Prognostic Significance of Lymph Node Density in Patients with Hypopharyngeal Squamous Cell Carcinoma.

BACKGROUND: Lymph node density (LND) is more useful than the TNM classification in predicting survival after surgery for many cancers. The purpose of this study was to clarify independent prognostic factors for hypopharyngeal squamous cell carcinoma (HPSCC) and broaden the staging system to improve its predictive value. METHODS: The present study included 105 patients with HPSCC treated with hypophagectomy and neck dissection between 1993 and 2014. RESULTS: The median LND in patients with HPSCC was 0.060 (range 0.026-0.620). We found a significant difference in LND values between patients with and without recurrence (0.063 vs. 0.030, respectively; p = 0.001). The cutoff value of LND for recurrence was 0.055, with a sensitivity of 68% and specificity of 71%. Cervical lymph node metastasis, advanced pathologic T stage, lymphovascular invasion, LND ≥0.055, and extracapsular spread had significant adverse effects on 5-year overall and disease-specific survival in a univariate analysis. Multivariate analysis confirmed a significant association between 5-year overall survival and LND ≥0.055 [hazard ratio (HR) 2.19; 95% confidence interval (CI) 1.06-4.51; p = 0.035] and extracapsular spread (HR 2.47; 95% CI 1.09-5.61; p = 0.030). Furthermore, LND ≥0.055 (HR 2.30; 95% CI 1.07-4.93; p = 0.034) and extracapsular spread (HR 2.95; 95% CI 1.20-7.29; p = 0.019) were associated with 5-year, disease-specific survival. CONCLUSIONS: The median LND cutoff values ≥0.055 are associated with a greater risk of recurrence and survival in patients with HPSCC.

Endoscope-assisted facelift thyroid surgery: an initial experience using a new endoscopic technique.

BACKGROUND: A new approach to modifying facelift incision was recently developed for robotic thyroid surgery that seemed to be advantageous over other existing approaches. In this study, we aimed to investigate the feasibility and safety of the facelift approach not only for robotic thyroid surgery, but also for endoscope-assisted thyroid surgery. METHODS: Endoscope-assisted facelift thyroid lobectomy was performed for 11 patients with papillary microcarcinoma. RESULTS: All 11 operations were successfully performed endoscopically. This approach through a modified facelift incision provided safe dissection of the laryngeal nerves and exposed an adequate working space. We identified and preserved all neighboring critical structures (parathyroid gland and superior and recurrent laryngeal nerves) during surgery. The operative duration for simple thyroid lobectomy with central lymph node dissection in 11 patients was 120-180 min (average duration: 140 min). Sensory change around the earlobe occurred in three patients and was recovered within 2 months after surgery in all patients. No patient displayed laryngeal nerve palsy or a low-pitched voice. CONCLUSIONS: The facelift approach seems to provide a shorter and more direct route to the thyroid, requiring minimal dissection, and an adequate workspace not only for robotic surgery but also for endoscopic surgery. It is worthwhile to develop and refine the surgical techniques of endoscopic facelift thyroid surgery.

The therapeutic decision making of the unilateral vocal cord palsy after thyroidectomy using thyroidectomy-related voice questionnaire (TVQ).

The objective of this study was to investigate the efficacy of early management of post-thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy-related voice questionnaire (TVQ) when planning UVCP treatment. The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre-thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post-thyroidectomy. Twenty-five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure. The average total TVQ scores 2 weeks post-thyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months (p < 0.01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post-intervention (p < 0.01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cut-off distinguishing the two groups was 45 (68.0 % sensitivity, 78.3 % specificity). In conclusion, early management following timely diagnosis of post-thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.

Prognostic value of preoperative 18F-FDG PET/CT for primary head and neck squamous cell carcinoma.

