomly assigned to the intervention group (access to Oncokompas, n = 320) or control group (6 months waiting list, n = 305). Outcome measures were HRQOL, tumour-specific symptoms, and patient activation. Potential moderators included socio-demographic (sex, age, marital status, education, employment), clinical (tumour type, stage, time since diagnosis, treatment modality, comorbidities), and personal factors (self-efficacy, personal control, health literacy, Internet use), and patient activation, mental adjustment to cancer, HRQOL, symptoms, and need for supportive care, measured at baseline. Linear mixed models were performed to investigate potential moderators. RESULTS The intervention effect on HRQOL was the largest among cancer survivors with low to moderate self-efficacy, and among those with high personal control and those with high health literacy scores. Cancer survivors with higher baseline symptom scores benefitted more on head and neck (pain in the mouth, social eating, swallowing, coughing, trismus), and colorectal cancer (weight) specific symptoms. DISCUSSION Oncokompas seems most effective in reducing symptoms in head and neck cancer and colorectal cancer survivors who report a higher burden of tumour-specific symptoms. Oncokompas seems most effective in improving HRQOL in cancer survivors with lower self-efficacy, and in cancer survivors with higher personal control, and higher health literacy.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B. I. Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | | | - J. A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R. J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N. L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D. W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, The Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C. G. Schaar
- Department of Internal Medicine, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - R. J. E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, The Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | - M. W. M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, The Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - S. E. J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. R. Leemans
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J. M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L. V. van de Poll-Franse
- CoRPS – Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I. M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Schimberg AS, Wellenstein DJ, Schutte HW, Honings J, Marres HAM, Takes RP, van den Broek GB. Feasibility and Safety of Office-Based Transnasal Balloon Dilation for Neopharyngeal and Proximal Esophageal Strictures in Patients with a History of Head and Neck Carcinoma. Dysphagia 2021; 37:93-98. [PMID: 33689024 PMCID: PMC8844154 DOI: 10.1007/s00455-021-10253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess feasibility and safety of office-based transnasal balloon dilation of neopharyngeal and proximal esophageal strictures in patients with a history of head and neck carcinoma. The secondary objective was to explore its effectiveness. This prospective case series included patients previously treated for head and neck carcinoma with neopharyngeal or proximal esophageal strictures who underwent transnasal balloon dilation under topical anesthesia. The target dilation diameter was 15 mm; if necessary dilation procedures were repeated every 2–4 weeks until this target was reached. Completion rates, adverse events, and patient experiences measured by VAS scores (0 = no complaints – 10 = unbearable complaints), dysphagia scores based on food consistency (0 = no dysphagia – 5 = unable to swallow liquids/saliva), and self-reported changes in swallowing symptoms were recorded. Follow-up was 2 months. Twenty-six procedures were performed in 12 patients, with a completion rate of 92%. One minor complication occurred, i.e. an infection of the dilation site. Tolerance of the procedure was good (median VAS = 2). The dysphagia score improved after a mean of 2.2 procedures per patient, however not significantly. Eight patients reported improvement in dysphagia, of whom 3 had recurrence of dysphagia within 1 month post-treatment. Office-based transnasal balloon dilation is a feasible and safe in-office procedure which is well-tolerated by patients. The dilations can improve dysphagia, although effects might be transient.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - J Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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17
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Lassche G, van Engen-van Grunsven ACH, Honings J, Dijkema T, Weijs WLJ, van Herpen CML. [Salivary gland carcinoma]. Ned Tijdschr Geneeskd 2020; 164:D4760. [PMID: 32779918] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Salivary gland cancer is a malignancy that arises in the head and neck area. It is not only rare but its clinical course is also very heterogeneous. A total of 22 different subtypes can be distinguished, the symptoms, treatment and prognosis of which may differ greatly. This means that both the diagnosis and treatment of the disease are prone to error. This is illustrated by two cases: a 62-year-old man with a salivary duct carcinoma, and a 56-year-old man with an adenoid cystic carcinoma. These cases are used to illustrate the advances that have been made in the treatment of salivary gland cancer.
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Affiliation(s)
- G Lassche
- Radboudumc, afd. Medische Oncologie, Nijmegen
| | | | - J Honings
- Radboudumc, afd. Keel-Neus-Oorheelkunde, Nijmegen
| | - T Dijkema
- Radboudumc, afd. Radiotherapie, Nijmegen
| | - W L J Weijs
- Radboudumc, afd. Mond-Kaak-Aangezichtschirurgie, Nijmegen
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18
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van der Hout A, Jansen F, van Uden-Kraan CF, Coupé VM, Holtmaat K, Nieuwenhuijzen GA, Hardillo JA, de Jong RJB, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. Cost-utility of an eHealth application 'Oncokompas' that supports cancer survivors in self-management: results of a randomised controlled trial. J Cancer Surviv 2020; 15:77-86. [PMID: 32656739 PMCID: PMC7822793 DOI: 10.1007/s11764-020-00912-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
Purpose The eHealth self-management application ‘Oncokompas’ was developed to support cancer survivors in monitoring health-related quality of life (HRQOL) and symptoms, and obtaining personalized feedback and options for supportive care. The aim of this study was to assess the cost-utility of Oncokompas compared with care as usual (CAU) among cancer survivors. Methods Survivors were randomly allocated to the intervention or control group. Direct (non-)medical, indirect non-medical costs, and HRQOL were measured at 3- and 6-month follow-up, using iMTA Medical Consumption and Productivity Costs and the EuroQol-5D questionnaires. Mean cumulative costs and quality-adjusted life-years (QALYs) were compared between both groups. Results In total, 625 survivors were randomized into intervention (n = 320) or control group (n = 305). Base case analysis showed that incremental costs from a societal perspective were − €163 (95% CI, − 665 to 326), and incremental QALYs were 0.0017 (95% CI, − 0.0121 to 0.0155) in the intervention group compared with those in the control group. The probability that, compared with CAU, Oncokompas is more effective was 60%, less costly 73%, and both more effective and less costly 47%. Sensitivity analyses showed that incremental costs vary between − €40 and €69, and incremental QALYs vary between − 0.0023 and − 0.0057. Conclusion Oncokompas is likely to be equally effective on utilities, and not more expensive than CAU, and will therefore contribute to sustainable cancer survivorship care in a (cost-)effective manner. Implications for Cancer Survivors Oncokompas seems to improve HRQOL and reduces the burden of several tumour-specific symptoms, while costs from a societal perspective are similar to CAU. Electronic supplementary material The online version of this article (10.1007/s11764-020-00912-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - F Jansen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C F van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - V M Coupé
