Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study.

Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, co-morbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher's exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9 %) developed SWI. Patients with advanced disease and tracheotomy showed a significantly higher rate of SWI than those with early stage disease and without tracheotomy (p = 0.012 and p = 0.00017, respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2 %, respectively; p = 0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI.

[New aspects in the treatment of thyroid cancer : Highlights of the ASCO Annual Meeting 2016]. / Neue Aspekte in der Therapie von Schilddrüsenkarzinomen : Highlights des ASCO-Kongresses 2016.

The annual meeting of the American Society of Clinical Oncology (ASCO) took place at the beginning of June 2016 in Chicago. This year a total of 28 studies on the treatment of patients with thyroid cancer were presented, described in this review article according to the degree of cancer cell differentiation. The leading curative treatment modality is still surgery. In contrast, kinase inhibitors are being used increasingly within palliative concepts. The latest state of the art of thyroid cancer treatment, both surgical and medical, is summarized in this review.

[Is (chemo)radiotherapy really the future standard in the treatment of oropharyngeal carcinoma?]. / Ist Radio(chemo)therapie wirklich der zukünftige Standard für die Behandlung von Oropharynxkarzinomen?

Treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC) requires interdisciplinary collaboration. Besides oncologic control, organ and function preservation are important priorities. One treatment option is primary concomitant chemoradiotherapy (CRT), particularly for locally advanced head and neck cancer. Another option is sequential CRT, where induction chemotherapy may be followed either by radiation alone or by CRT. An important aspect of these modalities is the development of functional sequelae with regards to swallowing as a direct consequence of radiogenic fibrosis, as well as tissue ctoxicity associated with cisplatin-based chemotherapy. Conventional open surgical approaches are being increasingly replaced by transoral surgical modalities with less treatment-related morbidity. As a further, equally important goal of appropriately indicated surgery, adjuvant (C)RT may be omitted or the dose significantly reduced. The advantages of primary surgery over primary CRT may be less obvious in cases still requiring adjuvant treatment, although not necessarily completely eliminated. For patients with human papillomavirus (HPV)-driven OPSCC, it is important to note that primary surgery may provide comparable or even increased survival benefit. To date, there is no evidence for a clear advantage of primary CRT over primary surgery in this group. In these cases, a de-escalated treatment package may be the preferred option. Here, the application of radioimmunotherapy as well as a reduced radiation dose may minimize long-term treatment-related morbidities.

Curative treatment of head and neck squamous cell carcinoma : Organ preservation strategies in clinical routine in German-speaking countries.

INTRODUCTION: For the treatment of head and neck squamous cell carcinoma (HNSCC), there are currently no official standard of care guidelines in German-speaking countries, with the exception of oral cavity cancer. In order to learn about the applied treatment modalities in the clinical routine, we conducted a web-based survey to evaluate the local standards of palliative and curative treatment of HNSCC. This article focuses on the curative treatment options and organ preservation strategies. MATERIALS AND METHODS: The survey consisted of a web-based questionnaire that was performed between November 2013 and July 2014. The questionnaire included ten multiple-choice questions and four open questions in the section about curative treatment. RESULTS: Altogether, 62 of the 204 addressed centers participated in the survey. For primary chemoradiation (CRT), most centers used a platinum-based chemotherapy (52/54, 96.3 %). Induction chemotherapy (ICT) was offered in 37 of the 62 centers (60 %). In oral cavity cancer, CRT and ICT were used in 37.5 and 4.3 % of the cases, respectively. In oropharyngeal cancer, CRT and ICT were applied in 44.5 and 10.3 % of cases, respectively. For hypopharyngeal cancer, 44.8 % of the patients received CRT and 11.8 % received ICT, while for laryngeal cancer 35.9 % received CRT and 9.4 % underwent ICT. CONCLUSION: Our data showed that a variety of treatments are used for HNSCC within German-speaking countries. Many centers offer ICT. The majority of the hospitals uses platinum-based therapy as a conservative first-line option in their organ preservation protocols.

[New aspects in thyroid cancer treatment: Highlights of the ASCO Annual Meeting 2015]. / Neue Aspekte in der Therapie von Schilddrüsenkarzinomen: Highlights des ASCO-Kongresses 2015.

