Trans-oral robotic surgery: a safe and effective tool in head and neck surgery in an Australian rural setting.

BACKGROUND: Trans-oral robotic surgery (TORS) facilitates surgical resection of tumours as an alternative to open surgery and has demonstrated favourable oncological results. Given the novelty of TORS and the paucity of evidence on TORS-specific complications in a rural setting, we report our experience with TORS at an Australian rural head and neck centre. METHODS: A retrospective review of all robotic cases performed at a regional head and neck centre in Queensland was undertaken from 2014 to 2019. Patient demographics, pre-operative surgical risk, complications and outcomes such as margins and cancer recurrence were recorded. Complications were graded based on the Clavien-Dindo grading system. Descriptive statistics were used to present patient characteristics and statistical analyses were performed using Stata. RESULTS: Forty-two TORS surgeries were performed. Twenty-one had histology confirming malignancy. There were no adverse intraoperative effects. Overall, seven patients (16.7%) had at least one complication. Four were recorded as a Clavien-Dindo 3b (post-operative bleed, wound infection and drain dislodgment). Of two cases with residual positive margins, one declined further surgery, and another received chemoradiotherapy. One patient recurred with distant metastatic disease, and another had locoregional nodal recurrence. The distribution of complications was significant across the pre-operative risk categories for both American Society of Anaesthesiologists and surgical risk score (P = 0.02). CONCLUSION: TORS in a rural head and neck centre is a safe and viable treatment option for patients so long as this is undertaken with appropriate training, mentorship and teamwork.

Care of laryngectomy stomas in general practice.

BACKGROUND: Laryngectomy stomas are formed following excision of the larynx, usually for the treatment of an underlying malignancy. This is a permanent stoma in which the trachea is separated from the oesophagus and brought to an opening in the neck. The complication rate of laryngectomy stomas is reported to be more than 60%. OBJECTIVE: The purpose of this article is to provide an overview of total laryngectomy stomas and inform general practitioners (GPs) of the frequently encountered complications, to improve stoma-related care and ultimately patient outcomes. DISCUSSION: Numerous early and late complications can be encountered by a GP, some of which are potentially life-threatening and require prompt recognition. Care of patients who have had a laryngectomy is multi-disciplinary, and GPs are often the first point of contact. The importance of a well-informed GP who can treat the patient and identify when they require referral to a stomal therapy nurse, speech pathologist or surgeon cannot be understated.

Use of fine-needle aspiration cytology in the diagnosis of parotid neoplasms.

BACKGROUND: This study aimed to assess the accuracy of fine-needle aspiration cytology (FNAC) in diagnosing parotid lesions, differentiating non-neoplastic lesions from neoplastic lesions and identifying benign and malignant lesions. METHOD: Retrospective data were collected from a single-surgeon practice in Toowoomba, a regional centre of Queensland. The FNAC results of 97 parotidectomy patients from 2006 to 2013 were compared with final histopathologic diagnosis, and statistical analysis of these results was carried out. RESULTS: The study found that FNAC could reliably differentiate between neoplastic and non-neoplastic lesions with a sensitivity and specificity of 95.4 and 100%. FNAC was less accurate in diagnosing malignancy, with sensitivity only 75% and specificity 97.5%. In the setting of squamous cell carcinoma, the most common malignancy identified, FNAC demonstrated even lower sensitivity of 58.8%. CONCLUSION: FNAC is a useful tool in the evaluation of parotid masses but should be used with caution in identifying neoplastic subtypes.

Outcomes of nodal metastatic cutaneous squamous cell carcinoma of the head and neck treated in a regional center.

BACKGROUND: Given its metastatic potential and high incidence, cutaneous squamous cell carcinoma of the head and neck (SCCHN) has significant morbidity and mortality. METHODS: We conducted a retrospective review of prospectively collected data for 113 consecutive patients with nodal metastatic cutaneous SCCHN treated surgically with curative intent in a regional center. Survival curves were generated by the Kaplan-Meier method. RESULTS: Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 80%, 83%, and 75%, respectively. Twenty-six patients (23%) relapsed, with 92% of relapses occurring within 2 years of surgery. Immunosuppression (p = .008) and N classification (p = .043) predicted decreased DFS on univariate analysis. On multivariate analysis, only immunosuppression independently predicted DFS (p = .034). CONCLUSION: This study validates the current N classification system, supports the adverse effect of immunosuppression, and suggests that intense follow-up for 2 years postsurgery is warranted. Survival at this regional center is comparable to that achieved at metropolitan tertiary cancer centers.

Incidence of osteoradionecrosis of the temporal bone.

BACKGROUND: Osteoradionecrosis of the temporal bone is a serious, late complication of radiotherapy to the temporal bone region. The aim of this study was to determine the incidence, risk and protective factors relating to the development of osteoradionecrosis of the temporal bone. METHODS: This is a retrospective review of prospectively collected data. A single surgeon collated a database over a 10-year period regarding patients undergoing surgery and subsequent radiotherapy for head and neck malignancies. This was reviewed, and information pertaining to demographics, nature of disease, radiation treatment regime and complications including osteoradionecrosis was extracted. Statistical analysis was then completed independently. RESULTS: A total of seven patients from the cohort of 82 developed osteoradionecrosis of the temporal bone within the period of the data collection. This represents an incidence of 8.5% (95% confidence interval = 3.6-13.4%). All who developed osteoradionecrosis had a metastatic parotid squamous cell carcinoma treated operatively with subsequent radiotherapy. There were no statistically significant risks or prognostic factors identified. Mean duration of follow-up was 32 months. CONCLUSION: The incidence of osteoradionecrosis of the temporal bone was 8.5% (95% confidence interval = 3.6-13.4%). Osteoradionecrosis of the temporal bone can present in excess of 10 years after treatment completion. This result may actually under -represent the true incidence of the complication. It has significant morbidity associated with its development and, occasionally, mortality. Those people undergoing radiotherapy to the parotid region may be at higher risk of osteoradionecrosis. A new classification system for osteoradionecrosis of the temporal bone has been proposed.