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Sivarajah S, Emerick K, Kaufman HL. What Surgeons Need to Know About Gene Therapy for Cancer. Adv Surg 2022; 56:151-168. [PMID: 36096566 DOI: 10.1016/j.yasu.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The broad field of gene therapy offers numerous innovative approaches for cancer treatment. An understanding of the different modalities including gene replacement therapy, cancer vaccines, oncolytic viruses, cellular therapy, and gene editing is essential for managing patients with neoplastic disease. As in other areas of oncology, the surgeon plays a pivotal role in the diagnosis and treatment of the disease. This review focuses on what the clinical surgeon needs to know to optimize the benefit of gene therapy for patients with cancer.
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Affiliation(s)
- Shanmugappiriya Sivarajah
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street Boston, MA 02114 USA
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street Boston, MA 02114 USA
| | - Howard L Kaufman
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7E, Boston, MA 02114, USA.
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Shalhout SZ, Emerick K, Kaufman HL, Miller DM. Clinical utility of cell-free DNA liquid biopsies in Merkel cell carcinoma. Dermatol Online J 2021; 27. [PMID: 35130390 DOI: 10.5070/d3271055629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sophia Z Shalhout
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bulbul MG, Wu M, Lin D, Emerick K, Deschler D, Richmon J, Goldsmith T, Zenga J, Puram SV, Varvares MA. Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study. Laryngoscope 2021; 131:2497-2504. [PMID: 33881173 DOI: 10.1002/lary.29573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/21/2021] [Revised: 03/09/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the impact of specific treatment-related variables on functional and quality of life outcomes in oral cavity cancer (OCC) patients. STUDY DESIGN Retrospective Cohort. METHODS Patients with primary OCC at least 6 months after resection and adjuvant therapy were included. Patients completed surveys including the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN). Performance Status Scale (PSS) and tongue mobility scale were completed to allow provider-rated assessment of speech and tongue mobility, respectively. Additional details regarding treatment were also collected. These data were used to generate a predictive model using linear regression. RESULTS Fifty-three patients with oral tongue and/or floor of mouth (FOM) resection were included in our study. In multivariable analysis, greater postoperative tongue range of motion (ROM) and time since treatment improved SHI. Flap reconstruction and greater postoperative tongue ROM increased MDADI and PSS (eating and speech). A larger volume of resected tissue was inversely correlated with PSS (diet and speech). Tumor site was an important predictor of PSS (all sections). There were no statistically significant predictors of FACT-HN. CONCLUSIONS In this pilot study, we propose a battery of tools to assess function in OCC patients treated with surgery. Using the battery of tools we propose, our results show that a surgical endpoint that preserves tongue mobility and employs flap reconstruction resulted in better outcomes, whereas those with greater volume of tissue resected and FOM involvement resulted in poorer outcomes. Larger prospective studies are needed to validate our findings. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Michael Wu
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Derrick Lin
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kevin Emerick
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel Deschler
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy Richmon
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tessa Goldsmith
- Department of Speech, language and swallowing disorders, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Joseph Zenga
- Department of Otolaryngology, Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology, Head and Neck Surgery Washington University in St Louis, St Louis, Missouri, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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Abstract
Sentinel lymph node biopsy has the potential to impact regional control and survival for high-risk cutaneous malignancy. The outcome of sentinel lymph node biopsy is a potential guide for treatment and surveillance. The population of high-risk nonmelanoma patients that will benefit from sentinel lymph node biopsy remains to be determined. Any cutaneous malignancy with a greater than 10% risk of occult metastasis should be considered for sentinel lymph node biopsy or active surveillance. Localized cutaneous squamous cell carcinoma lesions with multiple high-risk features and nearly all patients with localized Merkel cell carcinoma should be considered for sentinel lymph node biopsy.
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Affiliation(s)
- Rosh Sethi
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Kevin Emerick
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Lindeborg MM, Sethi RKV, Puram SV, Parikh A, Yarlagadda B, Varvares M, Emerick K, Lin D, Durand ML, Deschler DG. Predicting length of stay in head and neck patients who undergo free flap reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:461-467. [PMID: 32596488 PMCID: PMC7314462 DOI: 10.1002/lio2.410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS. METHODS A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS. RESULTS A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in-hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004). CONCLUSION Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients. LEVEL OF EVIDENCE 2b; retrospective cohort.
