Transoral Robotic Surgery for Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma.

With oropharyngeal cancer incidence rising globally, largely due to human papillomavirus (HPV), and hypopharyngeal cancer known for poor outcomes, innovative treatments are needed. Transoral robotic surgery (TORS) offers a minimally invasive approach that may improve upon traditional open surgery and radiotherapy/chemoradiotherapy (RT/CRT) methods. We conducted a literature review and included 40 PubMed studies comparing TORS, open surgery, and RT/CRT for oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC), focusing on survival rates and swallowing function outcomes. TORS provides favorable survival outcomes and typically results in superior swallowing function post-treatment compared to other therapeutic modalities in both oropharyngeal and hypopharyngeal SCCs. The clinical benefits of TORS, including improved operative precision and minimized tissue disruption, along with the elimination of surgical incision recovery and reduced RT toxicity, suggest it is a valuable surgical approach for head and neck cancers.

Surgical Management of a Large Well-Differentiated Liposarcoma in the Supraclavicular Fossa: A Case Report.

Background: Liposarcomas originating in the supraclavicular fossa are exceptionally rare, with only a few documented cases in the medical literature. Methods: We present a unique case involving a remarkably large indolent, atypical lipomatous tumor or well-differentiated liposarcoma situated in the right supraclavicular region, measuring 18 cm × 18 cm × 17 cm. To our knowledge, this represents the largest liposarcoma found in the supraclavicular fossa reported in the literature. This unique case highlights the effective management of a remarkably large supraclavicular liposarcoma through complete surgical resection. Result and Conclusion: Our findings further support the existing consensus that complete surgical removal is often curative for well-differentiated liposarcoma.

Medical Honey in Head and Neck Cancer.

Medical honey has been recognized for its medicinal properties for thousands of years, and several medical honey products have entered the market over the last two decades. In vitro studies have shown that honey has antimicrobial properties, protects against bacterial growth, and improves wound healing. However, these products are not widely used for wound treatment in head and neck surgery. Additionally, honey has been utilized in those undergoing radiotherapy for head and neck cancer (HNC) to treat radiation-induced mucositis. This literature review aims to describe and assess the utility of medical honey for patients undergoing treatment for HNC and thus review publications on medical honey for treating postoperative wounds and preventing radiation-induced mucositis. Ovid (Medicine), PubMed (Medline), and Google Scholar were searched using keywords related to medical honey and HNC. All abstracts retrieved in the search were screened for content relevance. Three randomized controlled trials on wound healing were reviewed and assigned a score using the revised Cochrane risk of bias tool for methodological quality. Three meta-analyses assessing radiation-induced mucositis were reviewed and evaluated. Using medical honey on postoperative wounds was associated with shorter hospital stays, faster healing of palatal graft defects, and reduced pigmentation of thyroidectomy scars. Medical honey had no impact on bacterial culture rates or other aesthetic measures. For patients undergoing radiation for HNC, orally ingested honey was associated with less weight loss and delayed the onset of severe radiation-induced mucositis. However, results across different meta-analyses were mixed. Minimal evidence supporting the use of honey in postoperative wounds for patients with HNC exists. However, the studies reviewed here, combined with in-vitro studies and studies in other anatomical regions, show honey may offer some wound healing benefits. More robust studies are needed to confirm the potential benefits of medical honey in the postoperative wounds of HNC patients. While radiation-induced mucositis continues to be a debilitating adverse effect of HNC treatment, the literature reviewed supports honey as a safe complementary therapy in preventing radiation-induced mucositis.

Safety of microvascular free tissue transfer reconstruction of the head and neck in the setting of chronic pharmacologic immunosuppression.

