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Lymph node density (LND)—the proportion of positive nodes among the total number of resected nodes—has emerged as a reliable prognostic factor in solid tumors. This study aims to assess the importance of LND in lingual squamous cell carcinoma (LSCC) and its prognostic involvement. A retrospective longitudinal study with 62 patients was performed. All patients were diagnosed with LSCC and submitted for tumor resection and neck dissection. Patients were stratified into low (<0.04) and high risk (≥0.04) based on LND. We analyzed the impact of LND on overall survival (OS) and disease-free survival (DFS), as well as the relationship between LND and the pathological staging, the involvement of positive margins, depth of invasion (DOI) and perineural infiltration. This study provides a substantial relationship between lymph node density (LND), overall survival (OS) and disease-free survival (DFS) in lingual squamous cell carcinoma (LSCC). A statistically significant distribution was found between LND, perineural infiltration and pathological staging, whereas no association was found with the rest of the prognostic variables analyzed., Depto. de Cirugía, Fac. de Medicina, TRUE, pub, Descuento UCM

Oral Papillary Squamous Cell Carcinoma (OPSCC) is a rare and a very occasional variant of squamous cell carcinoma with somewhat of a propitious prognosis. Generally, this OPSCC affects in the 6th -7th decade of life with a slight male predilection. PSCC generally mimics Verrucous Carcinoma (VC)in its papillary and verrucous appearance, but cellular atypia is not seen in VC as compared to PSCC. Generally, PSCC are solitary lesions or a collection of papillary lesions all having fibrovascular core and some even evolving from pre-existing papilloma. A 30-year-old male patient reported to the out -patient department of Oral and Maxillofacial Surgery with complain of unusual growth on the right side of tongue for two months. Incisional biopsy was done which later confirmed us on the diagnosis being Well differentiated Papillary Squamous Cell Carcinoma of the tongue. The treatment protocol included bilateral selective omohyoid neck dissection where in the right side up to level IV neck dissection was done and on the left side up to level IV neck dissection was done. This case report provides the details regarding the post-operative quality of life and associated complications of the same.

Oral Papillary Squamous Cell Carcinoma (OPSCC) is a rare and a very occasional variant of squamous cell carcinoma with somewhat of a propitious prognosis. Generally, this OPSCC affects in the 6th -7th decade of life with a slight male predilection. PSCC generally mimics Verrucous Carcinoma (VC)in its papillary and verrucous appearance, but cellular atypia is not seen in VC as compared to PSCC. Generally, PSCC are solitary lesions or a collection of papillary lesions all having fibrovascular core and some even evolving from pre-existing papilloma. A 30-year-old male patient reported to the out -patient department of Oral and Maxillofacial Surgery with complain of unusual growth on the right side of tongue for two months. Incisional biopsy was done which later confirmed us on the diagnosis being Well differentiated Papillary Squamous Cell Carcinoma of the tongue. The treatment protocol included bilateral selective omohyoid neck dissection where in the right side up to level IV neck dissection was done and on the left side up to level IV neck dissection was done. This case report provides the details regarding the post-operative quality of life and associated complications of the same.

Oral Papillary Squamous Cell Carcinoma (OPSCC) is a rare and a very occasional variant of squamous cell carcinoma with somewhat of a propitious prognosis. Generally, this OPSCC affects in the 6th -7th decade of life with a slight male predilection. PSCC generally mimics Verrucous Carcinoma (VC)in its papillary and verrucous appearance, but cellular atypia is not seen in VC as compared to PSCC. Generally, PSCC are solitary lesions or a collection of papillary lesions all having fibrovascular core and some even evolving from pre-existing papilloma. A 30-year-old male patient reported to the out -patient department of Oral and Maxillofacial Surgery with complain of unusual growth on the right side of tongue for two months. Incisional biopsy was done which later confirmed us on the diagnosis being Well differentiated Papillary Squamous Cell Carcinoma of the tongue. The treatment protocol included bilateral selective omohyoid neck dissection where in the right side up to level IV neck dissection was done and on the left side up to level IV neck dissection was done. This case report provides the details regarding the post-operative quality of life and associated complications of the same.

Oral Papillary Squamous Cell Carcinoma (OPSCC) is a rare and a very occasional variant of squamous cell carcinoma with somewhat of a propitious prognosis. Generally, this OPSCC affects in the 6th -7th decade of life with a slight male predilection. PSCC generally mimics Verrucous Carcinoma (VC)in its papillary and verrucous appearance, but cellular atypia is not seen in VC as compared to PSCC. Generally, PSCC are solitary lesions or a collection of papillary lesions all having fibrovascular core and some even evolving from pre-existing papilloma. A 30-year-old male patient reported to the out -patient department of Oral and Maxillofacial Surgery with complain of unusual growth on the right side of tongue for two months. Incisional biopsy was done which later confirmed us on the diagnosis being Well differentiated Papillary Squamous Cell Carcinoma of the tongue. The treatment protocol included bilateral selective omohyoid neck dissection where in the right side up to level IV neck dissection was done and on the left side up to level IV neck dissection was done. This case report provides the details regarding the post-operative quality of life and associated complications of the same.

Background: Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC. Materials and Methods: In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs. Results: Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398). Conclusion: SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.

Background: Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC. Materials and Methods: In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs. Results: Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398). Conclusion: SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.

Oral Papillary Squamous Cell Carcinoma (OPSCC) is a rare and a very occasional variant of squamous cell carcinoma with somewhat of a propitious prognosis. Generally, this OPSCC affects in the 6th -7th decade of life with a slight male predilection. PSCC generally mimics Verrucous Carcinoma (VC)in its papillary and verrucous appearance, but cellular atypia is not seen in VC as compared to PSCC. Generally, PSCC are solitary lesions or a collection of papillary lesions all having fibrovascular core and some even evolving from pre-existing papilloma. A 30-year-old male patient reported to the out -patient department of Oral and Maxillofacial Surgery with complain of unusual growth on the right side of tongue for two months. Incisional biopsy was done which later confirmed us on the diagnosis being Well differentiated Papillary Squamous Cell Carcinoma of the tongue. The treatment protocol included bilateral selective omohyoid neck dissection where in the right side up to level IV neck dissection was done and on the left side up to level IV neck dissection was done. This case report provides the details regarding the post-operative quality of life and associated complications of the same.