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Affiliation(s)
- Michael M. Lindeborg
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Rosh K. V. Sethi
- Department of OtolaryngologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sidharth V. Puram
- Department of OtolaryngologyWashington University School of Medicine in Saint LouisSaint LouisMissouriUSA
| | - Anuraag Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Bharat Yarlagadda
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Mark Varvares
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kevin Emerick
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Derrick Lin
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Marlene L. Durand
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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Tang L, Day AT, Lee R, Gordin E, Emerick K, Patel UA, Deschler DG, Richmon JD. Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons. Am J Otolaryngol 2020; 41:102291. [PMID: 31732308 DOI: 10.1016/j.amjoto.2019.102291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications. METHODS The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications. RESULTS Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced "very few" complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have "very few" complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course. CONCLUSIONS Practice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported "very few" complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.
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Chen JX, Kozin E, Bohnen J, George B, Deschler D, Emerick K, Gray ST. Tracking operative autonomy and performance in otolaryngology training using smartphone technology: A single institution pilot study. Laryngoscope Investig Otolaryngol 2019; 4:578-586. [PMID: 31890874 PMCID: PMC6929585 DOI: 10.1002/lio2.323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In the era of duty hour restrictions, otolaryngology residents may not gain the operative experience necessary to function autonomously by the end of training. This study quantifies residents' autonomy during key indicator cases, defined by the Accreditation Council for Graduate Medical Education. STUDY DESIGN Prospective cohort study. METHODS Faculty and residents at a large academic institution were surveyed on the surgical autonomy trainees should achieve for otolaryngology key indicator surgeries at each training level. Residents and faculty used the mobile application "System for Improving and Measuring Procedural Learning" (SIMPL) between December 2017 and July 2018 to log trainees' operative autonomy during cases on a validated four-level Zwisch scale, from "show and tell" to "supervision only." RESULTS The study included 40 participants (23 residents and 17 attendings). The survey response rate was 83%. In surveys, residents overestimated the autonomy PGY5 residents should achieve for parotidectomy, rhinoplasty, thyroid/parathyroidectomy, and airway procedures compared with faculty (P < .05). Using SIMPL, 833 evaluations were logged of which 253 were paired evaluations for key indicator cases. Comparing survey predictions with actual cases logged in SIMPL, residents and faculty overestimated the autonomy achieved by senior trainees performing mastoidectomy (PGY5, P < .05) and ethmoidectomy (PGY4/5, P < .05); both felt that senior residents should operate with between "passive help" and "supervision only" whereas residents actually had "passive help." Residents overestimated their autonomy during rhinoplasty (PGY5, P = .017) and parotidectomy (PGY5, P = .007) while attendings accurately expected chief residents to have "passive help." CONCLUSIONS Resident surgical autonomy varies across otolaryngology procedures. Multicenter studies are needed to elucidate national trends. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Jenny X. Chen
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Elliott Kozin
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Jordan Bohnen
- Department of General SurgeryMassachusetts General HospitalBostonMassachusetts
| | - Brian George
- Department of General SurgeryUniversity of MichiganAnn ArborMichigan
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Kevin Emerick
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Stacey T. Gray
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
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Chen JX, Kozin E, Bohnen J, George B, Deschler DG, Emerick K, Gray ST. Assessments of Otolaryngology Resident Operative Experiences Using Mobile Technology: A Pilot Study. Otolaryngol Head Neck Surg 2019; 161:939-945. [DOI: 10.1177/0194599819868165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Surgical education has shifted from the Halstedian model of “see one, do one, teach one” to a competency-based model of training. Otolaryngology residency programs can benefit from a fast and simple system to assess residents’ surgical skills. In this quality initiative, we hypothesize that a novel smartphone application called System for Improving and Measuring Procedural Learning (SIMPL) could be applied in an otolaryngology residency to facilitate the assessment of resident operative experiences. Methods The Plan Do Study Act method of quality improvement was used. After researching tools of surgical assessment and trialing SIMPL in a resident-attending pair, we piloted SIMPL across an otolaryngology residency program. Faculty and residents were trained to use SIMPL to rate resident operative performance and autonomy with a previously validated Zwisch Scale. Results Residents (n = 23) and faculty (n = 17) were trained to use SIMPL using a standardized curriculum. A total of 833 assessments were completed from December 1, 2017, to June 30, 2018. Attendings completed a median 20 assessments, and residents completed a median 14 self-assessments. All evaluations were resident initiated, and attendings had a 78% median response rate. Evaluations took residents a median 22 seconds to complete; 126 unique procedures were logged, representing all 14 key indicator cases for otolaryngology. Discussion This is the first residency-wide application of a mobile platform to track the operative experiences of otolaryngology residents. Implications for Practice We adapted and implemented a novel assessment tool in a large otolaryngology program. Future multicenter studies will benchmark resident operative experiences nationwide.