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - K Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - J A Hardillo
- Department of Otolaryngology and Head and Neck Surgery, ErasmusMC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, ErasmusMC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N L Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D W Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C G Schaar
- Department of Internal Medicine, Gelre ziekenhuis, Apeldoorn, The Netherlands
| | - R J E Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J F Petersen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, The Netherlands
| | - J Honings
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R P Takes
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - R de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - P Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - S E J Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C R Leemans
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J M Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - L V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
- Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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19
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Schutte HW, van den Broek GB, Steens SCA, Hermens RPMG, Honings J, Marres HAM, Merkx MAW, Weijs WLJ, Arens AIJ, van Engen-van Grunsven ACH, van Herpen CML, Kaanders JHAM, van den Hoogen FJA, Takes RP. Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer. Cancer 2020; 126:3982-3990. [PMID: 32634271 PMCID: PMC7496336 DOI: 10.1002/cncr.33037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/07/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022]
Abstract
Background Timely and efficient diagnostic workup of patients with head and neck cancer (HNC) is challenging. This observational study describes the implementation of an optimized multidisciplinary oncological diagnostic workup for patients with HNC and its impact on diagnostic and treatment intervals, survival, costs, and patient satisfaction. Methods All patients with newly diagnosed HNC who underwent staging and treatment at the Radboud University Medical Center were included. Conventional workup (CW) in 2009 was compared with the fast‐track, multidisciplinary, integrated care program, that is, optimized workup (OW), as implemented in 2014. Results The study included 486 patients with HNC (218 with CW and 268 with OW). The time‐to‐treatment interval was significantly lower in the OW cohort than the CW cohort (21 vs 34 days; P < .0001). The 3‐year overall survival rate was 12% higher after OW (72% in the CW cohort vs 84% in the OW cohort; P = .002). After correction for confounders, the 3‐year risk of death remained significantly lower in the OW cohort (hazard ratio, 1.73; 95% confidence interval, 1.14‐2.63; P = .010). Total diagnostic costs were comparable in the 2 cohorts. The general satisfaction score, as measured with the Consumer Quality Index for Oncological Care, was significantly better in a matched OW group than the CW group (9.1 vs 8.5; P = .007). Conclusions After the implementation of a fast‐track, multidisciplinary, integrated care program, the time‐to‐treatment interval was significantly reduced. Overall survival and patient satisfaction increased significantly, whereas costs did not change. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of HNC management. After the implementation of a fast‐track, multidisciplinary, integrated care program for patients with head and neck cancer, this study shows a significant reduction in the time‐to‐diagnosis and time‐to‐treatment intervals, a significant increase in 3‐year overall survival, and an increase in patient satisfaction without increased diagnostic costs. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of head and neck cancer management.
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Affiliation(s)
- Henrieke W Schutte
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan C A Steens
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem L J Weijs
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne I J Arens
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Carla M L van Herpen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Oppelaar MC, Zijtveld C, Kuipers S, Ten Oever J, Honings J, Weijs W, Wertheim HFL. Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 145:610-616. [PMID: 31070697 DOI: 10.1001/jamaoto.2019.0879] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance Antibiotic prophylaxis is widely used after surgical procedures operating on the mucosal tissues of the aerodigestive tract, but the optimal duration of these prophylactic therapies is often unclear. Objective To compare short-course antibiotic prophylaxis (≤24 hours) vs extended-course antibiotic prophylaxis (≥72 hours) after ear, nose, throat, and oral and maxillofacial surgery. Data Sources and Study Selection Literature searches of PubMed were completed in October 2017 and included prospective trials that compared antibiotic prophylaxis courses of 24 hours or less vs 72 hours or more after ear, nose, throat, and oral and maxillofacial surgery. Some studies were also handpicked from reference lists of studies found with the initial search terms. All analysis was performed between September 2017 and October 2018. Data Extraction and Synthesis All review stages were conducted in consensus by 2 reviewers. Data extraction and study quality assessment were performed with the Cochrane data extraction form and the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. The fixed-effects Mantel-Haenszel method was used for meta-analysis. Main Outcomes and Measures Relative risk (RR) of surgical site infections, microbial origins of surgical site infections, adverse events, duration of hospital stay, and treatment costs. Results Included in the meta-analysis were 21 articles with a cumulative 1974 patients. In patients receiving 24 hours or shorter vs 72 hours or longer antibiotic prophylaxis regimens, no significant difference was found in the occurrence of postoperative infections in the pooled population (RR, 0.90; 95% CI, 0.67-1.19), or in the ear, nose, throat (RR, 0.89; 95% CI, 0.54-1.45), and oral and maxillofacial populations (RR, 0.88; 95% CI, 0.63-1.21), separately. No heterogeneity was observed overall or in the subgroups. Patients receiving extended-course antibiotic prophylaxis were significantly more likely to develop adverse events unrelated to the surgical site (RR, 2.40; 95% CI, 1.20-3.54). Conclusions and Relevance No difference was found in the occurrence of postoperative infections between short-course and extended-course antibiotic prophylaxis after ear, nose, throat, and oral and maxillofacial surgery. Therefore, a short course of antibiotic prophylaxis is recommended unless documented conditions are present that would be best treated with an extended course. Using short-course antibiotics could avoid additional adverse events, antibiotic resistance development, and higher hospital costs. Future research should focus on identifying risk groups that might benefit from prolonged prophylaxis.