Background: Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC. Materials and Methods: In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs. Results: Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398). Conclusion: SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.

Introduction: Neck dissection is an important surgical procedure to treat head-neck cancers. It also helps to stage the disease as well as denotes further treatment plan. Materials and Methods: A retrospective analytical study is done between August 2017-July 2021 in tertiary care hospital to identify methods and practices to reduce complications of neck dissection. 104 patients who met the selection criteria were reviewed. Any intraoperative as well as post-operative complication was carefully assessed and managed as per protocol. Results: 62.5% were in the age group of 49-59 years. 66.35% were male. Maximum patient (65.38%) presented with oral cavity squamous call carcinoma. 51.92% had N1 neck node while 44.23% had N0 neck node. Internal jugular vein injury, spinal accessory nerve and marginal mandibular nerve injury, post-operative hematoma, seroma formation, chyle leak were found as significant complications in initial days. They were less in number or managed well with experience. Conclusion: Detailed knowledge of head-neck anatomy, meticulous dissection technique, early detection of any complication and its management can decrease the long-term morbidity and improve patient’s quality of life.   Keywords: Neck dissection, head-neck cancer, complication, meticulous haemostasis.

Introduction: Neck dissection is an important surgical procedure to treat head-neck cancers. It also helps to stage the disease as well as denotes further treatment plan. Materials and Methods: A retrospective analytical study is done between August 2017-July 2021 in tertiary care hospital to identify methods and practices to reduce complications of neck dissection. 104 patients who met the selection criteria were reviewed. Any intraoperative as well as post-operative complication was carefully assessed and managed as per protocol. Results: 62.5% were in the age group of 49-59 years. 66.35% were male. Maximum patient (65.38%) presented with oral cavity squamous call carcinoma. 51.92% had N1 neck node while 44.23% had N0 neck node. Internal jugular vein injury, spinal accessory nerve and marginal mandibular nerve injury, post-operative hematoma, seroma formation, chyle leak were found as significant complications in initial days. They were less in number or managed well with experience. Conclusion: Detailed knowledge of head-neck anatomy, meticulous dissection technique, early detection of any complication and its management can decrease the long-term morbidity and improve patient’s quality of life.   Keywords: Neck dissection, head-neck cancer, complication, meticulous haemostasis.

Introduction: Neck dissection is an important surgical procedure to treat head-neck cancers. It also helps to stage the disease as well as denotes further treatment plan. Materials and Methods: A retrospective analytical study is done between August 2017-July 2021 in tertiary care hospital to identify methods and practices to reduce complications of neck dissection. 104 patients who met the selection criteria were reviewed. Any intraoperative as well as post-operative complication was carefully assessed and managed as per protocol. Results: 62.5% were in the age group of 49-59 years. 66.35% were male. Maximum patient (65.38%) presented with oral cavity squamous call carcinoma. 51.92% had N1 neck node while 44.23% had N0 neck node. Internal jugular vein injury, spinal accessory nerve and marginal mandibular nerve injury, post-operative hematoma, seroma formation, chyle leak were found as significant complications in initial days. They were less in number or managed well with experience. Conclusion: Detailed knowledge of head-neck anatomy, meticulous dissection technique, early detection of any complication and its management can decrease the long-term morbidity and improve patient’s quality of life.   Keywords: Neck dissection, head-neck cancer, complication, meticulous haemostasis.

Background: Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC. Materials and Methods: In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs. Results: Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398). Conclusion: SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.

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Oral Papillary Squamous Cell Carcinoma (OPSCC) is a rare and a very occasional variant of squamous cell carcinoma with somewhat of a propitious prognosis. Generally, this OPSCC affects in the 6th -7th decade of life with a slight male predilection. PSCC generally mimics Verrucous Carcinoma (VC)in its papillary and verrucous appearance, but cellular atypia is not seen in VC as compared to PSCC. Generally, PSCC are solitary lesions or a collection of papillary lesions all having fibrovascular core and some even evolving from pre-existing papilloma. A 30-year-old male patient reported to the out -patient department of Oral and Maxillofacial Surgery with complain of unusual growth on the right side of tongue for two months. Incisional biopsy was done which later confirmed us on the diagnosis being Well differentiated Papillary Squamous Cell Carcinoma of the tongue. The treatment protocol included bilateral selective omohyoid neck dissection where in the right side up to level IV neck dissection was done and on the left side up to level IV neck dissection was done. This case report provides the details regarding the post-operative quality of life and associated complications of the same.

Background: Birt-Hogg-Dube Syndrome (BHDS) is a rare hereditary cancer syndrome which predisposes to renal cancer, pulmonary cysts and cutaneous fibromas. This case provides a novel account of an unexpected malignancy in a rare disease. Case report: A forty-five-year-old woman was detected to have bilateral renal masses on computed tomography (2 cm in diameter left and 3.6 cm in diameter right) when being investigated for abdominal pain. She underwent bilateral nephrectomies which revealed a chromophobe renal cell carcinoma, an oncocytic tumour and a hybrid oncocytic/chromophobe tumour. Following the surgery, the patient suffered irretrievable kidney injury and commenced on long-term haemodialysis thrice weekly. Genetic testing using multiplex ligation-dependent probe amplification revealed a deletion in major functional parts of folliculin gene in exon 14, and diagnosis of BHDS was made. The patient was subsequently considered for renal transplantation and was noted to have a thyroid nodule. Fine needle aspiration demonstrated highly atypical epithelial proliferation. She had a total thyroidectomy and left neck dissection to remove a 60 mm, poorly differentiated follicular thyroid carcinoma. Six months following her surgery, the patient reported severe back pain. Magnetic resonance imaging confirmed metastases to the spine and lungs. Biopsy of a lung lesion confirmed metastatic follicular thyroid carcinoma. The patient received palliative lenvatinib and survived for 15 monthswhilst still receiving haemodialysis. She subsequently died from complications of her metastatic disease. Conclusion(s): This case illustrates challenges in managing a patient with severe phenotypic presentation of BHDS. Whilst no causal association can be drawn on the basis of this case between thyroid cancer and BHDS, the case does support the notion that aggressive treatment of thyroid cancer in this patient group may be considered.