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Affiliation(s)
- Jenny X. Chen
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott Kozin
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Bohnen
- Department of General Surgery Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel G. Deschler
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Emerick
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T. Gray
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Day AT, Tang L, Emerick K, Patel UA, Deschler DG, Richmon JD. Supraclavicular flap practice patterns and outcomes: A survey of 221 AHNS surgeons. Laryngoscope 2018; 129:2012-2019. [PMID: 30570139 DOI: 10.1002/lary.27641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe American Head and Neck Society (AHNS) surgeon supraclavicular flap (SCF) practice patterns and to identify variables associated with SCF complications. METHODS The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between November 11, 2016, and December 31, 2016. The primary outcome was frequency of SCF complications. Independent variables included demographics, training, practice patterns, and SCF techniques. RESULTS Adequate survey responses were obtained from 221 AHNS surgeons. Among these, 54.3% (n = 120) performed supraclavicular flaps (SCFs). Most surgeons used the SCF for cutaneous (n = 85; 78.7%) or parotid-temporal bone (n = 59; 54.6%) defects. Nearly one-third (n = 31; 29.8%) of surgeons experienced more than a "few" SCF complications. Surgeons experienced fewer pectoralis major flap (P < 0.001) and radial forearm free flap (P < 0.001) complications compared to SCF complications. Univariate analysis demonstrated no association between surgeons with "few" SCF complications and Doppler use in SCF design (P = 0.90), harvest location (P = 0.51), and pedicle skeletonization (P = 0.25). Multivariable logistic regression revealed that surgeons performing more than 30 SCFs compared to less than or equal to 30 SCFs had a greater odds of having "few" SCF complications (odds ratio 7.1, 95% confidence interval [1.1-43.9], P = 0.04). CONCLUSION A majority of surgeons performing SCFs use the flap to reconstruct cutaneous and parotid-temporal bone defects. The significance of relatively higher SCF complications compared to other routine flaps should be explored further. Surgeon experience with the SCF appears to be significantly associated with SCF success, whereas training characteristics, practice patterns, and technical variations may not be associated with SCF outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 129:2012-2019, 2019.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Liyang Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Kevin Emerick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, U.S.A
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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Chen JX, Zenga J, Emerick K, Deschler D. Sublingual gland excision for the surgical management of plunging ranula. Am J Otolaryngol 2018; 39:497-500. [PMID: 30017374 DOI: 10.1016/j.amjoto.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/26/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. METHODS This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. RESULTS Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. CONCLUSION Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States
| | - Joseph Zenga
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States.