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Affiliation(s)
- Martinus C Oppelaar
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christian Zijtveld
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Saskia Kuipers
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaap Ten Oever
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Division of Ear, Nose, and Throat Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem Weijs
- Division of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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21
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Affiliation(s)
- Tim Willegers
- Radboud University/Radboud University Medical Center
| | - Jimmie Honings
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Stijn Bekkers
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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22
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Schimberg AS, Wellenstein DJ, Schutte HW, Honings J, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Flexible Endoscopic Biopsy: Identifying Factors to Increase Accuracy in Diagnosing Benign and Malignant Laryngopharyngeal Pathology. J Voice 2020; 36:128-133. [PMID: 32434679 DOI: 10.1016/j.jvoice.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the influence that several factors, such as the amount of obtained biopsies, difficult procedures, biopsy site and the experience of the attending physician, have on accuracy of flexible endoscopic biopsy (FEB). MATERIALS AND METHODS 203 FEB procedures for benign or malignant laryngopharyngeal lesions were prospectively included. During the procedure, three representative biopsies (macroscopically containing vital tumor tissue and not only necrosis or healthy tissue) were obtained. The accuracy of each biopsy was separately analyzed. Difficulties during the procedures leading to failure of acquiring three representative biopsies were recorded and classified into tumor, patient and procedural factors. Histological results of FEB were defined correct when consistent with clinical context, additional biopsies or Positron emission tomography-computed tomography (PET-CT) revealed equivalent pathology, or the lesion was stable or resolved in >6 months follow-up. RESULTS The first representative biopsy yielded a correct diagnosis in 65% of the cases. After the second representative biopsy, 78% was correctly diagnosed. The contribution of the third and fourth representative biopsies to accuracy was 3%. The overall accuracy of FEB was 85%. Difficult procedures were more likely to result in misdiagnosis, whereas biopsy site or experience of the attending physician did not influence results. CONCLUSIONS FEB was accurate in diagnosing laryngopharyngeal lesions when at least two representative biopsies were obtained. Accuracy of FEB could be further improved by limiting possible constraints during the procedures, for example by selecting, informing, and anesthetizing patients carefully.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Jansen F, Eerenstein SEJ, Cnossen IC, Lissenberg-Witte BI, de Bree R, Doornaert P, Halmos GB, Hardillo JAU, van Hinte G, Honings J, van Uden-Kraan CF, Leemans CR, Verdonck-de Leeuw IM. Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. Oral Oncol 2020; 103:104586. [PMID: 32045734 DOI: 10.1016/j.oraloncology.2020.104586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/16/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). MATERIALS AND METHODS This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness. RESULTS Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness. CONCLUSION The guided self-help exercise program improves swallowing and communication. TRIAL REGISTRATION NTR5255.
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Affiliation(s)
- Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Cancer Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - José A U Hardillo
- Department of Otorhinolaryngology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Gerben van Hinte
- Department of Rehabilitation, Radboud University Medical Center Nijmegen, Netherlands, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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24
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Schimberg AS, Klabbers TM, Wellenstein DJ, Heutink F, Honings J, van Engen-Van Grunsven I, Verdaasdonk RM, Takes RP, van den Broek GB. Optimizing Settings for Office-Based Endoscopic CO 2 Laser Surgery Using an Experimental Vocal Cord Model. Laryngoscope 2020; 130:E680-E685. [PMID: 32022931 PMCID: PMC7687150 DOI: 10.1002/lary.28518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS To provide insight in the thermal effects of individual laser settings in target tissues to optimize flexible endoscopic CO2 laser surgery treatment. STUDY DESIGN Experimental laboratory study. METHODS Thermal effects of the CO2 laser using a fiber delivery system were visualized using the color Schlieren technique in combination with a polyacrylamide gel tissue model. Variable settings were used for emission mode, power, laser fiber distance, and laser duration, which were evaluated in every possible combination. Collateral thermal expansion and incision depth were measured. To validate the model, the results were compared to histology after CO2 laser irradiation of ex vivo human vocal cords, and the intraclass correlation coefficient was calculated. Thermal damage and incision depth were measured by a blinded pathologist. RESULTS Of all parameters studied, duration of laser irradiation had the greatest effect on thermal expansion. Increased distance between laser tip and target tissue resulted in significantly reduced incision depth and increased thermal expansion. Pulsed emission modes led to increased incision depths. The intraclass correlation coefficient for consistency between the model setup and the ex vivo human vocal cords was classified as "fair." CONCLUSIONS By using high-intensity pulsed lasers at minimal distance to the target tissue, exposure times and subsequent damage to surrounding tissue can be reduced. If an evaporation technique is used, lower power in continuous wave at a larger distance to the target tissue will lead to superficial but broader thermal effects. The model setup used in this study is a valid model to investigate laser-induced thermal effects in vocal cord tissue. LEVEL OF EVIDENCE NA Laryngoscope, 130:E680-E685, 2020.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim M Klabbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris Heutink
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rudolf M Verdaasdonk
- Department of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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van der Hout A, van Uden-Kraan CF, Holtmaat K, Jansen F, Lissenberg-Witte BI, Nieuwenhuijzen GAP, Hardillo JA, Baatenburg de Jong RJ, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. Role of eHealth application Oncokompas in supporting self-management of symptoms and health-related quality of life in cancer survivors: a randomised, controlled trial. Lancet Oncol 2020; 21:80-94. [DOI: 10.1016/s1470-2045(19)30675-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022]
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Wellenstein DJ, Honings J, Schimberg AS, Schutte HW, Herruer JM, van den Hoogen FJA, Takes RP, van den Broek GB. Office-based CO 2 laser surgery for benign and premalignant laryngeal lesions. Laryngoscope 2019; 130:1503-1507. [PMID: 31498454 PMCID: PMC7318140 DOI: 10.1002/lary.28278] [Citation(s) in RCA: 11] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