Background: Birt-Hogg-Dube Syndrome (BHDS) is a rare hereditary cancer syndrome which predisposes to renal cancer, pulmonary cysts and cutaneous fibromas. This case provides a novel account of an unexpected malignancy in a rare disease. Case report: A forty-five-year-old woman was detected to have bilateral renal masses on computed tomography (2 cm in diameter left and 3.6 cm in diameter right) when being investigated for abdominal pain. She underwent bilateral nephrectomies which revealed a chromophobe renal cell carcinoma, an oncocytic tumour and a hybrid oncocytic/chromophobe tumour. Following the surgery, the patient suffered irretrievable kidney injury and commenced on long-term haemodialysis thrice weekly. Genetic testing using multiplex ligation-dependent probe amplification revealed a deletion in major functional parts of folliculin gene in exon 14, and diagnosis of BHDS was made. The patient was subsequently considered for renal transplantation and was noted to have a thyroid nodule. Fine needle aspiration demonstrated highly atypical epithelial proliferation. She had a total thyroidectomy and left neck dissection to remove a 60 mm, poorly differentiated follicular thyroid carcinoma. Six months following her surgery, the patient reported severe back pain. Magnetic resonance imaging confirmed metastases to the spine and lungs. Biopsy of a lung lesion confirmed metastatic follicular thyroid carcinoma. The patient received palliative lenvatinib and survived for 15 monthswhilst still receiving haemodialysis. She subsequently died from complications of her metastatic disease. Conclusion(s): This case illustrates challenges in managing a patient with severe phenotypic presentation of BHDS. Whilst no causal association can be drawn on the basis of this case between thyroid cancer and BHDS, the case does support the notion that aggressive treatment of thyroid cancer in this patient group may be considered.

Background/Aim: Previous studies of nodenegative oral squamous cell carcinoma have shown a benefit of elective neck dissection compared to observation. Evidence for radiotherapy as single-modality elective treatment of the node-negative neck is so far lacking. Patients and Methods: In a retrospective material of 420 early-stage oral cancers from 2000 to 2016, overall survival, disease-free survival, and regional relapse-free survival were calculated with the Kaplan-Meier method. Results: At five years, overall survival was 59.7%, disease-specific survival was 77.2%, and regional relapse-free survival was 83.5%. Among those with adjuvant treatment of the neck after surgery of T1-T2 tumours during 2009-2016, regional relapse-free survival at five years was 85.7% for elective radiotherapy of the neck and 87.4% for elective neck dissection. Conclusion: Elective radiotherapy to the neck with a modern technique and adequate dose might be an alternative to neck dissection for patients with early-stage oral squamous cell cancer.

Background To examine the effect of prior use of cetuximab and neck dissection on the effectiveness of nivolumab, we conducted a large-scale subgroup analysis in Japanese patients with recurrent/metastatic head and neck cancer. Methods Data on the effectiveness of nivolumab were extracted from patient medical records. All patients were analyzed for effectiveness by prior cetuximab use. In the analyses for prior neck dissection, only patients with locally advanced disease were included. Results Of 256 patients analyzed, 155 had received prior cetuximab. Nineteen of 50 patients with local recurrence underwent neck dissection. The objective response rate was 14.7 vs 17.2% (p = 0.6116), median progression-free survival was 2.0 vs 3.1 months (p = 0.0261), and median overall survival was 8.4 vs 12 months (p = 0.0548) with vs without prior cetuximab use, respectively. The objective response rate was 23.1 vs 25.9% (p = 0.8455), median progression-free survival was 1.8 vs 3.0 months (p = 0.6650), and median overall survival was 9.1 vs 9.9 months (p = 0.5289) with vs without neck dissection, respectively. Conclusions These findings support the use of nivolumab for patients with recurrent/metastatic head and neck cancer regardless of prior cetuximab use or neck dissection history.

Background To examine the effect of prior use of cetuximab and neck dissection on the effectiveness of nivolumab, we conducted a large-scale subgroup analysis in Japanese patients with recurrent/metastatic head and neck cancer. Methods Data on the effectiveness of nivolumab were extracted from patient medical records. All patients were analyzed for effectiveness by prior cetuximab use. In the analyses for prior neck dissection, only patients with locally advanced disease were included. Results Of 256 patients analyzed, 155 had received prior cetuximab. Nineteen of 50 patients with local recurrence underwent neck dissection. The objective response rate was 14.7 vs 17.2% (p = 0.6116), median progression-free survival was 2.0 vs 3.1 months (p = 0.0261), and median overall survival was 8.4 vs 12 months (p = 0.0548) with vs without prior cetuximab use, respectively. The objective response rate was 23.1 vs 25.9% (p = 0.8455), median progression-free survival was 1.8 vs 3.0 months (p = 0.6650), and median overall survival was 9.1 vs 9.9 months (p = 0.5289) with vs without neck dissection, respectively. Conclusions These findings support the use of nivolumab for patients with recurrent/metastatic head and neck cancer regardless of prior cetuximab use or neck dissection history.

Background: Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines. Methods: Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence-free survival was calculated using the Kaplan–Meier method. Results: Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high-grade histology tumors. In multivariate analyses, high-grade histology and vascular invasion were associated with occult metastases. Conclusion: We recommend END of levels II and III for patients with high-grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.

Background: Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines. Methods: Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence-free survival was calculated using the Kaplan–Meier method. Results: Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high-grade histology tumors. In multivariate analyses, high-grade histology and vascular invasion were associated with occult metastases. Conclusion: We recommend END of levels II and III for patients with high-grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.

