- Email: [email protected]
08:18: Percutaneous Treatment of Lymphatic Malformations
Scientific Sessions—Monday
8:00 AM to 9:30 AM SCIENTIFIC SESSION WCC 201
08:10 Racial Patterns of Thyroid Cancer Incidence in the U.S. Luc GT Morris, MD (presenter); Andrew Sikora, MD, PhD; Daniel Jethanamest, MD; Mark D DeLacure, MD
OBJECTIVES: In contradistinction to other cancers, black Americans have a lower incidence of thyroid cancer than whites. It is unknown if this is due to racial disparity in detection, or a true difference in incidence. This study hypothesized that the incidence gap might be attributable to poorer 08:02 cancer detection in blacks. Recurrent Laryngeal and Pharyngeal Cancer METHODS: Population-based cohort study of 53,990 patients Salvaged with TLM David George, Grant MB, ChB, BSc (St And) (presenter); between 1973-2003, using the Surveillance Epidemiology End Results (SEER) database. Subgroup analysis was conducted John R Salassa, MD; Michael L Hinni, MD; for well-differentiated (WDTC) and non-well-differentiated Bruce W Pearson, MD; Richard E Hayden, MD; histologies. William C Perry, PA-C RESULTS: Since 1973, thyroid cancer incidence among whites increased 150.2% (from 4.0 to 9.9/100,000), while OBJECTIVES: 1. Understand the role of Transoral Laser incidence among blacks increased 73.2% (from 3 to Microsurgery in the management of recurrent cancer of the 5.1/100,000). The incidence gap is almost entirely accounted larynx and pharynx. 2. Describe the outcomes and complicafor by excess WDTC in whites. For WDTC, blacks were tions following salvage TLM for recurrent larynx and pharynx slightly more likely to present with tumors ⬎1cm in size cancer. (p⫽.01, RR 1.08) or ⬎4cm (p⬍.0001, RR 1.13). However, METHODS: Study Design and Setting: A two-center prospecblacks were less likely to present with extrathyroidal extension tive case series analysis. Patients: One hundred and sixty-four of disease (p⫽.0008, RR 0.96); this was true for all histologies. patients undergoing salvage Transoral Laser Microsurgery Also, blacks were less likely to have nodal metastases of (TLM) for previously treated laryngeal or pharyngeal squaWDTC (p⬍.0001, RR 0.89). The number of pathologic posimous cell carcinoma between 1996 and 2006. Interventions: tive lymph nodes did not differ between whites and blacks. TLM in 164 patients, neck dissection in 35 and adjuvant CONCLUSIONS: Marginally smaller tumor size at diagnosis radiotherapy in 17 patients. Outcome measures: End points in whites may support the hypothesis of earlier cancer detecanalyzed included overall survival, disease-free survival, local tion. However, blacks are significantly less likely to present control, locoregional control, duration of hospital stay and with advanced or metastatic disease. It is likely that less agcomplications. gressive tumor biology in blacks, due to differing genetic and/or environmental risk factors, also contributes to lower RESULTS: One hundred and nine patients (67%) had salvage thyroid cancer incidence in blacks. TLM for recurrent primary tumors while 55 patients (33%) had salvage TLM for new primary tumors occurring within a previously treated region. The average follow-up period was 08:18 26 months. The distribution of tumor location was oropharynx Percutaneous Treatment of Lymphatic 75 (46%), glottic and subglottic larynx 57 (35%), supraglottic Malformations larynx 19 (12%), pyriform hypopharynx 11 (7%), hypopharD Richard Kang, MD (presenter); ynx and cervical esophagus 2 (1%). Overall two-year local and William E Shiels, II, MD; Gregory Wiet, MD, MBS locoregional control estimates were 75% and 72%, respectively. Two-year disease-free and overall survival estimates OBJECTIVES: 1. Understand successful treatment regimen were both 70%. The 5-year Kaplan-Meier estimates were: for treatment of head and neck lymphatic malformations (LM). local control, 71%; locoregional control, 68%; disease-free 2. Identify successful single-stage treatment for macrocystic survival 63% and overall survival 59%. The average duration LM. of hospitalization for all patients was two days. Five patients METHODS: Thirty-one patients (2 d-51y/o) underwent per(3%) suffered significant postoperative bleeding. cutaneous treatment for LM of the the head and neck, locations CONCLUSIONS: Transoral Laser Microsurgery offers select including orbit, ear, parotid, face, and neck, over five years patients an attractive salvage surgical therapy to the recurrent (2001-2006). Twenty-seven patients underwent primary treattumor site. ment of LM; 4 treated as recurrence following prior surgery. Moderators: Lawrence P A Burgess, MD; Robert P Zitsch III, MD
MONDAY
䡲
Scientific Session Orals: Head and Neck Surgery
P49
P50
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
Macrocyst (⬎1cm) access performed with coaxial 5F catheter system and treated with dual-drug chemoablation (sequential intracystic sodium tetradecyl sulfate and ethanol); doxycycline used for microcyts. Macrocysts and microcysts were treated after complete cyst aspiration with sonographic guidance. Macrocyst containment was confirmed with fluoroscopic cystography. Catheter drainage for macrocystic treatment was maintained for three days following treatment. Fifty-four macrocysts and 40 microcysts were treated; goals of treatment are complete cyst ablation documented by sonography, CT, or MR imaging, and excellent cosmetic results. RESULTS: Mean number of treatments ⫽ 1.7 per patient; mean number of treatments for macrocysts ⫽ 1.1; mean treatments for microcysts ⫽ 2.1 (macrocysts and microcysts most often treated as separate sessions). Treatment efficacy 54/54: macrocysts ablated (100%); microcyst controlled 17/17 pts; follow-up 2-60 mo. Treatments included massive cervical cysts and cysts surrounding the facial nerve and brachial plexus. Complications: infection in 2/31 patients; no postprocedural pain or other complications. CONCLUSIONS: Percutaneous interventional radiological regimens provide effective treatment, with rapid resolution, for macrocystic and microcystic LM as primary treatment, or for recurrence following surgical resection, without serious complications or deformity.
