The feasibility of pediatric TORS for lingual thyroglossal duct cyst.

A six-year-old boy who presented with symptoms of obstructive sleep apnea was found to have a midline tongue mass suspicious for lingual thyroglossal duct cyst (TGDC). Surgery was scheduled after workup confirmed the presence of functional, orthotopic thyroid tissue. The surgical robot was used to excise the mass endoscopically without removing any hyoid. He was extubated at the conclusion of the case. The child tolerated a soft diet and was discharged after an uneventful overnight stay in the ICU. Pathology confirmed TGDC. There have been no reported issues in eleven months of follow-up. Our report adds to the scarce literature on performing such a surgery in a child and demonstrates that with the correct circumstances, prompt extubation, discharge, and prolonged remission are possible.

Robot-Assisted Neck Dissection Through a Modified Facelift Incision.

OBJECTIVES: The aim of this study is to describe the feasibility as well as oncologic outcomes of robot-assisted neck dissection (RAND) through a modified facelift incision in an American population. STUDY DESIGN: Retrospective case series. SETTING: University tertiary care hospital. METHODS: All patients who underwent RAND between November 2012 and December 2014 were included. Medical records were reviewed for demographics, medical histories, staging, operative information, postoperative hospital course and complications, and oncologic outcomes. RESULTS: There were 11 RANDs identified among 10 patients. Five patients had known nodal metastasis at the time of surgery. Two patients had been previously irradiated. The average time of surgery was 284.4 ± 72.3 minutes, including other associated procedures. The average lymph node yield was 28.5 ± 9.3 nodes. There were no major complications. Average follow-up was 19.4 months. There was 1 supraclavicular recurrence in a previously irradiated patient. All patients are currently alive and without evidence of disease. CONCLUSIONS: Robot-assisted neck dissection is a safe and feasible procedure that can be performed by surgeons with familiarity with neck dissection and robot-assisted surgery and who have been trained in RAND. Appropriate oncologic outcomes can be obtained in a patient wishing to avoid a noticeable scar.

Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma.

OBJECTIVE: To determine the accuracy of pretreatment, contrast-enhanced computed tomography (CT) in the diagnosis of extracapsular spread (ECS) in cervical lymph node metastases from p16-positive head-and-neck squamous cell carcinoma (HNSCC). STUDY DESIGN: Retrospective observational study. METHODS: Sixty-five (n = 65) patients diagnosed between 2004 and 2013 with p16-positive HNSCC and with cervical lymph node metastases measuring at least 1 centimeter in diameter on pathological assessment were included. All patients underwent primary surgical treatment. Subjects' preoperative contrast-enhanced neck CT scans were independently assigned a score for the likelihood of ECS (5-point scale) by two board-certified neuroradiologists. Receiver-operating characteristic curves were generated, and optimal sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each radiologist. RESULTS: On histological analysis, the majority of patients (58%; 38/65) were found to have ECS, and 29% (19/65) of patients had ≥ three metastatic lymph nodes. For radiologist 1, PPV and NPV for ECS detection were 72% (95% confidence interval (CI), 53%-87%) and 53% (95% CI, 36%-70%), respectively. For radiologist 2, PPV and NPV for ECS detection were 82% (95% CI, 60 %-95%) and 53% (95% CI, 38%-69%), respectively. CONCLUSION: CT is not a reliable method for determining the presence of ECS in p16-positive HNSCC patients.

Factors contributing to recurrence of oral cavity and laryngeal tumors and estimation of tumor age.

OBJECTIVES/HYPOTHESIS: To identify factors contributing to local tumor recurrence in oral cavity and laryngeal squamous cell carcinomas treated with surgery alone, to approximate tumor age from time to recurrence data by applying Collins' law, and to identify factors that may affect time to recurrence. STUDY DESIGN: Retrospective review. METHODS: A retrospective review of all patients treated for head and neck cancer from 1997 to 2013 at the University of Pittsburgh Medical Center was performed. RESULTS: A total of 517 patients treated with surgery alone qualified for the study, of which 84 had local recurrence, and 433 had no local recurrences. History of tobacco use (P = .017), pack-year cigarette history (P = .001), and T stage (P = .03) were associated with disease recurrence. Overall, never tobacco users, those with fewer pack-years of smoking history, and those with lower T stage were more likely to recur. Time to recurrence was significantly shorter for laryngeal tumors compared to oral cavity tumors (P = .027). Median time to recurrence for oral cavity tumors was 8.6 months and laryngeal tumors was 7.1 months. CONCLUSIONS: In this study, lower pack-year smoking history, lower T stage, and history of never tobacco use were associated with local tumor recurrence. Applying the concept of Collins' law to estimate the age of tumors at diagnosis, the median tumor age at diagnosis was estimated to be 8.6 months for oral cavity tumors and 7.1 months for laryngeal tumors.

Transoral robotic surgery for pharyngeal stenosis.

BACKGROUND: Pharyngeal stenosis is a complication of head and neck cancer and sleep apnea treatment that results in functional impairment. Due to the location of the stenosis and tendency to recur, surgical management is challenging. Robotic surgery may allow these areas to be treated with surgical technique that would be difficult using traditional approaches. METHODS: A retrospective chart review was performed to identify patients who underwent transoral robotic surgery (TORS) for pharyngeal stenosis at a tertiary hospital system. RESULTS: Five patients were identified, ages 8-75 years. Length of follow-up ranged from 1-12 months. There was one failure, a 74 year old male with a history of chemoradiation to the area who has required additional procedures. CONCLUSION: TORS may offer improved surgical access to the pharynx in patients who require complex reconstruction that would otherwise be very difficult. Appropriate patient selection is necessary and long-term follow-up is warranted for the selected cases.

A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review.

OBJECTIVES/HYPOTHESIS: To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T-stage oropharyngeal cancer. DATA SOURCES: The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studies through September 2012. METHODS: Studies included patients treated for early T-stage oropharynx cancer with TORS or IMRT. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment- specific details, as well as recurrence, survival, and adverse events, were collected. Methodologic quality for each study was appraised. RESULTS: Twenty case series, including eight IMRT studies (1,287 patients) and 12 TORS studies (772 patients), were included. Patients receiving definitive IMRT also received chemotherapy (43%) or neck dissections for persistent disease (30%), whereas patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 84% to 96% for IMRT and from 82% to 94% for TORS. Adverse events for IMRT included esophageal stenosis (4.8%), osteoradionecrosis (2.6%), and gastrostomy tubes (43%)-and adverse events for TORS included hemorrhage (2.4%), fistula (2.5%), and gastrostomy tubes at the time of surgery (1.4%) or during adjuvant treatment (30%). Tracheostomy tubes were needed in 12% of patients at the time of surgery, but most were decannulated prior to discharge. CONCLUSION: This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events.