Objective Patients with laryngeal pathology are often treated with CO2 laser surgery, usually in the operating room under general anesthesia. Although office‐based laser surgery using several other laser types has been investigated, prospective studies on office‐based CO2 laser surgery are scarce. Our goal was to investigate the feasibility of office‐based CO2 laser surgery for benign and premalignant laryngeal pathology by analyzing completion rate, safety, effect on voice quality, and success rate (i.e., no residual or recurrent disease). Methods A prospective cohort study was performed of 30 consecutive procedures. Inclusion started in June 2016 and was completed in August 2018. Adult patients with clinically benign or premalignant laryngeal lesions who could not undergo transoral laser microsurgery in the operating room under general anesthesia were included. Reasons were either contraindications for general anesthesia, previously failed therapeutic laryngoscopy under general anesthesia, and preference of a procedure under topical anesthesia by the patient. The mean follow‐up was 9 months. Results Thirty procedures were performed in 27 patients (24 males) with an average age of 62 years. Twenty‐nine (97%) procedures were fully completed without complications. The mean preoperative Voice Handicap Index (VHI) score (VHI 44) significantly decreased 2 months (VHI 28, P = 0.032) and 6 months (VHI 14, P < 0.001) after the procedure. Almost two‐thirds of patients showed no residual or recurrent disease at their follow‐up visits. Conclusion Office‐based CO2 laser surgery is a feasible and safe procedure that results in significant voice‐quality improvement. Almost two‐thirds of patients did not require further treatment. Level of Evidence 2 Laryngoscope, 130:1503–1507, 2020
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Affiliation(s)
- David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jasmijn M Herruer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Schimberg AS, Wellenstein DJ, van den Broek EM, Honings J, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences. Eur Arch Otorhinolaryngol 2019; 276:2963-2973. [PMID: 31486936 PMCID: PMC6811667 DOI: 10.1007/s00405-019-05617-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
Purpose Office-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings. Methods PubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed. Results Of 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial. Conclusion Office-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia. Electronic supplementary material The online version of this article (10.1007/s00405-019-05617-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anouk S Schimberg
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Eline M van den Broek
- Center for Health Services Research, Larner College of Medicine, University of Vermont, Burlington, USA
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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Wellenstein DJ, Honings J, Schutte HW, Herruer JM, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Cost analysis of office-based transnasal esophagoscopy. Eur Arch Otorhinolaryngol 2019; 276:1457-1463. [PMID: 30806806 PMCID: PMC6458968 DOI: 10.1007/s00405-019-05357-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 12/23/2022]
Abstract
Purpose Although office-based transnasal esophagoscopy has been investigated extensively, a cost analysis is still lacking. We performed a cost analysis combined with feasibility study for two diagnostic processes: patients with globus pharyngeus and/or dysphagia, and hypopharyngeal carcinoma. Methods Prospective cohort study. Results Forty-one procedures were performed, of which 35 were fully completed. The procedure was well tolerated with mild complaints such as nasal or pharyngeal pain and burping. Four complications occurred: two minor epistaxis and two vasovagal reactions. In patients with globus pharyngeus and/or dysphagia, transnasal esophagoscopy resulted in a cost saving of €94.43 (p 0.026) per procedure, compared to our regular diagnostic process. In patients with suspicion of hypopharyngeal carcinoma, cost savings were €831.41 (p 0.000) per case. Conclusions Cost analysis showed that office-based transnasal esophagoscopy can provide significant cost savings for the current standard of care. Furthermore, this procedure resulted in good patient acceptability and few complications.
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Affiliation(s)
- David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands.
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Jasmijn M Herruer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
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Nelissen RC, Honings J, Meijer FJA, Kunst HPM, Ingels KJAO. [Consider the diagnosis 'Bell's palsy' carefully]. Ned Tijdschr Geneeskd 2019; 163:D2594. [PMID: 30698366] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients with facial palsy present with both cosmetic and functional symptoms. When a facial palsy develops quickly (within 72 hours) with no other symptoms, and no cause can be identified, it is probably an idiopathic facial palsy or 'Bell's palsy'. The diagnosis Bell's palsy is, thus, to a certain extent a diagnosis 'per exclusionem'. We present three cases with an incorrectly diagnosed Bell's palsy or inadequate diagnostics or treatment: a 5-year-old male with recurrent facial palsy caused by acute otitis media; a 46-year-old male with facial palsy caused by a malignant parotid tumour; and a 75-year-old female with facial palsy caused by a facial nerve schwannoma in the mastoid segment of the facial nerve. We, therefore, emphasize the importance of thorough history-taking and adequate diagnostics and imaging when patients present with facial palsy.
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Affiliation(s)
- Rik C Nelissen
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
- Contact: R.C. Nelissen
| | - Jimmie Honings
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
| | | | - H P M Kunst
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
| | - Koen J A O Ingels
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
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Schutte HW, Takes RP, Slootweg PJ, Arts MJ, Honings J, van den Hoogen FJ, Marres HA, van den Broek GB. Digital Video Laryngoscopy and Flexible Endoscopic Biopsies as an Alternative Diagnostic Workup in Laryngopharyngeal Cancer: A Prospective Clinical Study. Ann Otol Rhinol Laryngol 2018; 127:770-776. [DOI: 10.1177/0003489418793987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives: An office-based workup strategy for patients with laryngopharyngeal lesions suspicious for carcinoma is analyzed. The feasibility of office-based transnasal flexible endoscopic biopsies under local anesthesia and the impact on the diagnostic workup are evaluated. Methods: This study is a prospective analysis of patients with laryngeal, oropharyngeal, and hypopharyngeal lesions suspicious for carcinoma. One hundred eighty-eight participants were divided into 2 groups. The first group underwent an office-based biopsy procedure under local anesthesia using a flexible digital video laryngoscope with instrument channel (n = 53), and the second group underwent a biopsy procedure under general anesthesia using rigid laryngopharyngoscopy (n = 135). Results: Office-based flexible endoscopic biopsies were tolerated well, and there were no complications. These biopsies were 92.5% successful in acquiring a definitive diagnosis. Costs were reduced. Diagnostic workup time and time until start of therapy were reduced to 2 days and 27 days, respectively. Conclusion: Office-based biopsy under local anesthesia using flexible digital video laryngoscopy is safe, cost-effective, and successful in providing a histopathological diagnosis. It reduces the diagnostic workup time significantly in patients with laryngeal, oropharyngeal, and hypopharyngeal cancer, while also reducing the necessity to subsequently perform a rigid laryngopharyngoscopy under general anesthesia.