08:28 Effect of Neck Dissection on Quality of Life after Chemo-XRT Amy-Anne Donatelli Lassig, MD (presenter); Sonia A Duffy, PhD; Karen Fowler, MPH; Jeffrey E Terrell, MD OBJECTIVES: 1. Understand the differences in quality of life (QOL) in oropharyngeal squamous cell carcinoma patients treated with chemoradiation alone versus chemoradiation and neck dissection. 2. Evaluate such changes over time. METHODS: A prospective cohort study (2001 to present) was conducted at otolaryngology clinics at 2 tertiary care centers and a Veterans Affairs hospital. Patients: sample of 111 patients with SCCA of the oropharynx treated via chemotherapy and radiation therapy with or without neck dissection. Intervention: patients completed a self-administered health survey to collect health, demographic, and QOL information pretreatment and one year later. Clinical/treatment data and tumor site/stage were ascertained from the medical record. The main outcome measures were QOL as assessed by the SF-36 and HNQoL instruments. Type of treatment given was the independent variable. Descriptive statistics were calculated for all health and clinical characteristics, demographics, and QOL scores. T test was used to evaluate changes in QOL over time. RESULTS: Of 111 patients treated for oropharyngeal SCCA, 73 patients were treated with chemoradiation alone and 38 with
chemoradiation and neck dissection. There were no significant differences in QOL between the two groups. Only the pain index of the SF-36 approached significance (p equals .055) with the neck dissection group reporting greater pain. CONCLUSIONS: There are no significant differences in QOL in patients with SCCA of the oropharynx treated via chemoradiation alone versus chemoradiation and neck dissection. As the debate continues regarding the role of post-treatment neck dissection, this lack of added decrement in QOL should be considered.
08:36 Compare ALT and FRFF Flaps for Hypopharyngeal Reconstruction Johnson Chia-shen Yang, MD (presenter); Seng-feng Jeng, MD OBJECTIVES: Study and compare the functional outcomes associated with free anterior lateral thigh (ALT) and free radial forearm flaps (FRFF) for the reconstruction of hypopharyngeal defects. METHODS: A retrospective study for seven years (August 1999 to May 2006); 66 patients received 42 FRFF and 24 ALT flaps for reconstruction after hypopharyngeal cancer ablation. All reconstructions were performed by the same senior plastic surgeon. All patients were male, averaged 54 years old. Fiftyone skin tubing and 15 patches were designed for the defects. The average pharyngoesophageal defects was 84 cm2. The mean follow-up time was 44.5 months for the forearm group, and 10.7 month for the ALT group. Functional outcomes were compared. Chi-squared test used for statistical analysis. RESULTS: Twenty-three out of 42 patients in the forearm group and 12 out of 24 patients in the ALT group have completed an esophagogram for evaluation. Smooth barium passage was found in 83.3% of the ALT group as compared to 34.8% in the forearm group. The P-value is 0.006, which is statistically significant, based on Chi-square test. CONCLUSIONS: The ALT flap has several advantages such as minimal donor site morbidity, and it is a bulkier flap which helps to eliminate dead spaces as compared with FRFF. The lower fistula formation rate also leads to better functional outcome as demonstrated by an esophagogram. The ALT flap is therefore the preferred flap for hypopharyngeal reconstruction.
08:44 Identifying Candidates for Unilateral Parathyroidectomy James Norman, MD (presenter); Douglas Politz OBJECTIVES: Identify preoperative clinical data that may predict excellent versus poor candidates for unilateral parathyroidectomy.