At the beginning of June 2015, the Annual Meeting of the American Society of Clinical Oncology (ASCO) took place in Chicago. A total of 24 studies in the field of thyroid oncology were presented, being discussed in the present review article according to the degree of cancer cell differentiation. The leading curative treatment modality is still surgery. Kinase inhibitors are used primarily in the context of palliative treatment concepts. The most recent treatment options in thyroid oncology, both surgical and medical, are summarized in the following article.

TORS for head and neck squamous cell carcinoma (HNSCC): the Hamburg experience.

OBJECTIVE: To report 2.5-year survival outcomes for head and neck squamous cell carcinoma treated primarily with transoral robotic-assisted resection. PATIENTS AND METHODS: Fifty consecutive, appropriately staged patients were enrolled prospectively, and underwent transoral robotic surgery between September 2011 and August 2013. There were 18 patients with overall Stage I-II and 32 patients with Stage III-IV disease. Adjuvant treatment could be spared for 20 patients. Another 5 patients refused the recommended adjuvant treatment. Seventeen patients received 60 Gy adjuvant radiotherapy and 8 patients underwent 66 Gy adjuvant chemo-radiotherapy. RESULTS: Overall survival was 94% with two disease-specific deaths and one unrelated death. The 2.5-year disease free survival rate was 88%, and the 2.5-year recurrence-free survival was 80%. Local recurrence rate was 10% after 2.5 years. CONCLUSION: Using TORS as their primary modality, 40% of the patients did not need adjuvant treatment and showed similar survival rates to that of conventional surgery or primary chemoradiotherapy. In another 34% of the patients, adjuvant chemotherapy could be spared and adjuvant radiotherapy could be reduced by 10 Gy, compared to primary chemoradiotherapy of 70 Gy. This invited report is based on previously published data by the same authors.

New treatment strategies for HPV-positive head and neck cancer.

Epidemiological studies show an increasing incidence of human papilloma virus-associated oropharyngeal cancer. HPV-positive head and neck squamous cell carcinoma (HNSCC) is recognized as a special subgroup of HNSCC. Because HPV-positive patients are often younger and have an outstanding prognosis, long-term toxicities of therapy have become an important issue. Current clinical trials focus on a reduction of treatment-related toxicity and the development of HPV-specific therapies. New treatment strategies include a dose reduction of radiotherapy, the use of cetuximab instead of cisplatin for chemoradiation and transoral robotic surgery (TORS). Increasing comprehension of the molecular background of HPV-associated HNSCC has also lead to more specific treatment attempts including immunotherapeutic strategies. Whereas recently published data shed light on immune mechanisms resulting in a tolerogenic niche for HPV and HPV-associated HNSCC, other studies focus on specific vaccination of HPV-positive HNSCC. This study will summarize current therapy approaches and illustrate ongoing clinical trials in the field of HPV-positive HNSCC.

[The development of TORS in Europe]. / Die Entwicklung von TORS in Europa.

Transoral robotic surgery (TORS) using the da Vinci® System is being performed increasingly on an international level. Particularly in the US, TORS is a common and popular technique. It has several advantages over the alternative minimally invasive surgical technique of laser surgery: the 3D-HD lens generates a magnified, three dimensional deep-field view of the surgical site; the instrument has an exceptionally high degree of freedom and, in contrast to laser surgery, non-tangential incisions are possible. TORS is also being performed more frequently in Germany. At present, 10 TORS proctor surgeons with approval from Intuitive Surgical, Inc. are working in France, Belgium, Great Britain, Italy and Germany and helping to establish new TORS teams. This review article presents a summary of the literature that has been published by these European TORS experts to date.

[Hereditary sensorineural hearing impairment and macrothrombocytopenia: a rare MYH9 gene mutation]. / Hereditäre sensorineurale Schwerhörigkeit und Makrothrombozytopenie: Eine seltene Mutation des MYH9-Gens.

We report on a rare case of an exon 16 mutation of the MYH9 gene in a 23-year-old woman. This gene encodes for non-muscular myosin IIA, which acts as a cytoskeletal contractile protein in diverse cell types. This disorder led to sensorineural hearing loss, macrothrombocytopenia, and proteinuria. MYH9 gene mutation can lead to diverse organ manifestation like pre-senile cataract or renal failure which are progressive in course. Due to the current lack of causal treatment, diagnostic steps, advice for follow-up examinations and symptomatic therapy approaches are presented.