(18)F-FDG PET/CT is clinically useful in the initial staging and follow-up of patients with head and neck squamous cell carcinoma (HNSCC). We studied the potential prognostic significance of preoperative (18)F-FDG PET/CT in HNSCC. The medical records of 294 patients who underwent preoperative (18)F-FDG PET/CT for HNSCC were retrospectively reviewed. The median SUVmax of the primary lesions (SUVmax-p) and cervical lymph nodes (SUVmax-n) was 7.98 ± 5.04 (range 1.2-28.7) and 3.34 ± 3.70 (range 1.0-20.4), respectively. There was a significant difference between with and without recurrence in SUVmax-p (11.14 ± 5.36 vs. 6.78 ± 4.35, p < 0.001) and SUVmax-n (5.60 ± 4.22 vs. 1.75 ± 1.46, p < 0.001). The cut-off values of SUVmax-p and SUVmax-n in the context of recurrence and cancer-related death were 8.5 and 3.5. The 5-year disease-free survival of patients with SUVmax-p < 8.5 and SUVmax-n < 3.5 was 79 and 79%, respectively, whereas that of patients with SUVmax-p ≥ 8.5 and SUVmax-n ≥ 3.5 was 39 and 30 %, respectively. Multivariate analysis confirmed the significant association between 5-year disease-free survival and SUVmax-p ≥ 8.5 (hazard ratio (HR) 2.68, p < 0.001) and SUVmax-n ≥ 3.5 (HR 2.29, p = 0.007). Furthermore, SUVmax-p ≥ 8.5 (HR 3.20, p = 0.012) and SUVmax-n ≥ 3.5 (HR 2.14, p < 0.001) were associated with 5-year overall survival. (18)F-FDG PET/CT cut-off values of SUVmax-p ≥ 8.5 or SUVmax-n ≥ 3.5 are associated with a recurrence and survival in HNSCC.

Transoral endoscopic thyroidectomy via the tri-vestibular routes: results of a preclinical cadaver feasibility study.

The concept of natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery that eliminates skin incisions using an endoscope passed through a natural orifice (e.g., mouth, urethra, or anus). This study was designed to evaluate the feasibility and safety of thyroid resection via an entirely transoral tri-vestibular route using endoscopy, and to introduce NOTES to the head and neck area of medicine. We performed ten complete endoscopic thyroid lobectomies with central lymph node dissection via a tri-vestibular approach in fresh-frozen cadavers. A 5-mm endoscope with a deflectable tip was used to visualize the surgical field. Three cannulas were inserted through the midline and bilateral incision sites in the vestibule to position the instruments and endoscope. We refined and described the surgical technique in each step using video clips. We identified and preserved neighboring critical structures during surgery. We also confirmed that there were no obvious remnant thyroid tissues and no injury to the neighboring structures after exploration. The transoral tri-vestibular approach seems to provide a good view and surgical field for endoscopic thyroidectomy. However, the transoral approach for thyroidectomy remains experimental, and the detailed surgical technique should be refined via further clinical studies.

Intraoperative Facial Nerve Monitoring during Parotidectomy: The Current Practices and Patterns of the Korean Society of Head and Neck Surgery (KSHNS).

Objectives: This study aimed to evaluate the current practices and trends of intraoperative facial nerve (FN) monitoring (IOFNM) during parotidectomy. Methods: A questionnaire containing 33 questions collecting information on the usage, indications, settings, techniques, loss of signal (LOS) management, anesthesiologist cooperation, and perception of usefulness of IOFNM was distributed among 348 members of the Korean Society of Head and Neck Surgery (KSHNS) via a dedicated website. Results: The response rate was approximately 25.6%, and 97% of the respondents reported using IOFNM selectively or routinely during parotidectomy. IOFNM usage decreased as the surgeon's level of experience increased (p = 0.089), from 100% in those with less than 5 years of experience to 75% in those with 20 or more years. Approximately 95% of respondents reported that the initial event threshold for electromyography activity used was 50-149 µV. Moreover, 52.4% of respondents performed neural mapping of the FN before visual identification. Initial management of LOS in visually intact FNs included checking the IOFNM system (75.3%), confirmation of muscle relaxant dosage (75.3%), and facial twitch identification (58.8%). Further management included proceeding with surgery regardless of persistent LOS (81.2%) and steroid administration sometimes or all of the time (72.9%). Overall, 98.8% of respondents found IOFNM beneficial for safe execution of parotidectomy. Conclusions: The majority of KSHNS surgeons used IOFNM during parotidectomy, although the clinical implementation of the procedure and LOS management varied between practitioners. This could be attributed to the lack of standardized protocols for IOFNM, emphasizing the need for the development of evidence-based consensus guidelines for all institutions.