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Affiliation(s)
- Henrieke W. Schutte
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Piet J. Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marianne J.P.A. Arts
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank J.A. van den Hoogen
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henri A.M. Marres
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Wellenstein DJ, Schutte HW, Takes RP, Honings J, Marres HA, Burns JA, van den Broek GB. Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology. J Voice 2018; 32:502-513. [DOI: 10.1016/j.jvoice.2017.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
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Timman ST, Schoemaker C, Li WWL, Marres HAM, Honings J, Morshuis WJ, van der Heijden EHFM, Verhagen AFTM. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg 2018; 7:227-236. [PMID: 29707500 DOI: 10.21037/acs.2018.03.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/23/2023]
Abstract
Background In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome. Methods All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway- and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception. Results Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections. Overall response rate to the questionnaires on functional outcome was 63%. Conclusions (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid- and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires.
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Affiliation(s)
- Simone T Timman
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christiana Schoemaker
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wilson W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Wellenstein DJ, de Witt JK, Schutte HW, Honings J, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Safety of flexible endoscopic biopsy of the pharynx and larynx under topical anesthesia. Eur Arch Otorhinolaryngol 2017. [PMID: 28639059 PMCID: PMC5548855 DOI: 10.1007/s00405-017-4647-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recent advancements in transnasal endoscopy enable a shift in diagnostic workup of lesions in the pharynx and larynx, from an examination with biopsy under general anesthesia to an office-based examination with flexible endoscopic biopsy under topical anesthesia. Procedural complications were evaluated to assess the safety of office-based flexible endoscopic biopsy in patients with benign and malignant laryngopharyngeal lesions. Patients who underwent flexible endoscopic biopsy from 2012 to 2016 were evaluated retrospectively. Complications were classified using the Clavien–Dindo classification of surgical complications. A total of 201 flexible endoscopic biopsies were performed in 187 patients. Two Clavien–Dindo grade I (laryngospasm and anterior epistaxis), one grade II (laryngeal bleeding), and one grade IIIb (laryngeal edema) complication were observed. The first complication was self-limiting and the other three required an intervention. All patients fully recovered without sequelae. Flexible endoscopic biopsy appears to be a safe office-based procedure for the diagnosis of benign and malignant laryngopharyngeal lesions.
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Affiliation(s)
- David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands.
| | - Joey K de Witt
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
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Wellenstein DJ, Schutte HW, Marres HAM, Honings J, Belafsky PC, Postma GN, Takes RP, van den Broek GB. Office-based procedures for diagnosis and treatment of esophageal pathology. Head Neck 2017; 39:1910-1919. [DOI: 10.1002/hed.24819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- David J. Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henrieke W. Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri A. M. Marres
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Peter C. Belafsky
- Center for Voice and Swallowing; Department of Otolaryngology and Head and Neck Surgery, University of California, Davis School of Medicine; Sacramento California
| | - Gregory N. Postma
- Department of Otolaryngology; Medical College of Georgia at Augusta University; Augusta Georgia
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
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Delsing CPA, Viergever T, Honings J, van den Hoogen FJA. Bilateral transcervical submandibular gland excision for drooling: A study of the mature scar and long-term effects. Eur J Paediatr Neurol 2016; 20:738-44. [PMID: 27245880 DOI: 10.1016/j.ejpn.2016.05.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/06/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
AIM Several surgical techniques are available to treat drooling in neurologically disabled children and adolescents, with bilateral submandibular gland excision being the only transcervical procedure. External scars can be a reason to decline for this surgical approach. We investigated which factors influenced caregiver satisfaction by evaluating the long-term scar in relation to treatment outcome. METHODS We identified a historical cohort, in which all neurologically disabled patients who underwent bilateral submandibular gland excision for drooling between January 2009 and December 2013 were identified (n = 41). The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate observer and clinician satisfaction. All included patients were contacted by telephone and completed a digital questionnaire that included digital images of the scars. RESULTS Of the caregivers that responded the questionnaire 76% (19/25) were satisfied with the overall outcome. Twenty-four (96%) caregivers considered the scars acceptable. Caregiver satisfaction was not correlated to the appearance of scars, but was significantly correlated with the decrease in drooling severity on a visual analogue scale (p = 0.035) and decrease in lower respiratory tract infections (p = 0.042). INTERPRETATION The appearance of scars does not influence satisfaction after bilateral submandibular gland excision for drooling. As expected, satisfaction is correlated to the treatment outcome.
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Affiliation(s)
- Corinne P A Delsing
- Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands.
| | - Tieneke Viergever
- Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands
| | - Jimmie Honings
- Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands
| | - Frank J A van den Hoogen
- Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands
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Jansen F, Cnossen IC, Eerenstein SEJ, Coupé VMH, Witte BI, van Uden-Kraan CF, Doornaert P, Braunius WW, De Bree R, Hardillo JAU, Honings J, Halmos GB, Leemans CR, Verdonck-de Leeuw IM. Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy: protocol of a multi-center randomized controlled trial. BMC Cancer 2016; 16:580. [PMID: 27484126 PMCID: PMC4971642 DOI: 10.1186/s12885-016-2613-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application "In Tune without Cords" among patients treated with total laryngectomy. METHODS/DESIGN Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application "In Tune without Cords". Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up. DISCUSSION This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice. TRIAL REGISTRATION NTR5255 Protocol version 4 date September 2015.