BACKGROUND/AIM: Previous studies of node-negative oral squamous cell carcinoma have shown a benefit of elective neck dissection compared to observation. Evidence for radiotherapy as single-modality elective treatment of the node-negative neck is so far lacking. PATIENTS AND METHODS: In a retrospective material of 420 early-stage oral cancers from 2000 to 2016, overall survival, disease-free survival, and regional relapse-free survival were calculated with the Kaplan-Meier method. RESULTS: At five years, overall survival was 59.7%, disease-specific survival was 77.2%, and regional relapse-free survival was 83.5%. Among those with adjuvant treatment of the neck after surgery of T1-T2 tumours during 2009-2016, regional relapse-free survival at five years was 85.7% for elective radiotherapy of the neck and 87.4% for elective neck dissection. CONCLUSION: Elective radiotherapy to the neck with a modern technique and adequate dose might be an alternative to neck dissection for patients with early-stage oral squamous cell cancer., Funding Agecies:Region Örebro LänÖrebro University, Örebro, Sweden

BackgroundTelehealth postoperative visits are an attractive strategy to minimize exposure, especially during the SARS-CoV-2 (COVID-19) pandemic. The use of a surgical drain often prevents this minimal-exposure approach in that patients return to the outpatient clinic for drain removal.Methods and resultsFollowing unilateral neck dissection, the customary closed-suction drain was replaced with a self-removing, passive drain dressing to facilitate same-day discharge and telehealth postoperative follow-up. The patient removed the dressing and drain at home during a telehealth visit on postoperative day 4 and she healed favorably without any signs of infection or seroma.ConclusionsWhen thoughtfully applied in the appropriate clinical context, small practice adaptations like this can facilitate telehealth solutions that diminish unnecessary exposure for patients, their caregivers, and health care staff.

Background: Oral squamous cell carcinoma (SCC) with cardiac metastasis is a rare antemortem finding. A case demonstrating significant right ventricular (RV) cavity obliteration due to metastatic SCC in an asymptomatic patient is presented. Case Summary: A 46-year-old gentleman underwent routine preoperative electrocardiogram which raised concern of possible anterior and inferior ST elevation (Image 1A). Clinically he had no chest pain but a 2-week history of night sweats, anorexia and weight loss. This was on a background of meta-static floor of mouth SCC treated with neoadjuvant carboplatin/paclitaxel chemotherapy and wide local excision of the floor of the mouth, subtotal glossectomy, segmental mandibulectomy, left sided selective lymph node dissection, and right modified radical neck dissection. Histopathology revealed T4aN2cM0 locally advanced SCC. Clinical examination was unremarkable except for a JVP with a prominent 'a' wave and a pericardial friction rub. Investigations revealed a normal Troponin (<0.04 ng/ml). CT Pulmonary Angiogram demonstrated a large pericardial effusion, a large filling defect (49x45mm) within the RV, multiple enlarged mediastinal and anterior pericardial lymph nodes. Several lung nodules were found bilaterally (largest 14x17mm). FDG-PET scan demonstrated an intensely avid mass involving the myocardium, the interventricular septum and floor of the ventricle (Image 1D). Nodular FDG avid pericardial disease and bilateral pulmonary metastases were noted in addition to uptake in the subcutaneous soft tissues anterior to the left oropharynx (SUV max 6). Urgent transtho-racic echocardiogram revealed moderate right ventricular (RV) dilation, with a large lobulated echodense mass invading the RV free wall, occupying most of the RV cavity (Image 1B & C). Estimated RV systolic pressure was 32 mmHg. A moderate circumferential pericardial effusion was detected, measuring 25 mm in diameter posteriorly with no tamponade physiology. Management: A pres

Background: Oral squamous cell carcinoma (SCC) with cardiac metastasis is a rare antemortem finding. A case demonstrating significant right ventricular (RV) cavity obliteration due to metastatic SCC in an asymptomatic patient is presented. Case Summary: A 46-year-old gentleman underwent routine preoperative electrocardiogram which raised concern of possible anterior and inferior ST elevation (Image 1A). Clinically he had no chest pain but a 2-week history of night sweats, anorexia and weight loss. This was on a background of meta-static floor of mouth SCC treated with neoadjuvant carboplatin/paclitaxel chemotherapy and wide local excision of the floor of the mouth, subtotal glossectomy, segmental mandibulectomy, left sided selective lymph node dissection, and right modified radical neck dissection. Histopathology revealed T4aN2cM0 locally advanced SCC. Clinical examination was unremarkable except for a JVP with a prominent 'a' wave and a pericardial friction rub. Investigations revealed a normal Troponin (<0.04 ng/ml). CT Pulmonary Angiogram demonstrated a large pericardial effusion, a large filling defect (49x45mm) within the RV, multiple enlarged mediastinal and anterior pericardial lymph nodes. Several lung nodules were found bilaterally (largest 14x17mm). FDG-PET scan demonstrated an intensely avid mass involving the myocardium, the interventricular septum and floor of the ventricle (Image 1D). Nodular FDG avid pericardial disease and bilateral pulmonary metastases were noted in addition to uptake in the subcutaneous soft tissues anterior to the left oropharynx (SUV max 6). Urgent transtho-racic echocardiogram revealed moderate right ventricular (RV) dilation, with a large lobulated echodense mass invading the RV free wall, occupying most of the RV cavity (Image 1B & C). Estimated RV systolic pressure was 32 mmHg. A moderate circumferential pericardial effusion was detected, measuring 25 mm in diameter posteriorly with no tamponade physiology. Management: A pres

BACKGROUND: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. METHODS: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. RESULTS: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4-23.4) and 8.0% (95% CI 2.7-13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0-6.1%), 2.0% (95% CI 0.9-3.1) and 0.4% (95% CI 0-1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0-1.3). CONCLUSIONS: The incidence of occult lymph node metastasis is higher in supraglottic and T3-4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.

PURPOSE OF REVIEW: In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS: Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.

BackgroundTelehealth postoperative visits are an attractive strategy to minimize exposure, especially during the SARS-CoV-2 (COVID-19) pandemic. The use of a surgical drain often prevents this minimal-exposure approach in that patients return to the outpatient clinic for drain removal.Methods and resultsFollowing unilateral neck dissection, the customary closed-suction drain was replaced with a self-removing, passive drain dressing to facilitate same-day discharge and telehealth postoperative follow-up. The patient removed the dressing and drain at home during a telehealth visit on postoperative day 4 and she healed favorably without any signs of infection or seroma.ConclusionsWhen thoughtfully applied in the appropriate clinical context, small practice adaptations like this can facilitate telehealth solutions that diminish unnecessary exposure for patients, their caregivers, and health care staff.