8:00 AM to 9:30 AM SCIENTIFIC SESSION WCC 201
08:10 Racial Patterns of Thyroid Cancer Incidence in the U.S. Luc GT Morris, MD (presenter); Andrew Sikora, MD, PhD; Daniel Jethanamest, MD; Mark D DeLacure, MD
OBJECTIVES: In contradistinction to other cancers, black Americans have a lower incidence of thyroid cancer than whites. It is unknown if this is due to racial disparity in detection, or a true difference in incidence. This study hypothesized that the incidence gap might be attributable to poorer 08:02 cancer detection in blacks. Recurrent Laryngeal and Pharyngeal Cancer METHODS: Population-based cohort study of 53,990 patients Salvaged with TLM David George, Grant MB, ChB, BSc (St And) (presenter); between 1973-2003, using the Surveillance Epidemiology End Results (SEER) database. Subgroup analysis was conducted John R Salassa, MD; Michael L Hinni, MD; for well-differentiated (WDTC) and non-well-differentiated Bruce W Pearson, MD; Richard E Hayden, MD; histologies. William C Perry, PA-C RESULTS: Since 1973, thyroid cancer incidence among whites increased 150.2% (from 4.0 to 9.9/100,000), while OBJECTIVES: 1. Understand the role of Transoral Laser incidence among blacks increased 73.2% (from 3 to Microsurgery in the management of recurrent cancer of the 5.1/100,000). The incidence gap is almost entirely accounted larynx and pharynx. 2. Describe the outcomes and complicafor by excess WDTC in whites. For WDTC, blacks were tions following salvage TLM for recurrent larynx and pharynx slightly more likely to present with tumors ⬎1cm in size cancer. (p⫽.01, RR 1.08) or ⬎4cm (p⬍.0001, RR 1.13). However, METHODS: Study Design and Setting: A two-center prospecblacks were less likely to present with extrathyroidal extension tive case series analysis. Patients: One hundred and sixty-four of disease (p⫽.0008, RR 0.96); this was true for all histologies. patients undergoing salvage Transoral Laser Microsurgery Also, blacks were less likely to have nodal metastases of (TLM) for previously treated laryngeal or pharyngeal squaWDTC (p⬍.0001, RR 0.89). The number of pathologic posimous cell carcinoma between 1996 and 2006. Interventions: tive lymph nodes did not differ between whites and blacks. TLM in 164 patients, neck dissection in 35 and adjuvant CONCLUSIONS: Marginally smaller tumor size at diagnosis radiotherapy in 17 patients. Outcome measures: End points in whites may support the hypothesis of earlier cancer detecanalyzed included overall survival, disease-free survival, local tion. However, blacks are significantly less likely to present control, locoregional control, duration of hospital stay and with advanced or metastatic disease. It is likely that less agcomplications. gressive tumor biology in blacks, due to differing genetic and/or environmental risk factors, also contributes to lower RESULTS: One hundred and nine patients (67%) had salvage thyroid cancer incidence in blacks. TLM for recurrent primary tumors while 55 patients (33%) had salvage TLM for new primary tumors occurring within a previously treated region. The average follow-up period was 08:18 26 months. The distribution of tumor location was oropharynx Percutaneous Treatment of Lymphatic 75 (46%), glottic and subglottic larynx 57 (35%), supraglottic Malformations larynx 19 (12%), pyriform hypopharynx 11 (7%), hypopharD Richard Kang, MD (presenter); ynx and cervical esophagus 2 (1%). Overall two-year local and William E Shiels, II, MD; Gregory Wiet, MD, MBS locoregional control estimates were 75% and 72%, respectively. Two-year disease-free and overall survival estimates OBJECTIVES: 1. Understand successful treatment regimen were both 70%. The 5-year Kaplan-Meier estimates were: for treatment of head and neck lymphatic malformations (LM). local control, 71%; locoregional control, 68%; disease-free 2. Identify successful single-stage treatment for macrocystic survival 63% and overall survival 59%. The average duration LM. of hospitalization for all patients was two days. Five patients METHODS: Thirty-one patients (2 d-51y/o) underwent per(3%) suffered significant postoperative bleeding. cutaneous treatment for LM of the the head and neck, locations CONCLUSIONS: Transoral Laser Microsurgery offers select including orbit, ear, parotid, face, and neck, over five years patients an attractive salvage surgical therapy to the recurrent (2001-2006). Twenty-seven patients underwent primary treattumor site. ment of LM; 4 treated as recurrence following prior surgery. Moderators: Lawrence P A Burgess, MD; Robert P Zitsch III, MD
MONDAY
䡲
Scientific Session Orals: Head and Neck Surgery
P49
P50
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
Macrocyst (⬎1cm) access performed with coaxial 5F catheter system and treated with dual-drug chemoablation (sequential intracystic sodium tetradecyl sulfate and ethanol); doxycycline used for microcyts. Macrocysts and microcysts were treated after complete cyst aspiration with sonographic guidance. Macrocyst containment was confirmed with fluoroscopic cystography. Catheter drainage for macrocystic treatment was maintained for three days following treatment. Fifty-four macrocysts and 40 microcysts were treated; goals of treatment are complete cyst ablation documented by sonography, CT, or MR imaging, and excellent cosmetic results. RESULTS: Mean number of treatments ⫽ 1.7 per patient; mean number of treatments for macrocysts ⫽ 1.1; mean treatments for microcysts ⫽ 2.1 (macrocysts and microcysts most often treated as separate sessions). Treatment efficacy 54/54: macrocysts ablated (100%); microcyst controlled 17/17 pts; follow-up 2-60 mo. Treatments included massive cervical cysts and cysts surrounding the facial nerve and brachial plexus. Complications: infection in 2/31 patients; no postprocedural pain or other complications. CONCLUSIONS: Percutaneous interventional radiological regimens provide effective treatment, with rapid resolution, for macrocystic and microcystic LM as primary treatment, or for recurrence following surgical resection, without serious complications or deformity.