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Affiliation(s)
- Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Ingrid C. Cnossen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Simone E. J. Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Birgit I. Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Cornelia F. van Uden-Kraan
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Weibel W. Braunius
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - José A. U. Hardillo
- Department of Otorhinolaryngology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - György B. Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Irma M. Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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Hoesseini A, Honings J, Taus-Mohamedradja R, van den Hoogen FJA, Marres HAM, van den Broek GB, Kalf H, Takes RP. Outcomes of endoscopic cricopharyngeal myotomy with CO2 laser surgery: A retrospective study of 47 patients. Head Neck 2016; 38:1022-7. [PMID: 26873575 DOI: 10.1002/hed.24400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Endoscopic cricopharyngeal myotomy (ECPM) using CO2 laser surgery presents a less invasive treatment technique when compared to transcervical cricopharyngeal myotomy. METHODS Forty-seven patients who underwent ECPM from 2002 until 2013 were included in this study. Patient characteristics, and preoperative and postoperative outcome and complications were scored by retrospective chart review and by using the Deglutition Handicap Index (DHI). RESULTS Overall, 40 of 47 patients (85%) experienced relief of symptoms postoperatively. Ten patients (25%) developed recurrent symptoms of dysphagia requiring re-laser surgery. All 40 patients were satisfied at the postoperative visit after an average of 1.3 interventions. DHI scores were better in patients with idiopathic dysfunction and neurologic disease, compared to dysfunction because of prior treatment of head and neck cancer. One patient developed mediastinitis that was successfully treated with antibiotics. There was no mortality. CONCLUSION ECPM is an effective treatment for cricopharyngeal dysfunction with a low rate of surgical morbidity and complications. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1022-1027, 2016.
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Affiliation(s)
- Arta Hoesseini
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rabia Taus-Mohamedradja
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Kalf
- Department of Rehabilitation, Section of Speech and Language Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Cnossen IC, van Uden-Kraan CF, Eerenstein SEJ, Jansen F, Witte BI, Lacko M, Hardillo JA, Honings J, Halmos GB, Goedhart-Schwandt NLQ, de Bree R, Leemans CR, Verdonck-de Leeuw IM. An online self-care education program to support patients after total laryngectomy: feasibility and satisfaction. Support Care Cancer 2015; 24:1261-8. [PMID: 26306518 PMCID: PMC4729815 DOI: 10.1007/s00520-015-2896-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/09/2015] [Indexed: 12/23/2022]
Abstract
Purpose The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Methods Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program “In Tune without Cords” (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs’ uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. Results HCPs of 6 out of 9 centers (67 % uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73 % uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69 % usage rate). Most (66 %) TLPs were satisfied (i.e., score ≥7 (scale 1–10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P = .004, P = .038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life. Conclusion The online self-care education program ITwC supporting early rehabilitation was feasible in clinical practice. In general, TLPs were satisfied with the program.
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Affiliation(s)
- Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center (Erasmus MC), PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center (Radboud UMC), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen (UMCG), PO Box 30001, 9700, RD, Groningen, The Netherlands
| | - Noortje L Q Goedhart-Schwandt
- Department of Otolaryngology-Head and Neck Surgery, Medical Center Leeuwarden (MCL), PO Box 888, 8901, BR, Leeuwarden, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center (UMCU), PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
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Honings J, van Rossum MM, van den Hoogen FJA. Vocal fold hyalinosis in Urbach-Wiethe disease, a rare cause of hoarseness. B-ENT 2015; 11:151-155. [PMID: 26563017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Lipoid proteinosis is an autosomal recessive disorder characterized by hyalin deposits in the skin and mucosa of the upper aerodigestive tract; currently, no treatment exists. Nearly all patients experience hoarseness and speech difficulties, due to hyalin deposition in the vocal folds and diminished mobility in infiltrated lips, tongue, and palate. METHODS We describe a patient with extensive hyalin plaques on the vocal folds, which resulted in near-aphonic hoarseness. Hyalin deposits in the vocal folds and skin were treated with laser resection. RESULTS Both the vocal folds and skin improved in appearance, with smoother surface epithelium. However, the patient's speech remained impaired, due to extensive hyalin plaques in the mouth, tongue, and lips. The voice improved only temporarily. CONCLUSIONS Laser resection of hyalin plaques in the vocal folds and skin is a feasible treatment for lipoid proteinosis. However, speech may remain severely limited, due to impaired tongue and lip movement.
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Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJA, van den Broek GB, Takes RP, Wijnen MHWA, Marres HAM. Recurrences after thyroglossal duct cyst surgery: Results in 207 consecutive cases and review of the literature. Head Neck 2014; 37:1699-704. [PMID: 24985922 DOI: 10.1002/hed.23817] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 12/12/2013] [Revised: 04/04/2014] [Accepted: 06/26/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A thyroglossal duct cyst is the most common form of congenital anomaly in the neck. Surgical removal is very effective. However, in some cases, a cyst recurs. The purpose of this study was to identify factors that predispose to recurrence of a thyroglossal duct cyst. METHODS A retrospective study was conducted of consecutive patients who underwent surgical resection for histologically confirmed thyroglossal duct cysts between 1998 and 2013 in a tertiary referral center. RESULTS Two hundred seven patients were included. The overall recurrence rate was 9.7%. The most important factor predicting recurrence was the type of resection: recurrence rate was 5.3% after the Sistrunk procedure, and 55.6% after plain excision (p < .001). The only other factor that was significantly associated with chance of recurrence was postoperative infection. CONCLUSION The Sistrunk procedure is the treatment of choice for thyroglossal duct cysts because it yields low recurrence and morbidity. Postoperative infections, rather than preoperative infections, are associated with recurrence.