ImportanceTransoral endocrine surgery (TES) allows thyroid and parathyroid operations to be performed without leaving any visible scar on the body. Controversy regarding the value of TES remains, in part owing to the common belief that TES is only applicable to a small, select group of patients. Knowledge of the overall applicability of these procedures is essential to understand the operation, as well as to decide the amount of effort and resources that should be allocated to further study the safety, efficacy, and value of these operations.ObjectiveTo determine what percentage of US patients undergoing thyroid and parathyroid surgery are eligible for TES using currently accepted exclusion criteria.Design, setting, and participantsCross-sectional study of 1000 consecutive thyroid and parathyroid operations (with or without neck dissection) performed between July 1, 2015, and July 1, 2018, at 3 high-volume academic US thyroid- and parathyroid-focused surgical practices (2 general surgery, 1 otolaryngology-head and neck endocrine surgery). Eligibility for TES was determined by retrospectively applying previously published exclusion criteria to the cases.Main outcomes and measuresThe primary outcome was the percentage of thyroid and parathyroid cases eligible for TES. Secondary outcomes were a subgroup analysis of the percentage of specific types of cases eligible and the reasons for ineligibility.ResultsThe mean (SD) age of the 1000 surgical patients was 53 (15) years, mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 29 (7), and 747 (75.0%) of the patients were women. Five hundred fifty-eight (55.8%) of the patients were eligible for TES. Most patients with thyroid nodules with cytologically indeterminate behavior (165 of 217 [76.0%]), benign thyroid conditions (166 of 240 [69.2%]), and primary hyperparathyroidism (158 of 273 [57.9%]) were eligible for TES, but only 67 of 231 (29.0%) of patients with thyroid cancer

Osteoradionecrosis (ORN) is an infrequent but serious complication of radiotherapy, especially in the head and neck region. It is a slowly progressive condition, with management in the early stages focused on symptom control, and surgery usually reserved for advanced ORN. However, established ORN is difficult to treat. The role of hyperbaric oxygen therapy has recently been contested. The use of pentoxifylline in the management of ORN was first described by Delanian in 2004, but its benefits have not been replicated in other studies. In cases of advanced ORN with pathological fractures, many centres still advocate surgical resection and reconstruction. However, in this group of patients who often have multiple medical comorbidities, many of whom have previously undergone significant surgery, a resective plan is not always ideal. This paper presents two successful cases of bony union after the use of pentoxifylline and tocopherol to manage grade III ORN of the mandible. Both patients had pathological fractures and orocutaneous fistulas and were deemed unsuitable for surgery. The possible reasons for the success of pentoxifylline and tocopherol are discussed, and a review of the current literature evidence of similar cases is presented. Pentoxifylline and tocopherol should be considered for the management of advanced ORN where surgical management is not appropriate.Copyright © 2019 International Association of Oral and Maxillofacial Surgeons

Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node-negative neck, there is debate about the role of elective neck dissection (END), irradiation or observation. This systematic review assesses the prevalence of occult cervical disease and the evidence for END. A literature search was performed using Medline and Embase. All papers describing management of the neck in metastatic CSCC to the parotid were assessed for inclusion. Eighty-nine papers were identified and 17 met inclusion criteria. A total of 874 ENDs were performed in 874 patients with metastatic CSCC to the parotid with no clinically evident cervical disease. The overall prevalence of occult disease in a random effects model was 22.5% (95% confidence intervals 18.9-26.0). The prevalence of occult cervical disease in metastatic CSCC to the parotid is high. END is recommended in this patient group.Copyright © 2018 Wiley Periodicals, Inc.

INTRODUCTION: Management of clinically negative neck (cN0) in patients with parotid gland cancer is controversial. Treatment options can include observation, elective neck dissection or elective radiotherapy. AREAS COVERED: We addressed the treatment options for cN0 patients with parotid gland cancer. A literature review was undertaken to determine the optimal management of this group of patients. EXPERT OPINION: Patients with parotid carcinoma and clinically negative neck have various options for their management. The analysis of tumor stage, histology and grade is essential to better define patients at risk for occult lymph node metastasis. These patients can be managed by surgery, radiotherapy or their combination, depending on the presence of risk factors, the moment at which such risk factors are detected, patient-related clinical conditions, medical provider expertise and institutional facilities.

