James K. Byrd

A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: A systematic review

To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T‐stage oropharyngeal cancer.

Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma

To determine the accuracy of pretreatment, contrast‐enhanced computed tomography (CT) in the diagnosis of extracapsular spread (ECS) in cervical lymph node metastases from p16‐positive head‐and‐neck squamous cell carcinoma (HNSCC).

Robot-Assisted Neck Dissection Through a Modified Facelift Incision

Objectives: The aim of this study is to describe the feasibility as well as oncologic outcomes of robot-assisted neck dissection (RAND) through a modified facelift incision in an American population. Study Design: Retrospective case series. Setting: University tertiary care hospital. Methods: All patients who underwent RAND between November 2012 and December 2014 were included. Medical records were reviewed for demographics, medical histories, staging, operative information, postoperative hospital course and complications, and oncologic outcomes. Results: There were 11 RANDs identified among 10 patients. Five patients had known nodal metastasis at the time of surgery. Two patients had been previously irradiated. The average time of surgery was 284.4 ± 72.3 minutes, including other associated procedures. The average lymph node yield was 28.5 ± 9.3 nodes. There were no major complications. Average follow-up was 19.4 months. There was 1 supraclavicular recurrence in a previously irradiated patient. All patients are currently alive and without evidence of disease. Conclusions: Robot-assisted neck dissection is a safe and feasible procedure that can be performed by surgeons with familiarity with neck dissection and robot-assisted surgery and who have been trained in RAND. Appropriate oncologic outcomes can be obtained in a patient wishing to avoid a noticeable scar.

Transoral robotic surgery for pharyngeal stenosis

Pharyngeal stenosis is a complication of head and neck cancer and sleep apnea treatment that results in functional impairment. Due to the location of the stenosis and tendency to recur, surgical management is challenging. Robotic surgery may allow these areas to be treated with surgical technique that would be difficult using traditional approaches.

Robotic-Assisted Neck Dissection via Facelift Incision: Preliminary Findings in North American Patients

Objectives: Describe the technique and lymph node yield of robotic-assisted neck dissection (RAND) via facelift incision in a North American cohort. Methods: Patients with squamous cell carcinoma of the head and neck at a tertiary hospital in 2012 were offered selective neck dissection via facelift incision. Operative time, estimated blood loss, complications, and lymph node yield were collected. Additionally, seven sequential open selective neck dissections were retrospectively reviewed for lymph node yield. A two-tailed t-test was used to compare nodal yield between the two groups (RAND vs open). Results: Four patients underwent five RANDs, including a simultaneous transoral robotic surgery base of tongue resection and one partial glossectomy. Four lateral neck dissections and one supraomohyoid neck dissection were performed. Mean operative time for the cohort was 4:29 +/- 1:33 (including extirpation); the average time for the three RAND only was 3:29 +/- 0:55. Average blood loss was 77 +/- 68 ml. The only complication was an intraoperative internal jugular vein injury, which was repaired with surgical clipping and suturing. The average number of lymph nodes removed was 29 in patients undergoing level 2-4 RAND, compared to 35.9 in the open group (P = 0.28). Conclusions: Our preliminary experience suggests that RAND is feasible and safe in the North American population. Our data is also the first to demonstrate that nodal yield is the same between robotic-assisted and open lymphadenectomy. Further study will determine the learning curve for the procedure, and long-term oncologic follow up is needed.

Cervical Metastasis of Unknown Primary: Use of Discovering Occult Primary Lesions

Objectives: Cancer of an unknown primary squamous cell carcinoma (CUP) metastatic to cervical lymph nodes is a challenging problem for the treating physician. The use of discovering the primary lesion in these patients with regards to oncologic outcomes remains unclear. Our aim is to determine if identification of the primary is associated with improved oncologic outcomes. Methods: Records of 136 patients initially diagnosed as CUP were retrospectively reviewed (1980-2010). Patients were divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan-Meier analysis. A nested subset of 34 patients in which the primary was discovered were matched to 34 patients remaining undiscovered according to nodal stage and age. Matched-pair analysis was compared using the stratified Cox regression model. Results: Discovery of the occult primary was associated with improvement in overall survival (10.19 vs 8.83 years, P < 0.001) when stratified across N1-N2c disease. Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (hazard ratio [HR] = 0.222; 95% confidence interval [CI] 0.06 to 0.81; P = 0.023). Discovery of the primary trended towards association with lower recurrence (HR = 0.33; 95% CI 0.09 to 1.19; P = 0.091). Conclusions: Discovery of the primary lesion is associated with improved overall survival in patients initially presenting as CUP, both in matched-pair and cohort comparison analyses. Within this subset, improved locoregional control with discovery of the primary was suggested by a trend towards decreased recurrence. Further studies may clarify treatment discrepancies and molecular differences.