[Transoral robotic total laryngectomy and neck dissection: the concept of robotic combo surgery]. / Roboterassistierte Salvage Laryngektomie und Neck Dissection: das Konzept "Robotic Combo Surgery"

The classic indications of TORS are still limited mostly to partial resections of the oropharynx, hypopharynx und supraglottic larnyx. In addition to these, there has been some promising applications towards broadening the limits of robotic assisted head and neck surgery and to perform a trans oral total laryngectomy (TORTL). Using the robotic assisted transoral approach for a total laryngectomy can reduce the risk of fistula formation after salvage laryngectomy effectively, avoiding a wide apron flap and with no plane dissected between the skin and the strap muscles. Trans Axillary Robotic Surgery, or TARS, offers similar advantages through an axillary access to the outer neck: this way, the skin incision will be placed outside of the future radiation field, if the latter is indicated. The transaxillary thyroidectomy is an important step in the learning curve of robotic assisted neck dissection and other TARS-procedures, and is seen as "the gateway to the neck". The present review article provides with a summary of the published literature of this novel approach to date, i. e., transoral robotic total laryngectomy and robotic assisted neck dissection. The fusion of these 2 adds up to the concept of Robotic Combo Surgery, resulting in the ultimate combination of scarless head and neck surgery for the primary as well as for the neck.

Timing of neck dissection in patients undergoing transoral robotic surgery for head and neck cancer.

BACKGROUND: Oncologic transoral robotic surgery (TORS) requires in most cases the concurrent or staged surgical treatment of the regional lymph nodes in the neck as well. The purpose of this study was to determine whether the timing of the regional lymphadenectomy (neck dissection) has an impact on the surgical outcomes and on the complication rates. METHODS: Single-institution, prospective case series with internal control group. Twenty-one patients underwent TORS and appropriate neck dissection concurrently (control group), while 20 patients underwent neck dissection in a timely staged fashion, 8.4 days (median; range, 3-28 days) following their TORS procedure (experimental group). Outcome measures included nodal yield, intraoperative pharyngocervical fistula formation, postoperative fistula formation, postoperative bleeding from the primary and from the neck dissection site, haematoma, seroma, and infection. RESULTS: Nodal yield values, as the oncologic quality indicator of a neck dissection, were comparable in the experimental and in the control group. Complication rates did not differ between the groups: intraoperative and postoperative fistula formation, postoperative bleeding, haematoma and seroma rates were similarly low in the two groups. There was no infection in either group. CONCLUSIONS: In the present cohort of 41 TORS-patients, the timing of neck dissection did not make a significant difference in the outcomes. We suggest therefore that aspiring and established TORS-teams do not restrict their appropriate indications due to robotic slot and theatre time constraints, but perform each indicated TORS-case as soon as possible within their given systems, even if the neck dissections cannot be done on the same day.

Therapy of periprosthetical leakage with tissue augmentation using Bioplastique around the implanted voice prosthesis.

Having a voice prosthesis provides a good possibility for speech rehabilitation after total laryngectomy has been performed, especially if common complications such as leakage around the valve can be reduced effectively. The early applications of a voice prosthesis-which was originally invented and applied by Mozolewski in 1972, was further developed by Blom and Singer and became an internationally available implantable instrument by 1980- already made clear not only the typical benefits, but also the complications, such as possible leakage around the implanted valve. Remacle proposed the injection of collagen into the surrounding tissues in order to stop leakage. Knowing that collagen is usually resorbed as time goes by, new substances that can be tolerated by human tissues must be found. This article reports the experiences of the authors in the search for such an injectable material that cannot be resorbed and does not migrate. In order to solve the above-mentioned problem, Lichtenberger introduced the injection of Bioplastique into the perivalvular tissues. This delivered the best results ever achieved in this field at our department. During the past 2 years, Bioplastique augmentation was performed for seven laryngectomized and speech-rehabilitated patients in order to reduce periprosthetical leakage. All procedures were successful in terms of either eliminating or reducing the leakage, and also the non-resorbable property of Bioplastique has been proven.