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Byrd SA, Xu MJ, Cass LM, Wehrmann DJ, Naunheim M, Christopher K, Dombrowski JJ, Walker RJ, Wirth L, Clark J, Busse P, Chan A, Deschler DG, Emerick K, Lin DT, Varvares MA. Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis. Oral Oncol 2018; 78:171-176. [DOI: 10.1016/j.oraloncology.2018.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/13/2018] [Accepted: 01/23/2018] [Indexed: 11/15/2022]
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Creighton F, Lin A, Leavitt E, Lin D, Deschler D, Emerick K. Factors affecting survival and locoregional control in head and neck cSCCA with nodal metastasis. Laryngoscope 2017; 128:1881-1886. [DOI: 10.1002/lary.27048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 10/04/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Francis Creighton
- Department of OtolaryngologyHarvard Medical School, Massachusetts Eye and EarBoston Massachusetts
| | - Alice Lin
- Department of OtolaryngologySUNY DownstateNew York New York U.S.A
| | - Erica Leavitt
- Department of OtolaryngologyHarvard Medical School, Massachusetts Eye and EarBoston Massachusetts
| | - Derrick Lin
- Department of OtolaryngologyHarvard Medical School, Massachusetts Eye and EarBoston Massachusetts
| | - Dan Deschler
- Department of OtolaryngologyHarvard Medical School, Massachusetts Eye and EarBoston Massachusetts
| | - Kevin Emerick
- Department of OtolaryngologyHarvard Medical School, Massachusetts Eye and EarBoston Massachusetts
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Creighton FX, Feng AL, Goyal N, Emerick K, Deschler D. Chicken thigh microvascular training model improves resident surgical skills. Laryngoscope Investig Otolaryngol 2017; 2:471-474. [PMID: 29299526 PMCID: PMC5743170 DOI: 10.1002/lio2.94] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/16/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high‐fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design Validation study Methods Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model. Anastomoses were video‐recorded and the time required for trainees to complete the first stitch of their first anastomosis was compared to the time required for the first stitch of their last anastomosis. Comparison of first and last stitch times was completed using a paired student t‐test. All participants completed a survey regarding their experience with the simulator. Results There was a statistically significant decrease between the time required for the first stitch (235 s, 95%CI 198–272 s) compared to last stitch (120 s, 95%CI 92–149 s), and an average 48.7% (115 s) decrease in time (p < 0.001). Junior (PGY 2/3) and senior (PGY 4/5) residents had similar decreases in time, 49.1% and 48.21%, respectively. One hundred percent of residents felt they improved during the session and 92% of residents agreed or strongly agreed that their final stitch was better than their last stitch. All residents agreed or strongly agreed that the simulation is realistic, effective in teaching the procedure, and would translate to improved intraoperative performance. Conclusions The chicken thigh model demonstrates objective improvements in resident microvascular surgical skills. Level of Evidence NA
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Affiliation(s)
- Francis X Creighton
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Allen L Feng
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Neerav Goyal
- Department of Otolaryngology Penn State Medical School Hershey Pennsylvania U.S.A
| | - Kevin Emerick
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Daniel Deschler
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
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Creighton F, Bergmark R, Emerick K. Drainage Patterns to Nontraditional Nodal Regions and Level IIB in Cutaneous Head and Neck Malignancy. Otolaryngol Head Neck Surg 2016; 155:1005-1011. [PMID: 27554510 DOI: 10.1177/0194599816662864] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) Determine the frequency of nontraditional sentinel lymph node (SLN) locations in cutaneous head and neck malignancy and (2) determine the frequency of level IIB SLNs in cutaneous head and neck malignancy. DESIGN Case series with chart review. SETTING Tertiary academic hospital. SUBJECTS AND METHODS In total, 145 consecutive sentinel lymph node biopsy (SLNB) specimens for cutaneous head and neck malignancies were reviewed from 2007 to 2015. Nodal regions were categorized into levels I to V, parotid, external jugular (EJ), perifacial, suboccipital, and postauricular regions. Primary locations were divided into scalp, forehead, cheek, ear, neck, nose, periocular, and lip. Frequencies of sentinel lymph node (SLN) locations for each primary location were determined. RESULTS Parotid, EJ, perifacial, suboccipital, postauricular, and level IIB lymph SLNs were identified as nontraditional lymph node regions at risk in head and neck cutaneous malignancy. EJ SLNs were present in over 15% of all cases and over 25% of periocular and cheek lesions. Perifacial SLNs were frequently present in nose and lip lesions. Suboccipital and postauricular nodes were only present in scalp lesions. Level II was the most common location for a SLN. In total, 15.9% of all cases involved level IIB. Scalp and ear primary lesions were most likely to drain to level IIB. CONCLUSIONS Nontraditional SLN locations, such as EJ, perifacial, suboccipital, postauricular, and parotid, as well as level IIB, are important sites of drainage for head and neck cutaneous malignancy. Prediction of at-risk lymph node regions is important to help guide SLNBs, elective and completion neck lymphadenectomy and radiation, and long-term observation.