BACKGROUND: Patients on chronic pharmacologic immunosuppressive therapy are at increased risk of wound infection and complications after surgery. There is a paucity of data examining perioperative complications after microvascular free tissue transfer (MVFTT) reconstruction of the head and neck in this patient population. METHODS: Retrospective cohort study performed at two tertiary referral centers between August 2016 and May 2020. RESULTS: Nine hundred and seventy-nine patients underwent MVFTT during the study period; of these 47 (5%) patients were taking chronic immunosuppressive medications. The most common indications for immunosuppression were solid organ transplant and autoimmune disease. Fourteen (30%) patients had surgical complications within 30 days of surgery: 8 (17%) wound dehiscences, 6 (12%) hematomas, and 2 (4%) surgical site infections. There was one total and one partial flap failure with a 30-day reoperation rate of 4%. CONCLUSIONS: MVFTT of the head and neck appears to be safe in patients on chronic pharmacologic immunosuppression.

Predictors of Nodal Metastasis in Mucoepidermoid Carcinoma of the Oral Cavity and Oropharynx.

INTRODUCTION: Mucoepidermoid carcinoma (MEC) of the upper aerodigestive tract (UADT) is an uncommon malignancy, with limited literature available on its clinical and pathologic characteristics. Here, we describe the behavior of MEC of the UADT including pathologic characteristics and predictors of nodal metastasis. METHODS: Retrospective cohort study of patients with MEC of the UADT treated at an academic medical center from January 2008 to May 2018. Data was collected about demographics and tumor characteristics including clinical and histological data. The two-tailed Student t test and χ2 analysis were performed to assess for predictors of nodal metastasis. RESULTS: We identified 44 patients with minor salivary gland MEC of the oral cavity (OC) and oropharynx (OP). All patients were treated with primary site surgery. The primary site was the OC in 25 patients (57%) and OP in 19 (43%). Low-grade histology was seen in 27 specimens (61.4%), intermediate histology in 9 specimens (20.5%), and high-grade histology in 8 specimens (18.2%). Perineural invasion was noted in 10 specimens (22.7%). Neck dissection was performed in 17 patients (39%), with pathologically positive nodes found in 9 (20.5%). Notably, 5 of the 9 positive nodal specimens were found in clinically node-negative necks. Pathologically positive cervical lymph nodes were significantly associated with the OP as the primary site (p = 0.0005), perineural invasion (p = 0.012), lymphovascular invasion (p < 0.001), and high-grade histology (p = 0.004) in the primary specimen. DISCUSSION: MEC of the UADT is an uncommon malignancy. Our findings suggest elective neck dissection should be considered with perineural and lymphovascular invasion, high-grade tumor, and the OP as the primary site.

Predictors of nodal metastasis in sinonasal squamous cell carcinoma: A national cancer database analysis.

OBJECTIVE: We present the largest population based study of sinonasal squamous cell carcinoma (SCC) to identify risk factors for presentation with nodal metastasis. METHODS: The National Cancer Database (NCDB) was used for this study. Location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy were queried. Logistic regression analysis was performed to identify factors associated with presentation with nodal metastasis. RESULTS: 6448 cases met inclusion criteria. Nodal metastasis at presentation was seen in 13.2% of patients, with the sinus subsite (19.3%) being a significant risk factor for nodal metastasis at presentation when compared to the nasal cavity (7.9%). Logistic regression analysis showed black, uninsured and Medicaid patients were more likely than white and privately insured patients, respectively, to present with nodal metastasis. CONCLUSIONS: In sinonasal SCC, the sinus subsite has a significantly increased risk of nodal metastasis compared to the nasal cavity. Black race, uninsured and Medicaid patients are more likely to have nodal metastasis at presentation.

Major head and neck reconstruction during the COVID-19 pandemic: The University of Pittsburgh approach.

The 2019 novel coronavirus (COVID-19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to the providers, patients, and families.

The virome of HPV-positive tonsil squamous cell carcinoma and neck metastasis.