Position Statement about Gender-Neutral HPV Vaccination in Korea.

Given the rising incidence of human papillomavirus (HPV)-related diseases, including cervical, penile, and oropharyngeal cancers, particularly among men, the implementation of comprehensive HPV vaccination strategies is necessary in South Korea. This position statement advocates the introduction of gender-neutral vaccination (GNV) in the country. It recommends the administration of the HPV vaccine to both men and women aged 9-26 years to prevent a broad spectrum of HPV-related conditions. Specifically, individuals aged 9-14 years are advised to receive two doses of the vaccine, whereas those aged 15-26 years are advised to receive three doses. The optimal age for vaccination is identified as 11-12 years old. Additionally, this statement recommends that women aged 27 years and older be vaccinated based on the discretion of healthcare providers. The introduction of GNV is essential to curb the spread of HPV and reduce the overall burden of HPV-related cancers, making it a critical public health initiative in Korea.

Role of local flaps in the prevention of soft tissue necrosis after transoral robotic surgery for tonsillar cancer.

OBJECTIVE: Soft tissue necrosis (STN) can occur after transoral robotic surgery (TORS) with radiation therapy (RT). We investigated the usefulness of local flap reconstruction for preventing STN after TORS in patients with tonsillar cancer. METHODS: This case-control study retrospectively reviewed clinicopathological data of patients who underwent TORS for tonsillar cancer at a tertiary referral center. The incidence of STN was compared in patients who underwent secondary intention healing or local flap reconstruction, and factors predicting STN were identified. RESULTS: STN occurred in 20 (25%) of 80 patients in the study. The incidence of STN was higher in the secondary intention healing than the flap reconstruction group. Mucositis grade (odds ratio [OR] 3.694, p = 0.02), RT dose (OR 4.667, p = 0.001), and secondary intention healing (OR 14.985, p = 0.035) were predictive factors for STN. CONCLUSION: Flap reconstruction can prevent STN after TORS with RT in patients with tonsillar cancer. The use of local flaps preserves the minimally invasive nature of TORS.

Predictive factors of distant metastasis in surgically treated HPV-positive tonsil cancer.

BACKGROUND: Human papilloma virus (HPV)-related tonsil cancer is associated with favorable outcomes. OBJECTIVE: The purpose of this study was to define factors affecting distant metastasis in patients with surgically treated HPV-positive tonsil cancer. METHODS: The present study enrolled 76 patients diagnosed with HPV-positive tonsil cancer who underwent primary surgery between January 2010 and December 2021. RESULTS: Twelve (15.7%) patients experienced a distant failure with a median follow-up time of 43 months. Sites of distant metastasis included the lung (n = 10), liver (n = 1), and brain (n = 1). Upon multivariate analysis, an advanced T stage (odds ratio [OR]: 13.94, 95% confidence interval [CI]: 1.29-149.863, p = 0.003) and margin involvement (OR: 5.96, 95% CI: 1.33-26.76, p = 0.02) were independent predictors of distant metastases. The five-year disease-specific survival for the entire cohort was 85%. The multivariate analysis confirmed that distant metastasis (hazard ratio [HR]: 12.688, 95% CI: 3.424-47.016; p < 0.001) and margin involvement (HR: 6.243; 95% CI: 1.681-23.191; p = 0.006) were significant factors associated with the five-year disease-specific survival. CONCLUSION: HPV-positive tonsil cancer patients with an advanced T stage and a positive surgical margin have a substantial risk of distant metastases. Distant metastasis and margin involvement are factors that affect their survival.

Oncological and functional outcomes of partial or total laryngopharyngectomy for hypopharyngeal cancer with thyroid or cricoid cartilage invasion.