Objective. In surgical treatment of thyroid cancer, the appropriate resection of lymph nodes affected by metastases is mandatory. Minimally invasive inter­vention for metastatic process in thyroid cancer is alternative method of treatment in case of solitary neck metastases. The specific complications associa­ted with surgical trauma occur in cases of repeated interventions, namely the damage of Х, ХІ, and ХІІ pairs of cranial nerves, motor and sensory fibers of the cervical and brachial plexus, lymphorrhea. Complications associated with dissection of lymph drainage collectors lead to prolongation of post­operative stay in hospital. Thus, the need to minimize surgery risk and to increase efficacy of lymp­ha­den­e­ctomies in primary and repea­ted neck dissections emerges. The aim is to develop method of preoperative la­­beling of lymph nodes affected by thyroid cancer metastases to facilitate their intraoperative identi­fication. Materials and methods. The methylene blue dye for biological tissue labeling was used. In preoperative period, 24 hours before surgery FNAP was performed under the ultrasonography control with the purpose of metastatic lesion verification and then the 1 % solution of methylene blue dye was injected directly to affected node. During the dissection the labeled node was identified by its blue color. Results and discussion. Lymph nodes of different collector groups were labeled in 10 patients. The visual intraoperative identification of lymph node was feasible in all patients. The operation time was shortened in 9 patients (90 %). The mean decrease of operation time was 31.2 ± 7.6 min (p ≤ 0.05). The consecutive patho­logical investigation of all removed labelled lymph nodes confirmed the presence of metastatic thyroid cancer. Conclusion. The preoperative labeling of affected lymph nodes 24 hours ahead surgery is efficient, easy to use and cost-saving method of visualization which allows to mitigate excessive surgical traumatization during the l, Актуальность. При оперативном лечении рака щитовидной железы необходимо адекватное удаление лимфатических узлов, пораженных метастатическим процессом. Малоинвазивные методы лечения метастатического процесса рака щитовидной железы — это альтернативный метод лечения еди­ничных метастазов шеи. Специфические осложнения, связанные с хирургической травмой окружающих структур, возникают при повторных опера­тивных вмешательствах: повреждения X, XI и XII пар черепных нервов, двигательных и чувствительных волокон шейного и плечевого сплетений, лимфорея. Осложнения, которые сопровождаются диссекцией коллекторов лимфооттока, приводят к увеличению послеоперационного пребывания больного в стационаре. Возникает необходимость в уменьшении операционных рисков и повышении эффек­тивности лимфаденэктомий при первичных и повт­ор­­ных диссекциях шеи. Цель работы — разработка способа предопе­рационного маркирования лимфатических узлов, по­­ра­­женных метастазами рака щитовидной же­­лезы, для облегчения их идентификации во время операции. Материалы и методы. В основу была положена методика окрашивания биологических тканей раст­вором метиленового синего. На предоперационном этапе, за 24 ч перед операцией, больному под контролем УЗИ выполнялась тонкоигольная аспирационная пункционная биопсия (ТАПБ) лимфатического узла с целью подтверждения наличия метастатического поражения и вводился 1 % раствор метиленового синего непосредственно в ткань лимфоузла. В дальнейшем во время диссекции идентификация маркированного лимфоузла проводилась по характерной синей окраске последнего. Результаты и обсуждение. Были промарки­ро­ваны лимфоузлы разных групп коллекторов 10 боль­ных. У всех больных визуальная интраоперационная идентификация лимфатического узла была по­­зи­­тив­ной. Укорочение операционного времени наблюдалось у 9 больных (90 %). Усредненное укорочение времени, которое тратилось на операцию, составляло 31,2 ± 7,6 мин (р ≤ 0,05). При дальнейшем патогистологическом исследовании всех удаленных «ма, Актуальність. При оперативному лікуванні раку щитоподібної залози необхідне адекватне видалення лімфатичних вузлів, уражених метастатичним процесом. Малоінвазивні методи лікування метастатичного процесу раку щитоподібної залози — це альтернативний метод лікування одиничних метастазів шиї. Специфічні ускладнення, що пов’я­­зані з хірургічною травмою оточуючих структур, виникають при повторних оперативних втручаннях: пошкодження Х, ХІ та ХІІ пар черепних нервів, рухових та чутливих волокон шийного та плечового сплетінь, лімфорея. Ускладнення, що супроводжують дисекції колекторів лімфовідтоку, призводять до збільшення післяопераційного перебування хворого в стаціо­нарі. Постає необхідність у зменшенні операційних ризиків та підвищенні ефективності лімфаденектомій при первинних та повторних дисекціях шиї. Мета роботи — розробка способу передопераційного маркування лімфатичних вузлів, уражених метастазами раку щитоподібної залози, для полегшення їх ідентифікації під час операції. Матеріали та методи. В основу було покладено методику забарвлення біологічних тканин розчином метиленового синього. На передопераційному етапі, за 24 год перед операцією, хворому під контро­­лем УЗД виконувалась ТАПБ лімфатичного вузла, з метою підтвердження наявності метастатичного ураження, та вводився 1 % розчин метиленового синього безпосередньо в тканину лімфовузла. У подальшому, під час дисекції, ідентифікація маркованого лімфовузла проводилась за характерним синім забарвленням останнього. Результати та обговорення. Було промарковано лімфовузли різних груп колекторів 10 хворих. У всіх хворих візуальна інтраопераційна ідентифікація лімфатичного вузла була позитивною. Вкорочення операційного часу спостерігалось у 9 хворих (90 %). Усереднене вкорочення часу, що витрачався на операцію, становило 31,2 ± 7,6 хв (p ≤ 0,05). При по­­дальшому патогістологічному дослідженні всіх ви­­далених «маркованих» лімфовузлів було підтвердже­но наявність метастазів раку щитоподібної залози. Висновки. Спосіб пе

Introduction: Lymph node yield (LNY) in neck dissection has been identified as a prognostic factor in oral cavity cancer. The purpose of this study was to investigate the impact of additional use of optical imaging on LNY in therapeutic ND in oral cancer. Methods: Consecutive patients with oral squamous cell carcinoma with clinical neck metastasis planned for primary tumor resection were randomized to conventional neck dissection or near-infrared fluorescence (NIRF)-guided neck dissection, respectively. In the intervention group, patients were injected with ICG-Nanocoll prior to surgery. Intraoperatively, an optical hand-held camera system was used for lymph node identification. Also, NIRF imaging of the neck specimen was performed, and optical signals were pinned with needle markings to guide the pathological examination. The endpoint of the study was LNY per neck side in levels Ib-III. Results: 31 patients were included with 18 neck sides in the control group and 18 neck sides in the intervention group for evaluation. During NIRF-guided ND, individual lymph nodes could be identified by a bright fluorescent signal and individual tumor-related drainage patterns could be observed in the neck. The LNY in the intervention group was significantly higher compared to the control group (p = 0.032) with a mean of 24 LN (range: 12–33 LN in levels Ib-III compared to 18 LN (range: 10–36 LN) in the control group, respectively. Conclusions: NIRF-guided ND significantly improved the nodal yield compared to the control group. Intraoperative real-time optical imaging enabled direct visualization of tumor-related drainage patterns within the neck lymphatics.