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Affiliation(s)
- Francis Creighton
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Regan Bergmark
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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15
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Dwojak S, Deschler D, Sargent M, Emerick K, Guadagnolo BA, Petereit D. Knowledge and screening of head and neck cancer among American Indians in South Dakota. Am J Public Health 2015; 105:1155-60. [PMID: 25320895 PMCID: PMC4431103 DOI: 10.2105/ajph.2014.302177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We established the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians in South Dakota and determined whether head and neck cancer screening detected clinical findings in this population. METHODS We used the European About Face survey. We added questions about human papillomavirus, a risk factor for head and neck cancer, and demographics. Surveys were administered at 2 public events in 2011. Participants could partake in a head and neck cancer screening at the time of survey administration. RESULTS Of the 205 American Indians who completed the survey, 114 participated in the screening. Mean head and neck cancer knowledge scores were 26 out of 44. Level of education was the only factor that predicted higher head and neck cancer knowledge (b = 0.90; P = .01). Nine (8%) people had positive head and neck cancer screening examination results. All abnormal clinical findings were in current or past smokers (P = .06). CONCLUSIONS There are gaps in American Indian knowledge of head and neck cancer risk factors and symptoms. Community-based head and neck cancer screening in this population is feasible and may be a way to identify early abnormal clinical findings in smokers.
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Affiliation(s)
- Sunshine Dwojak
- Sunshine Dwojak, Daniel Deschler, and Kevin Emerick are with the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Michele Sargent and Daniel Petereit are with the John T. Vucurevich Cancer Care Institute at Rapid City Regional Hospital, Rapid City, SD. B. Ashleigh Guadagnolo is with the University of Texas M.D. Anderson Cancer Center, Houston
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16
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Chambers KJ, Kraft S, Emerick K. Evaluation of frozen section margins in high-risk cutaneous squamous cell carcinomas of the head and neck. Laryngoscope 2014; 125:636-9. [PMID: 25230253 DOI: 10.1002/lary.24945] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 08/21/2014] [Accepted: 09/04/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify histopathologic features associated with poor correlation of frozen and permanent pathology margins following wide local excision for advanced cutaneous squamous cell carcinomas of the head and neck. STUDY DESIGN Retrospective review. METHODS A retrospective review of patients undergoing excision of advanced head and neck squamous cell carcinomas between the years 2010 AND 2013 was performed. Demographic, operative, and pathology data were collected. Overall correlation between frozen section margins and final margins on permanent section results was calculated. Positive and negative predictive values of several histopathologic features were determined. RESULTS Forty-one cases were identified from the database. Perineural invasion, lymphovascular invasion, and a component of poorly differentiated carcinoma were identified in 61.3%, 34.5%, and 17.1% of cases, respectively. Discrepancy between frozen section margins and permanent margins was identified in eight cases (19.5%). The false-negative rate for poorly differentiated carcinoma, lymphovascular invasion, and perineural invasion was 14%, 36%, 26%, respectively. The positive and negative predictive value of poorly differentiated carcinoma, lymphovascular invasion, and perineural invasion in predicting discrepancy between frozen and permanent margins was 14% and 80%, 36% and 84%, and 26% and 92%, respectively. CONCLUSIONS This study demonstrated a moderate rate of discrepancy between frozen and permanent section analysis of operative margins from high-risk cutaneous squamous cell carcinomas of the head and neck. The presence or absence of certain histopathologic features appears to be associated with a higher rate of frozen section discrepancy. Evaluation of these features in a preoperative biopsy or staging excision may be useful in planning definitive excision and reconstruction.