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Affiliation(s)
- Daan Rohof
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus J Theunisse
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJA, van den Broek GB, Takes RP, Wijnen MHWA, Marres HAM. Recurrences after thyroglossal duct cyst surgery: Results in 207 consecutive cases and review of the literature. Head Neck 2014. [PMID: 24985922 DOI: 10.1002/hed.23817.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A thyroglossal duct cyst is the most common form of congenital anomaly in the neck. Surgical removal is very effective. However, in some cases, a cyst recurs. The purpose of this study was to identify factors that predispose to recurrence of a thyroglossal duct cyst. METHODS A retrospective study was conducted of consecutive patients who underwent surgical resection for histologically confirmed thyroglossal duct cysts between 1998 and 2013 in a tertiary referral center. RESULTS Two hundred seven patients were included. The overall recurrence rate was 9.7%. The most important factor predicting recurrence was the type of resection: recurrence rate was 5.3% after the Sistrunk procedure, and 55.6% after plain excision (p < .001). The only other factor that was significantly associated with chance of recurrence was postoperative infection. CONCLUSION The Sistrunk procedure is the treatment of choice for thyroglossal duct cysts because it yields low recurrence and morbidity. Postoperative infections, rather than preoperative infections, are associated with recurrence.
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Affiliation(s)
- Daan Rohof
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus J Theunisse
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Kleiss IJ, Verhagen AFTM, Honings J, Schuurbiers OCJ, van der Heijden HFM, Marres HAM. Tracheal surgery for benign tracheal stenosis: our experience in sixty three patients. Clin Otolaryngol 2014; 38:343-7. [PMID: 23714142 DOI: 10.1111/coa.12131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES Myospherulosis is a foreign body reaction induced by the application of oil-based ointments. Myospherulosis in the ear is extremely rare. Only 4 cases have been described, all of which occurred after (repeated) mastoid surgery. METHODS We present a case of persistent otorrhea and conductive hearing loss caused by myospherulosis in the middle ear following tympanoplasty. RESULTS The patient underwent revision middle ear surgery with removal of abnormally thick, pale tissue in the middle ear. Histology showed a foreign body reaction with signs of myospherulosis. CONCLUSIONS Myospherulosis is a very rare complication of the use of oil-based ointments. Surgeons should be aware that these products might cause a foreign body reaction leading to myospherulosis. In patients who have chronic otorrhea after previous mastoid or middle ear surgery, myospherulosis should be considered in the differential diagnosis.
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Affiliation(s)
- Jimmie Honings
- Department of Otorhinolaryngology, VieCuri Medical Center, Venlo, The Netherlands
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Honings J, Gaissert HA, van der Heijden HF, Verhagen AF, Kaanders JH, Marres HA. Clinical aspects and treatment of primary tracheal malignancies. Acta Otolaryngol 2010; 130:763-72. [PMID: 20569185 DOI: 10.3109/00016480903403005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Selecting patients that are candidates for surgical treatment is important in the work-up of patients with tracheal cancer. Toward this goal, centralization of care concerning tracheal tumors is advised. Centralization may increase long-term survival and decrease operative morbidity and mortality even further. OBJECTIVE Primary tracheal tumors pose a diagnostic and therapeutic challenge for the physician when confronted with this mostly malignant tumor. Diagnosis is often delayed for months or years due to its aspecific and asthma-mimicking symptoms. Knowledge from retrospective series is limited and few clinicians have gained experience with this tumor. The available literature on the diagnosis and management of this group of tumors is reviewed to summarize the available knowledge about these uncommon tumors. New diagnostic, staging, and treatment guidelines are proposed. METHODS PubMed was searched for English publications from 1960. The available literature was reviewed and summarized. RESULTS Surgical resection and primary reconstruction is the best curative treatment modality available at present. In centers of experience, more than half of all patients with tracheal cancer may be candidates for surgical resection, although in population-based studies this treatment is applied in only 10-25% of patients.
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Abstract
OBJECTIVES/HYPOTHESIS To describe the controversies in the management of thyroid carcinoma invading the airway. STUDY DESIGN Contemporary review of literature; level of evidence: 5. RESULTS Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resection provides effective palliation of airway obstruction and hemoptysis. CONCLUSIONS Long-term (>10-20 years) prospective studies are required to compare the outcome after shave excision with segmental airway resection for thyroid carcinoma. Based on the current literature and on our experience, we advocate circumferential tracheal resection in the setting of airway involvement.