Osteoradionecrosis (ORN) is an infrequent but serious complication of radiotherapy, especially in the head and neck region. It is a slowly progressive condition, with management in the early stages focused on symptom control, and surgery usually reserved for advanced ORN. However, established ORN is difficult to treat. The role of hyperbaric oxygen therapy has recently been contested. The use of pentoxifylline in the management of ORN was first described by Delanian in 2004, but its benefits have not been replicated in other studies. In cases of advanced ORN with pathological fractures, many centres still advocate surgical resection and reconstruction. However, in this group of patients who often have multiple medical comorbidities, many of whom have previously undergone significant surgery, a resective plan is not always ideal. This paper presents two successful cases of bony union after the use of pentoxifylline and tocopherol to manage grade III ORN of the mandible. Both patients had pathological fractures and orocutaneous fistulas and were deemed unsuitable for surgery. The possible reasons for the success of pentoxifylline and tocopherol are discussed, and a review of the current literature evidence of similar cases is presented. Pentoxifylline and tocopherol should be considered for the management of advanced ORN where surgical management is not appropriate.Copyright © 2019 International Association of Oral and Maxillofacial Surgeons

Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node-negative neck, there is debate about the role of elective neck dissection (END), irradiation or observation. This systematic review assesses the prevalence of occult cervical disease and the evidence for END. A literature search was performed using Medline and Embase. All papers describing management of the neck in metastatic CSCC to the parotid were assessed for inclusion. Eighty-nine papers were identified and 17 met inclusion criteria. A total of 874 ENDs were performed in 874 patients with metastatic CSCC to the parotid with no clinically evident cervical disease. The overall prevalence of occult disease in a random effects model was 22.5% (95% confidence intervals 18.9-26.0). The prevalence of occult cervical disease in metastatic CSCC to the parotid is high. END is recommended in this patient group.Copyright © 2018 Wiley Periodicals, Inc.

Objective: To compare the neck and shoulder motor function of patients following neck dissection, including comparison with a group of healthy volunteers. Study Design: Cross-sectional study. Setting: Two tertiary hospitals in Brisbane, Australia. Subjects and Methods: Participants included patients 0.5 to 5 years after unilateral nerve-sparing neck dissection and healthy control subjects. Demographic and clinical information was collected with cervical and shoulder motor function measures (scapular resting position, active range of motion, and isometric muscle strength). Differences between groups were examined via regression analyses that included statistical adjustment for the potential effect of age, sex, body mass index, and other disease-related variables. Results: The 57 patients (68%, men; median age, 62 years) were typically older than the 34 healthy controls (47%, men; median age, 46 years). There were no differences between types of nerve-preserving neck dissection for any of the motor function measures. When adjusted for age, sex, and body mass index, healthy volunteers (vs patients) had significantly greater cervical range (eg, extension coefficient [95% CI]: 11.04° [4.41°-17.67°]), greater affected shoulder range (eg, abduction: 16.64° [1.19°-31.36°]), and greater isometric strength of the cervical flexors (eg, men: 4.24 kgf [1.56-6.93]) and shoulder flexors (eg, men: 8.00 kgf [1.62-14.38]). Conclusions: Strength and flexibility of the neck and shoulder are impaired following neck dissection in comparison with healthy controls. Clinicians and researchers are encouraged to consider the neck—and the neck dissection as a whole—as a source of motor impairment for these patients and not just the status of the accessory nerve.

Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition ofanaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.

ImportanceTransoral endocrine surgery (TES) allows thyroid and parathyroid operations to be performed without leaving any visible scar on the body. Controversy regarding the value of TES remains, in part owing to the common belief that TES is only applicable to a small, select group of patients. Knowledge of the overall applicability of these procedures is essential to understand the operation, as well as to decide the amount of effort and resources that should be allocated to further study the safety, efficacy, and value of these operations.ObjectiveTo determine what percentage of US patients undergoing thyroid and parathyroid surgery are eligible for TES using currently accepted exclusion criteria.Design, setting, and participantsCross-sectional study of 1000 consecutive thyroid and parathyroid operations (with or without neck dissection) performed between July 1, 2015, and July 1, 2018, at 3 high-volume academic US thyroid- and parathyroid-focused surgical practices (2 general surgery, 1 otolaryngology-head and neck endocrine surgery). Eligibility for TES was determined by retrospectively applying previously published exclusion criteria to the cases.Main outcomes and measuresThe primary outcome was the percentage of thyroid and parathyroid cases eligible for TES. Secondary outcomes were a subgroup analysis of the percentage of specific types of cases eligible and the reasons for ineligibility.ResultsThe mean (SD) age of the 1000 surgical patients was 53 (15) years, mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 29 (7), and 747 (75.0%) of the patients were women. Five hundred fifty-eight (55.8%) of the patients were eligible for TES. Most patients with thyroid nodules with cytologically indeterminate behavior (165 of 217 [76.0%]), benign thyroid conditions (166 of 240 [69.2%]), and primary hyperparathyroidism (158 of 273 [57.9%]) were eligible for TES, but only 67 of 231 (29.0%) of patients with thyroid cancer

BackgroundThe AJCC/UICC classification is widely used for predicting survival in papillary thyroid cancer (PTC), but has not been evaluated as a predictor of recurrence. The hypothesis of this study was that the eighth edition of the AJCC system can be used in this novel way.MethodsAll patients in the study underwent surgery for PTC at a high-volume endocrine surgery centre in France between 1985 and 2015. The seventh and eighth editions of the AJCC/UICC staging system for PTC were employed to predict recurrence and disease-specific survival using the Kaplan-Meier and log rank tests.ResultsAmong 4124 patients (79·7 per cent female), median age was 50 (i.q.r. 38-60) years; 3906 patients (94·7 per cent) underwent total thyroidectomy, with lymph node dissection in 2495 (60·5 per cent). The eighth edition of the AJCC/UICC staging system placed 91·8, 7·1, 0·4 and 0·7 per cent of patients in stages I-IV respectively. After reclassifying patients from the seventh to the eighth AJCC/UICC edition, the disease was downstaged in 23·8 per cent. Over a median follow-up of 7 years, 260 patients (6·4 per cent) developed recurrent disease, including 5·2 per cent of patients with stage I, 19·6 per cent with stage II, 59 per cent with stage III and 50 per cent with stage IV disease, according to the eighth edition. The eighth edition was a better predictor of recurrence than the seventh edition.ConclusionThe eighth edition of the AJCC/UICC staging system appears to be a novel tool for predicting PTC recurrence, which is a meaningful outcome for this indolent disease. The eighth edition can be used to risk-stratify patients, keeping in mind that other molecular and pathological predictive factors must be integrated into the assessment of recurrence risk.