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Affiliation(s)
- Kyle J Chambers
- Department of Otolaryngology-Head and Neck Surgery , Massachusetts Eye and Ear Infirmary, Boston; Department of Otology and Laryngology , Harvard Medical School, Boston
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17
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Zaghi S, Ghasri P, Busse P, Clark J, Emerick K. Extensive basal cell carcinoma of the face: an extreme case of denial. Ear Nose Throat J 2014; 93:E40-E44. [PMID: 24932829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Patients with head and neck cancer are particularly susceptible to using denial as a coping mechanism. While some forms of denial may help patients achieve better levels of physical functioning, persistent denial can serve as a major barrier to treatment. We report a case of extreme denial by a 60-year-old woman with an extensive basal cell carcinoma of the face that had been neglected for more than 20 years. We present this case to raise awareness of the potential danger of denial, and we discuss strategies that physicians can undertake to properly manage patients who engage in it. Since the diagnosis and treatment of head and neck cancer can result in profound psychological trauma, gaining an appreciation for how patients cope with it is an important part of the comprehensive care of head and neck oncology patients.
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Affiliation(s)
- Soroush Zaghi
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, 10833 LeConte Ave., Room 62-132 CHS, Los Angeles, CA 90095, USA.
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18
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Dwojak SM, Sequist TD, Emerick K, Deschler DG. Survival differences among American Indians/Alaska natives with head and neck squamous cell carcinoma. Head Neck 2012; 35:1114-8. [DOI: 10.1002/hed.23089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/11/2022] Open
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Abstract
Perineural tumor spread (PNS) is a mode of neoplastic spread whereby tumor cells use neural conduits to escape the borders of a primary tumor. MRI is generally favored over CT for evaluating PNS, and findings include obliteration of fat within skull base foramina, enlargement and enhancement of the involved nerves, and enlargement and destruction of the bony foramina. Careful examination of the entire course of the nerve allows detection of skip lesions. Recognition of the complete extent of PNS is crucial for correct treatment because it facilitates both surgical and radiotherapy targeting of entire extent of disease.
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Affiliation(s)
- Gul Moonis
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
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20
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Divi V, Lin DT, Emerick K, Rocco J, Deschler DG. Primary TEP Placement in Patients with Laryngopharyngeal Free Tissue Reconstruction and Salivary Bypass Tube Placement. Otolaryngol Head Neck Surg 2011; 144:474-6. [DOI: 10.1177/0194599810391960] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors examined the feasibility and advantages of primary tracheoesophageal puncture (TEP) with intraoperative placement of the voice prosthesis for patients undergoing laryngopharyngectomy requiring free tissue reconstruction and salivary bypass tube placement. Six patients were identified; 4 underwent total laryngopharyngectomy, and 2 underwent total laryngectomy with partial pharyngectomy. All 6 required free tissue reconstruction, and a salivary bypass tube was placed in all cases. All patients had a 20F Indwelling Blom-Singer prosthesis (InHealth Technologies, Carpinteria, California) placed. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. At 6 months, 4 patients available for evaluation had successful voice outcomes, and 3 were disease free. This study demonstrates the effectiveness of voice prosthesis placement at the time of primary TEP associated with free tissue reconstruction of a laryngopharyngeal defect with salivary bypass tube placement.
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Affiliation(s)
- Vasu Divi
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Derrick T. Lin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Kevin Emerick
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - James Rocco
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel G. Deschler
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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22
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Abdul-Aziz D, Silver AL, Faquin WC, Emerick K. Sebum encased by sebaceous cells and a lymphoid stroma: A rare case of cystic sebaceous lymphadenoma of the parotid gland. Laryngoscope 2011. [DOI: 10.1002/lary.21955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Worden FP, Moyer J, Lee JS, Taylor JMG, Urba SG, Eisbruch A, Teknos TN, Chepeha DB, Prince ME, Hogikyan N, Lassig AAD, Emerick K, Mukherji S, Hadjiski L, Tsien CI, Miller TH, Wallace NE, Mason HL, Bradford CR, Wolf GT. Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion. Laryngoscope 2009; 119:1510-7. [PMID: 19504552 DOI: 10.1002/lary.20294] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies. STUDY DESIGN Retrospective. METHODS Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m(2)) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m(2)/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin-100 mg/m(2) [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation. RESULTS Twenty-nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3-year OS was 78%, and the disease-specific survival was 80% (median follow-up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g-tube dependent and 6/36 (17%) were tracheostomy dependent. CONCLUSIONS Our results suggest that chemo-selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion.