BACKGROUND: Patients with cartilage invasion in hypopharyngeal squamous cell carcinoma (HPSCC) would benefit from partial laryngopharyngectomy (PLP). AIMS/OBJECTIVES: The purpose of this study was to examine the treatment outcomes of PLP for HPSCC with cartilage invasion, with a focus on the oncological safety and the function preservation. MATERIALS AND METHODS: We performed a retrospective review of 28 patients with HPSCC with thyroid or cricoid cartilage invasion who had undergone upfront surgery and were followed for more than one year between 1993 and 2019. RESULTS: Twelve patients treated with PLP (42.9%) and 16 patients treated with total laryngopharyngectomy (TLP) for cartilage invasion in HPSCC were identified. There was no significant difference in recurrence between the PLP group (7/12, 58.3%) and the TLP group (8/16, 50.0%) (p = .718). PLP was not associated with decreased five-year disease free survival (p = .662) or disease specific survival (p = .883) rates compared to TLP. Nine patients receiving PLP could be decannulated and retained intelligible speech (9/12, 75%). Gastrostomy tubes were placed in the PLP group (5/12, 42.9%) and TLP group (1/16, 6.2%) (p = .057). CONCLUSIONS AND SIGNIFICANCE: PLP appears to be a feasible option for the treatment of thyroid or cricoid cartilage invasion in HPSCC.

Maxillary sinus squamous cell carcinoma with concurrent prolonged foreign body impaction.

Several elements in the maxillary sinus are reported to be carcinogenic. Also, foreign body reaction can cause cancer in any part of the body. We report a case of squamous cell carcinoma at the site in the maxillary sinus where a bullet splinter, analyzed as iron afterward, was inserted during the Korean War, approximately 60 years earlier.

Prophylactic contralateral neck dissection has no advantage in patients with early stage HPV-positive tonsil cancer.

BACKGROUND: Patients with locally advanced HPV-positive tonsil cancer would benefit from prophylactic contralateral neck dissection (pCND). AIMS/OBJECTIVES: The aim of this study was to analyze rates of contralateral lymph node metastases (LNM) and their prognostic effects on locally advanced HPV-positive tonsillar squamous cell carcinoma. MATERIALS AND METHODS: Medical records of 54 patients who underwent upfront primary surgery and pCND were retrospectively reviewed. RESULTS: Six (11.1%) patients had contralateral LNM in 54 locally advanced HPV-positive tonsil cancer. Of these, five patients had contralateral level II LNM and one patient had contralateral level II and III LNM. Contralateral LNM showed significant positive correlations with advanced T stage (p = .017) and the presence of extracapsular spread (p = .007). Contralateral lymph node metastasis had no significant association with five-year disease-specific survival. CONCLUSIONS AND SIGNIFICANCE: This study demonstrated no advantage in performing pCND in early stage HPV-positive tonsil cancer.

MicroRNA-769-3p Acts as a Prognostic Factor in Oral Squamous Cell Cancer by Modulating Stromal Genes.

miR-769-3p expression is suppressed in the stromal subtype of head and neck squamous cell carcinoma (HNSCC); however, its role in stromal HNSCC has not been fully elucidated. To investigate the biological relevance of miR-769-3p in the stromal phenotype, we established oral squamous cell cancer (OSCC) cell lines, namely CAL27, HSC3, and YD8, overexpressing miR-769-3p. miR-769-3p expression was positively and negatively correlated with interferon-gamma-related genes and MYC target gene sets, respectively. miR-769-3p decreased OSCC cell migration and invasion as well as mesenchymal marker expression and increased epithelial marker expression. Moreover, miR-769-3p enhanced OSCC cell sensitivity to 5-fluorouracil. High miR-769-3p expression was associated with good prognosis of HNSCC patients. Collectively, these results suggest that miR-769-3p suppression enhances stromal gene expression and promotes the epithelial-to-mesenchymal transition. Therefore, miR-769-3p may be a potential biomarker of the miRNA phenotype in OSCC patients.

Close Surgical Margins in Oral and Oropharyngeal Cancer: Do They Impact Prognosis?