08:28 Effect of Neck Dissection on Quality of Life after Chemo-XRT Amy-Anne Donatelli Lassig, MD (presenter); Sonia A Duffy, PhD; Karen Fowler, MPH; Jeffrey E Terrell, MD OBJECTIVES: 1. Understand the differences in quality of life (QOL) in oropharyngeal squamous cell carcinoma patients treated with chemoradiation alone versus chemoradiation and neck dissection. 2. Evaluate such changes over time. METHODS: A prospective cohort study (2001 to present) was conducted at otolaryngology clinics at 2 tertiary care centers and a Veterans Affairs hospital. Patients: sample of 111 patients with SCCA of the oropharynx treated via chemotherapy and radiation therapy with or without neck dissection. Intervention: patients completed a self-administered health survey to collect health, demographic, and QOL information pretreatment and one year later. Clinical/treatment data and tumor site/stage were ascertained from the medical record. The main outcome measures were QOL as assessed by the SF-36 and HNQoL instruments. Type of treatment given was the independent variable. Descriptive statistics were calculated for all health and clinical characteristics, demographics, and QOL scores. T test was used to evaluate changes in QOL over time. RESULTS: Of 111 patients treated for oropharyngeal SCCA, 73 patients were treated with chemoradiation alone and 38 with
chemoradiation and neck dissection. There were no significant differences in QOL between the two groups. Only the pain index of the SF-36 approached significance (p equals .055) with the neck dissection group reporting greater pain. CONCLUSIONS: There are no significant differences in QOL in patients with SCCA of the oropharynx treated via chemoradiation alone versus chemoradiation and neck dissection. As the debate continues regarding the role of post-treatment neck dissection, this lack of added decrement in QOL should be considered.
08:36 Compare ALT and FRFF Flaps for Hypopharyngeal Reconstruction Johnson Chia-shen Yang, MD (presenter); Seng-feng Jeng, MD OBJECTIVES: Study and compare the functional outcomes associated with free anterior lateral thigh (ALT) and free radial forearm flaps (FRFF) for the reconstruction of hypopharyngeal defects. METHODS: A retrospective study for seven years (August 1999 to May 2006); 66 patients received 42 FRFF and 24 ALT flaps for reconstruction after hypopharyngeal cancer ablation. All reconstructions were performed by the same senior plastic surgeon. All patients were male, averaged 54 years old. Fiftyone skin tubing and 15 patches were designed for the defects. The average pharyngoesophageal defects was 84 cm2. The mean follow-up time was 44.5 months for the forearm group, and 10.7 month for the ALT group. Functional outcomes were compared. Chi-squared test used for statistical analysis. RESULTS: Twenty-three out of 42 patients in the forearm group and 12 out of 24 patients in the ALT group have completed an esophagogram for evaluation. Smooth barium passage was found in 83.3% of the ALT group as compared to 34.8% in the forearm group. The P-value is 0.006, which is statistically significant, based on Chi-square test. CONCLUSIONS: The ALT flap has several advantages such as minimal donor site morbidity, and it is a bulkier flap which helps to eliminate dead spaces as compared with FRFF. The lower fistula formation rate also leads to better functional outcome as demonstrated by an esophagogram. The ALT flap is therefore the preferred flap for hypopharyngeal reconstruction.
08:44 Identifying Candidates for Unilateral Parathyroidectomy James Norman, MD (presenter); Douglas Politz OBJECTIVES: Identify preoperative clinical data that may predict excellent versus poor candidates for unilateral parathyroidectomy.