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Affiliation(s)
- Jimmie Honings
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Honings J, Gaissert HA, Weinberg AC, Mark EJ, Wright CD, Wain JC, Mathisen DJ. Prognostic value of pathologic characteristics and resection margins in tracheal adenoid cystic carcinoma. Eur J Cardiothorac Surg 2010; 37:1438-44. [PMID: 20356756 DOI: 10.1016/j.ejcts.2010.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/18/2009] [Accepted: 01/05/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We investigate the influence of tumour and resection characteristics on survival in adenoid cystic carcinoma (ACC) of the trachea. METHODS A retrospective study of 12 laryngotracheal, 58 tracheal and 38 carinal resections for primary ACC in 108 consecutive operative survivors between 1962 and 2007 was conducted. Postoperative radiotherapy was administered to 82% of patients (89/108). Depth of invasion, extramural extent, organ invasion, perineural growth, margin status and lymph node involvement were described. RESULTS The tumour was intramural in 15% (16/108), extramural in 85% (92/108) and invaded adjacent organs in 20% (22/108). Airway margins were grossly positive in 9 (8%), microscopically positive in 59 (55%) and negative in 40 (37%) of 108 resections. Adventitial (radial) margins of transmural sections were grossly positive in 3 (3%), microscopically positive in 95 (88%) and negative in 10 (9%) cases. Perineural growth was present in 37 (34%) and absent in 12 (11%); it was not observed in 59 (55%) cases. Lymph nodes were positive in 16 (15%) and negative in 45 (42%) cases; it was not sampled in 47 (44%) cases. Median overall survival (OS) and disease-free survival (DFS) for the entire group were 17.7 and 10.2 years, respectively. OS was longer after resection with: negative airway margins (20.4 vs 13.3 years, P=0.028) and negative radial margins (21.7 vs 13.3 years, P=0.050); absence of extramural disease (21.7 vs 13.3 years, P=0.007), perineural growth (22.8 vs 7.5 years, P=0.011) or lymph node metastases (16.8 vs 6.1 years, P=0.017). DFS was longer after resection with: negative airway margins (16.6 vs 9.3, P=0.005) and absence of extramural disease (17.9 vs 9.3 years, P=0.008), perineural growth (17.9 vs 6.6 years, P=0.033) or lymph node metastases (10.2 vs 3.0 years, P=0.005). CONCLUSIONS After tracheal resection for ACC, limited tumour extent and complete resection are associated with longer overall and disease-free survival. Long-term survival (>10 years), however, is also observed after tracheal resection of locally advanced ACC.
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Affiliation(s)
- Jimmie Honings
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Honings J, Gaissert HA, Ruangchira-Urai R, Wain JC, Wright CD, Mathisen DJ, Mark EJ. Pathologic characteristics of resected squamous cell carcinoma of the trachea: prognostic factors based on an analysis of 59 cases. Virchows Arch 2009; 455:423-9. [PMID: 19838727 PMCID: PMC2772963 DOI: 10.1007/s00428-009-0843-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 09/24/2009] [Accepted: 09/25/2009] [Indexed: 12/01/2022]
Abstract
While squamous cell carcinoma (SCC) is the most common tracheal malignancy, few reports describe the pathologic considerations that may guide intraoperative decisions and prognostic assessment. We reviewed 59 tracheal SCC treated between 1985 and 2008 by segmental resection of the trachea, including resection of the carina in 24% and inferior larynx in 14%. We classified these tumors by grading histologic differentiation and microscopic features used in SCC of other sites. Of 59 tumors, 24% (14 of 59) were well differentiated, 49% (29 of 59) were moderately differentiated, and 27% (16 of 59) were poorly differentiated. Unfavorable prognostic factors were tumor extension into the thyroid gland (all of five so-afflicted patients died of tumor progression within 3 years) and lymphatic invasion (mean survival 4.6 versus 7.6 years). Keratinization, dyskeratosis, acantholysis, necrosis, and tumor thickness did not predict prognosis. As surgical resection is the only curative treatment; the surgeon should establish clean lines of resection using, as appropriate, intraoperative frozen section. The pathologist can provide additional important prognostic information, including tumor differentiation and extent, invasion of surgical margins, and extension into the thyroid.
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Affiliation(s)
- Jimmie Honings
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street, Blake 1570, Boston, MA, 02114, USA
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Honings J, Gaissert HA, Verhagen AFTM, van Dijck JAAM, van der Heijden HFM, van Die L, Bussink J, Kaanders JHAM, Marres HAM. Undertreatment of Tracheal Carcinoma: Multidisciplinary Audit of Epidemiologic Data. Ann Surg Oncol 2008; 16:246-53. [DOI: 10.1245/s10434-008-0241-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/27/2008] [Accepted: 10/28/2008] [Indexed: 11/18/2022]
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Gaissert HA, Honings J, Grillo HC, Donahue DM, Wain JC, Wright CD, Mathisen DJ. Segmental Laryngotracheal and Tracheal Resection for Invasive Thyroid Carcinoma. Ann Thorac Surg 2007; 83:1952-9. [PMID: 17532377 DOI: 10.1016/j.athoracsur.2007.01.056] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 01/23/2007] [Accepted: 01/29/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laryngotracheal invasion worsens prognosis in patients with thyroid carcinoma. The extent of resection is controversial. METHODS We performed a retrospective study of patients with thyroid carcinoma and invasion of the larynx or trachea between 1964 and 2005. RESULTS Eighty-two patients, mean age 64 years and 50% female, underwent segmental airway resection. Differentiated carcinoma was present in 76% (62 of 82 patients), prior tracheal "shave" procedures in 40% (33 of 82 patients), transmural invasion in 58% (48 of 82 patients), and preoperative vocal cord paralysis in 35% (29 of 82 patients). There were 29 tracheal and 40 laryngotracheal resections (reconstruction group: 69 patients); 5 underwent laryngectomy, 7 cervical exenteration, and 1 tracheal resection after exenteration (salvage group: 13 patients). Operative mortality was 1.2% (1 of 82 patients) and anastomotic dehiscence 4.3% (3 of 69 patients). Tracheostomy was permanent in 4.3% (3 of 69 patients). Mean follow-up was 6.1 years. After reconstruction, mean survival was 9.4 years and 10-year survival was 40%; after salvage, these were 5.6 years and 15%, respectively. In differentiated carcinoma, thyroidectomy, immediate shave procedure, and delayed (mean, 67 months) resection of airway recurrence in 15 patients resulted in overall and disease-free survival of 13.1 and 5.1 years, respectively, compared with 17.9 and 14.6 years, respectively, after thyroidectomy and early airway resection in 11 patients. Airway symptoms, metastases at presentation, recurrent disease, and salvage operation were associated with decreased survival; airway resection early after thyroidectomy, complete resection, and well-differentiated tumors were associated with improved prognosis. CONCLUSIONS Segmental airway resection for invasive thyroid cancer is safe, preserves the voice, and relieves airway obstruction. Complete resection of laryngeal and tracheal invasion during or early after thyroidectomy is associated with improved survival.
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Affiliation(s)
- Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
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