Introduction. Mucosal margins exhibit a mean shrinkage of 30−40% after resection of oral and oropharyngeal cancers, and an adequate in situ surgical margin frequently results in a pathological close margin. However, the impact on prognosis remains unclear. We investigated the impact of a pathological close margin on disease-free survival (DFS) and overall survival (OS). Methods. We retrospectively reviewed the clinicopathological data of 418 patients diagnosed with squamous cell carcinomas of the oral cavity or oropharynx who underwent initial surgery (with curative intent) at our institute between 2010 and 2016. Results. Of the total population, the pathological marginal status of 290 (69.4%) patients was reported as clear (>5 mm), 61 (14.6%) as close (>1 mm, ≤5 mm), and 67 (16.0%) as positive (≤1 mm). The 5-year DFSs were 79.3%, 65.1%, and 52% in patients in the negative margin (group 1), close margin (group 2), and positive margin (group 3) groups, respectively. The difference between groups 1 and 2 was not significant (p = 0.213) but the difference between groups 2 and 3 was (p = 0.034). The 5-year OSs were 79.4%, 84%, and 52.3% in groups 1, 2, and 3, respectively. The difference between groups 1 and 2 was not significant (p = 0.824) but the difference between groups 2 and 3 was (p = 0.001). In multivariate analysis, older age, advanced T stage, and a positive margin were independently prognostic of the 5-year DFS and OS. Conclusion. In conclusion, the OS of patients with close margins was no different than that of others when appropriate postoperative adjuvant and/or salvage treatment were/was prescribed. However, we could not determine the impact of close margins on locoregional recurrence given various biases in our study setting. A future prospective study is needed.

Fasciocutaneous free flap reconstruction for squamous cell carcinoma of the hypopharynx.

The purpose of this study was to examine functional and surgical outcomes after fasciocutaneous free flap reconstruction of the hypopharynx. A retrospective review of the records of 48 consecutive patients that underwent hypopharyngectomy and reconstruction using fasciocutaneous free flaps between 1996 and 2009 was performed. Flap donor sites included the radial forearm (n = 42), anterolateral thigh (n = 5), and lateral thigh (n = 1). There was no perioperative mortality, and the free flap survival rate was 95.8%. Five (10.4%) patients developed a postoperative pharyngocutaneous fistula. In three (6.3%) patients a stricture developed during the postoperative period. Forty-four (92%) patients were decannulated and maintained their voice. Forty-four (92%) patients were able to take oral nutrition, although 4 (8%) needed additional PEG-tube feeding. Five-year overall and disease-specific survival rates were 56 and 61%, respectively. Functional reconstruction of extensive laryngohypopharyngeal defects can be achieved using fasciocutaneous free flaps with favorable functional and surgical results.

Perioperative clinical factors affecting volume changes of reconstructed flaps in head and neck cancer patients: free versus regional flaps.

Postoperative volume changes in reconstructed flaps are known to influence the functional restoration of resected areas of the upper aerodigestive tract. The purposes of this study were to estimate the volume decreases in flaps and investigate clinical factors affecting the volume decrease. The medical records of 19 patients who underwent ablation and flap reconstruction surgeries for head and neck cancers were reviewed. The volume of the reconstructed flap was measured at 3, 12, and 24 months postoperatively using CT or MR imaging and the 3D-DOCTOR software. The relationships between volume changes and perioperative clinical parameters were examined. The primary tumor locations were the nasal cavity and paranasal sinus, oropharynx, oral cavity, and hypopharynx in 8, 6, 4, and 1 case, respectively. Twelve patients underwent anterolateral thigh flap (ALTF) reconstruction, and seven patients underwent pectoralis major myocutaneous flap (PMMCF) reconstruction. Twelve (63.2%) patients received postoperative radiation. The estimated volume decreases at 12 and 24 months postoperatively for ALTF were 20.9 and 24.8%, respectively, while those for PMMCF were 7.3 and 10.8%, respectively. Among clinical factors, only the type of flap affected the volume change. When determining the volume of reconstructed flaps, the type of flap must be considered. It was recommended to make free and regional flaps at least 20 and 10% larger, respectively than the actual defect.

Analysis of factors influencing voice quality and therapeutic approaches in vocal polyp patients.

The task of the present study was to investigate the relationship between parameters and factors predictive of voice quality and to suggest treatment guidelines for patients suffering from vocal polyps. In total, 158 patients diagnosed with vocal polyps and who received voice therapy were enrolled. Clinicomorphological factors such as size, location, color, and type of the polyp were evaluated. Perceptive and acoustic voice evaluation was conducted and the relationship of these voice parameters with clinicomorphological factors was analyzed. Additionally, factors favorable for voice therapy were investigated. GRBAS scale grade was closely related to acoustic parameters, such as jitter and shimmer. Univariate analysis showed the size of the polyp, the color of the vocal fold, a history of voice abuse, associated muscle tension dysphonia (MTD), and opposing reactive scar affected voice quality. In multivariate analysis, only the size of the polyp was associated with voice quality. The patients in whom the voice quality improved with voice therapy initially had smaller polyps and whitish-colored vocal folds. Results of the present study indicate that although the most influential factor on voice quality in vocal polyp patients was the size, several other factors should be considered in evaluating and treating vocal polyps. The size of the polyp and the color of the vocal fold are indicative of success or failure in voice therapy.