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Affiliation(s)
- Francis P Worden
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA.
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Deschler DG, Bunting GW, Lin DT, Emerick K, Rocco J. Evaluation of voice prosthesis placement at the time of primary tracheoesophageal puncture with total laryngectomy. Laryngoscope 2009; 119:1353-7. [PMID: 19507224 DOI: 10.1002/lary.20490] [Citation(s) in RCA: 26] [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: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Primary tracheoesophageal puncture (TEP) is a well-described and accepted method of surgical voice restoration and is standardly completed with a catheter placement intraoperatively, which is replaced with a prosthesis at a later date. This study evaluates the intraoperative placement of the voice prosthesis at the time of the primary TEP in an effort to understand the potential advantages and disadvantages of voice prosthesis placement at the time of primary TEP completed in conjunction with total laryngectomy. STUDY DESIGN Retrospective chart review within an academic medical center. METHODS After approval by the institutional review board of the Massachusetts Eye and Ear Infirmary, a retrospective chart review was completed of all cases of primary tracheoesophageal prosthesis placement completed in conjunction with primary tracheoesophageal puncture performed at the time of total laryngectomy. RESULTS Thirty patients were identified, 29 of whom underwent laryngectomy for advanced laryngeal carcinoma. Twenty-eight of 29 patients received preoperative full-dose radiation therapy. Twenty-nine of 30 patients had a 20F classic Indwelling Blom-Singer prosthesis (InHealth Technologies, Carpinteria, CA) placed. One had placement of 16F Indwelling Blom-Singer prosthesis. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Twenty-nine of 30 subjects had initial success with tracheoesophageal voice production. At 1-year follow-up, 23/30 subjects (77%) had successful voice restoration. Five failed because of recurrent disease, one subject never achieved successful voice, and one subject wanted the prosthesis removed although successful voice was achieved. Twenty-three of 25 (92%) disease-free subjects had functional voice restoration at 1-year post-total laryngectomy and primary prosthesis placement. CONCLUSIONS This study demonstrates that the voice prosthesis can be safely and effectively placed intraoperatively at the time of primary TEP and laryngectomy. Initial voice acquisition rates were high and long-term success was well within the acceptable range.
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Affiliation(s)
- Daniel G Deschler
- Massachusetts Eye and Ear Infirmary, Division of Head and Neck Surgery, Department of Otology and Laryngology, Harvard Medical School, Boston 02114, Massachusetts, USA.
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Abstract
PURPOSE To examine the role of palivizumab, a monoclonal antibody vaccine designed to prevent respiratory syncytial virus (RSV) infection, in the surgical setting, and to explore the feasibility, in terms of medical benefit and cost, of its use in pediatric airway reconstruction patients. MATERIALS AND METHODS Literature review of MEDLINE database using the following indexing terms ("respiratory syncytial virus," "palivizumab," "laryngotracheal reconstruction," and "cricotracheal reconstruction") and limited to following subcategories (English language, postoperative complication, and morbidity and mortality). All phase IV clinical trials reporting data regarding safety, efficacy, and application of palivizumab in the general pediatric population were selected, as well as all studies from any surgical specialty with data on postoperative outcome complicated by RSV infection. RESULTS The literature demonstrates significant postoperative morbidity and mortality attributable to RSV infection within several surgical specialties including otolaryngology. Meta-analysis of the data from phase IV clinical trials suggests potential benefit from the perioperative use of palivizumab. The cost of vaccination is the principal limiting factor preventing its more widespread application. CONCLUSION Otolaryngologists need to be aware of the potential significant morbidity caused by perioperative RSV infection and should consider the prophylactic use of palivizumab in their pediatric airway reconstruction patients in high-risk seasons. A large multicenter study would be required to adequately perform a cost-benefit analysis of palivizumab use for this specific indication.
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Affiliation(s)
- Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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