PURPOSE:The aim of the current work is to provide evidence-based recommendations to practicing physicians and others on the management of the neck in patients with squamous cell carcinoma of the oral cavity and oropharynx. METHODS:ASCO convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2018. Outcomes of interest included survival, regional disease control, neck recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS:The literature search identified 124 relevant studies to inform the evidence base for this guideline. Six clinical scenarios were devised; three for oral cavity cancer and three for oropharynx cancer, and recommendations were generated for each one. RECOMMENDATIONS:For oral cavity cancers, clinical scenarios focused on the indications for and the hallmarks of a high-quality neck dissection, indications for postoperative radiotherapy or chemoradiotherapy, and whether radiotherapy alone is sufficient elective treatment of an undissected neck compared with high-quality neck dissection. For oropharynx cancers, clinical scenarios focused on hallmarks of a high-quality neck dissection, factors that would favor operative versus nonoperative primary management, and clarifying criteria for an incomplete response to definitive chemoradiation for which salvage neck dissection would be recommended. Consensus was reached and recommendations were made for all six clinical scenarios. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition ofanaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.

Introduction: Lymph node yield (LNY) in neck dissection has been identified as a prognostic factor in oral cavity cancer. The purpose of this study was to investigate the impact of additional use of optical imaging on LNY in therapeutic ND in oral cancer. Methods: Consecutive patients with oral squamous cell carcinoma with clinical neck metastasis planned for primary tumor resection were randomized to conventional neck dissection or near-infrared fluorescence (NIRF)-guided neck dissection, respectively. In the intervention group, patients were injected with ICG-Nanocoll prior to surgery. Intraoperatively, an optical hand-held camera system was used for lymph node identification. Also, NIRF imaging of the neck specimen was performed, and optical signals were pinned with needle markings to guide the pathological examination. The endpoint of the study was LNY per neck side in levels Ib-III. Results: 31 patients were included with 18 neck sides in the control group and 18 neck sides in the intervention group for evaluation. During NIRF-guided ND, individual lymph nodes could be identified by a bright fluorescent signal and individual tumor-related drainage patterns could be observed in the neck. The LNY in the intervention group was significantly higher compared to the control group (p = 0.032) with a mean of 24 LN (range: 12–33 LN in levels Ib-III compared to 18 LN (range: 10–36 LN) in the control group, respectively. Conclusions: NIRF-guided ND significantly improved the nodal yield compared to the control group. Intraoperative real-time optical imaging enabled direct visualization of tumor-related drainage patterns within the neck lymphatics.

Background: Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction. Method(s): A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques. Result(s): A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P <.02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P <.01). Conclusion(s): Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.Copyright © 2017 Wiley Periodicals, Inc.

Background: Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction. Method(s): A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques. Result(s): A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P <.02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P <.01). Conclusion(s): Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.Copyright © 2017 Wiley Periodicals, Inc.

Purpose: The purpose of this study was to examine the relationship between physical impairments, quality of life and disability in patients following neck dissection, with consideration of patient and clinical characteristics. Methods: Cross-sectional study of patients < 5 years after neck dissection for head and neck cancer. Quality of life and self-reported disability were measured with the Neck Dissection Impairment Index, Quick Disabilities of the Arm, Shoulder and Hand, and Neck Disability Index. Active neck and shoulder range of motion and isometric muscle strength were also assessed. Generalised linear modelling was used to explore relationships between variables. Results: Eighty-four participants (68% male, median age 61 years) demonstrated reduced quality of life (median (interquartile range) score = 76 (49, 93) from 0 (worst) to 100 (best)), and mild levels of upper limb (14 (2, 32)) and neck disability (14 (6, 28)) (from 0 (best) to 100 (worst)). Bilateral neck dissection was associated with reduced quality of life (coeff (95% CI) = − 12.49 (− 24.69, − 0.29)). Post-operative chemoradiation therapy was associated with reduced quality of life (− 21.46 (− 37.57, − 5.35)) and neck disability (0.71 (0.10, 1.32)). Measures of shoulder flexibility or strength were associated with quality of life and self-reported disability. Conclusions: Quality of life and musculoskeletal disability after neck dissection are associated with factors from multiple domains including physical motor function and treatment modality. Implications for Cancer Survivors: Having reduced shoulder flexibility or strength is related to functional deficits and quality of life after neck dissection for head and neck cancer.

BACKGROUND:Patients undergoing salvage laryngectomy are predisposed to radiation-induced hypothyroidism and impaired wound healing secondary to the tissue effects of prior treatment. The impact of hypothyroidism on postoperative wound healing is not established. METHODS:A single-institution retrospective case series was performed. The inclusion criteria specified preoperatively euthyroid adults who underwent salvage laryngectomy with concurrent neck dissection between 1997 and 2015 for persistent or recurrent laryngeal squamous cell carcinoma after radiation or chemoradiation therapy (n = 182). The principal explanatory variable was postoperative hypothyroidism, defined as thyroid-stimulating hormone (TSH) higher than 5.5 mIU/L. The primary end points of the study were pharyngocutaneous fistulas and wounds requiring reoperation. Multivariate analysis was performed. RESULTS:The fistula rate was 47% among hypothyroid patients versus 23% among euthyroid patients. In the multivariate analysis, the patients who experienced hypothyroidism in the postoperative period had a 3.6-fold greater risk of fistula [95% confidence interval (CI) 1.8-7.1; p = 0.0002]. The hypothyroid patients had an 11.4-fold greater risk for a required reoperation (24.4 vs 5.4%) than the euthyroid patients (95% CI 2.6-49.9; p = 0.001). The risk for fistula (p = 0.003) and reoperation (p = 0.001) increased with increasing TSH. This corresponds to an approximate 12.5% incremental increase in the absolute risk for fistula and a 10% increase in the absolute risk for reoperation with each doubling of the TSH. CONCLUSION:Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.