Oropharyngeal squamous cell carcinoma (OPSCC) represents the most common HPV-related malignancy in the United States with increasing incidence. There is heterogeneity between the behavior and response to treatment of HPV-positive oropharyngeal squamous cell carcinoma that may be linked to the tumor virome. In this prospective study, a pan-pathogen microarray (PathoChip) was used to determine the virome of early stage, p16-positive OPSCC and neck metastasis treated with transoral robotic surgery (TORS) and neck dissection. The virome findings of primary tumors and neck lymph nodes were correlated with clinical data to determine if specific organisms were associated with clinical outcomes. A total of 114 patients were enrolled in the study. Double-stranded DNA viruses, specifically Papillomaviridae, showed the highest hybridization signal (viral copies) across all viral families in the primary and positive lymph node samples. High hybridization signals were also detected for signatures of Baculoviridae, Reoviridae, Siphoviridae, Myoviridae, and Polydnaviridae in most of the cancer specimens, including the lymph nodes without cancer present. Across all HPV signatures, HPV16 and 18 had the highest average hybridization signal index and prevalence. To our knowledge, this is the first study that has identified the viral signatures of OPSCC tumors. This will serve as a foundation for future research investigating the role of the virome in OPSCC. Further investigation into the OPSCC microbiome and its variations may allow for improved appreciation of the impact of microbial dysbiosis on risk stratification, oncologic outcomes, and treatment response which has been shown in other cancer sites.

Outcomes after complete endoscopic sinus surgery and aspirin desensitization in aspirin-exacerbated respiratory disease.

BACKGROUND: In this study we assessed patient outcomes after complete endoscopic sinus surgery (ESS) and aspirin desensitization for patients with aspirin-exacerbated respiratory disease (AERD). METHODS: A retrospective chart review was conducted for patients with aspirin challenge-proven AERD who underwent complete ESS followed by aspirin desensitization. Outcomes assessed included need for revision surgery and quality-of-life measures using the 22-item Sino-Nasal Outcomes Test (SNOT-22). Data were collected preoperatively, postoperatively prior to desensitization, and then at intervals post-desensitization through 30 months after aspirin desensitization. A longitudinal linear mixed-effects model was used for data analysis. RESULTS: Thirty-four patients met the inclusion criteria for this study. Thirty-two patients successfully completed aspirin desensitization and were subsequently followed for 30 months after desensitization. Two patients were unable to complete desensitization. Five patients discontinued aspirin maintenance therapy due to gastrointestinal and respiratory side effects. Within the follow-up period, there were only 3 (9.4%) revision sinus surgeries. Notably, 1 of these revision cases occurred in a patient who had discontinued aspirin maintenance therapy. After surgical treatment and prior to desensitization patients had significant reductions in SNOT-22 scores. Our results demonstrate that total SNOT-22 scores remained statistically unchanged from immediate post-desensitization throughout the 30-month follow-up period. CONCLUSION: Complete sinus surgery followed by timely aspirin desensitization and maintenance therapy is an effective combination in the long-term management of sinus disease in patients with AERD.

Predictors of clinical outcome after tracheotomy in critically ill obese patients.

OBJECTIVES/HYPOTHESIS: To identify patient factors associated with outcomes in critically ill obese patients requiring tracheotomy. STUDY DESIGN: Single-institution, retrospective cohort study. METHODS: Charts were reviewed for inpatients admitted to an intensive care unit from 2007 to 2010 with International Classification of Diseases, 9th Revision codes of obesity or morbid obesity and tracheotomy. Variables collected in the dataset include subject age, ethnicity, gender, body mass index, tracheotomy type, patient outcome, chief diagnosis, and medical comorbid conditions. The primary outcomes of interest were tracheotomy type and patient outcome at the time of hospital discharge. Logistic regression models were developed for the probability of each patient outcome using univariate and multivariate models. RESULTS: One hundred two patients met inclusion criteria. The most common outcome was tracheostomy dependence (49%). Increased mortality was independently significantly associated with pulmonary hypertension (P = .019) and African American ethnicity (P = .045). Increased tracheostomy dependence was significantly associated with obstructive sleep apnea (P = .030). Increased decannulation was significantly associated with percutaneous tracheotomy (P = .016) and Caucasian ethnicity (P < .001). CONCLUSIONS: Obese patients in the intensive care unit who undergo tracheotomy have a high likelihood of remaining tracheostomy dependent at the time of discharge from the hospital. The factors most commonly found to be significantly associated with poor outcomes were open tracheotomy, African American ethnicity, obstructive sleep apnea, and pulmonary hypertension.