Supracricoid laryngectomy: oncologic validity and functional safety.

The objectives of this study are to elucidate the oncologic validity of the supracricoid laryngectomy (SCL) for locally advanced endolaryngeal cancers and as a salvage procedure, and to determine its safety in maintaining laryngeal physiology. The medical records of 114 patients that underwent SCL were reviewed. We examined whether the extended procedures, salvage procedure, adjuvant treatment, and type of reconstruction were associated with patient survival and the mean time of decannulation and nasogastric tube removal. Postoperative complications were investigated. There was no significant difference in survival according to the extent of the resection of the primary tumors and the presence or absence of previous treatment. However, the survival of patients that received radiation or concurrent chemoradiation after SCL was significantly lower than that of patients without any adjuvant treatment. Decannulation and nasogastric tube removal was possible for all except for two patients, and the mean time required was 18.4 and 26.1 days, respectively. The interval to starting oral feeding was significantly increased in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery compared to their counterparts. Pulmonary complications, particularly aspiration pneumonia, were the most common postoperative complications. The results of this study suggest that SCL was feasible for locally advanced laryngeal cancers and as a salvage procedure. Active and effective postoperative swallowing rehabilitation, particularly in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery, is needed to prevent aspiration pneumonia.

The impact of paratracheal lymph node metastasis in squamous cell carcinoma of the hypopharynx.

The aim of this study was to analyze the prevalence and prognostic importance of paratracheal lymph nodes in squamous cell carcinoma of the hypopharynx. A retrospective review of 64 previously untreated patients with squamous cell carcinoma (SCC) of the hypopharynx that underwent surgery was performed. Ipsilateral paratracheal lymph node metastases occurred in 22% (14 out of 64) and the mean number of paratracheal lymph nodes dissected per side was 2.3 (range 1-6). Contralateral paratracheal lymph node metastases were present in 2% (1 out of 42). Sixty-seven percent with postcricoid SCC and 22% with pyriform sinus SCC developed clinical node-positive ipsilateral paratracheal lymph node metastases, whereas 11% with posterior pharyngeal wall SCC developed paratracheal metastases. There was a significant correlation between paratracheal lymph node metastasis and cervical metastasis (p = 0.005), and the primary tumor site (postcricoid, 57.1%; pyriform sinus, 20.0%; posterior pharyngeal wall, 8.3%) (p = 0.039). Patients with no evidence of paratracheal lymph node metastasis may have a survival benefit (5-year disease-specific survival rate, 60 vs. 29%). However, this result did not reach statistical significance (p = 0.071). The patients with SCC of the postcricoid and/or pyriform sinus were at risk for ipsilateral paratracheal lymph node metastasis; furthermore, patients with paratracheal node metastasis had a high frequency of cervical metastasis and a poorer prognosis. Therefore, routine ipsilateral paratracheal node dissection is recommended during the surgical treatment of patients with SCC of the postcricoid and/or pyriform sinus with clinical node metastases.

Risk factors of free flap compromise in 247 cases of microvascular head and neck reconstruction: a single surgeon's experience.

The aim of this study was to evaluate relationships between free flap compromise and perioperative risk factors. A retrospective review was conducted for 237 patients who underwent 247 microvascular free flap reconstructions after head and neck ablative surgery. Twenty-one (8.5%) cases of free flap compromise due to a vascular obstruction were identified, and 11 flaps were lost (4.5%); an overall success rate of 95.5%. A significant correlation was found between diabetes mellitus and free flap compromise (p = 0.048). Preoperative irradiation was also found to influence free flap compromise, but with borderline significance (p = 0.052). However, multivariate analysis revealed a significant association between free flap compromise and diabetes mellitus [odds ratio = 4.9 (95% CI 1.1-22.8, p = 0.041)]. The presence of diabetes mellitus may require more attention to improve patient management and free flap outcomes.