Jessica Somerville

Mesenchymal Chondrosarcoma in Children and Young Adults: A Single Institution Retrospective Review

Background. Mesenchymal chondrosarcoma is an aggressive, uncommon histologic entity arising in bone and soft tissues. We reviewed our institutional experience with this rare diagnosis. Methods. We conducted a retrospective chart review on patients with mesenchymal chondrosarcoma over a 24-year period. Clinicopathologic and radiographic features were reviewed. Results. Twelve patients were identified. Nine were females; median age was 14.5 years (1.2–19.7 years). The most common site was the head/neck (7/12). Disease was localized in 11/12 patients (one with lung nodules). Six with available tissue demonstrated NCOA2 rearrangement by FISH. Six underwent upfront surgical resection, and six received neoadjuvant therapy (2 chemotherapy alone and 4 chemotherapy and radiation). All patients received adjuvant chemotherapy (most commonly ifosfamide/doxorubicin) and/or radiation (median dose 59.4 Gy). At a median follow-up of 4.8 years, 5-year disease-free survival and overall survival were 68.2% (95% CI 39.8%, 96.6%) and 88.9% (95% CI 66.9%, 100%). Two patients had distant recurrences at 15 and 42 months, respectively. Conclusion. Aggressive surgical resection of mesenchymal chondrosarcoma with chemoradiotherapy yields excellent local control and may reduce likelihood of late recurrence. Characterization of downstream targets of the HEY1-NCOA2 fusion protein, xenograft models, and drug screening are needed to identify novel therapeutic strategies.

Oropharyngeal Contamination Predisposes to Complications after Neck Dissection An Analysis of 9462 Patients

Objective While neck dissection is important in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. We sought to compare preoperative variables and outcomes between clean and contaminated neck dissections, using the 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data sets. Study Design Retrospective review of prospectively maintained database. Setting Multicenter (university hospitals; tertiary referral centers). Subjects and Methods A retrospective review was performed of the NSQIP database to identify patients undergoing neck dissection in clean vs oropharyngeal contaminated cases. Clinical factors, comorbidities, epidemiologic factors, and procedural characteristics were analyzed to identify factors associated with 30-day postoperative adverse events, including medical and surgical complications, unplanned reoperation, and mortality. Bivariate and multivariable analyses were performed for the outcome of one or more adverse events. Results In total, 8890 patients had clean neck dissections, while 572 patients had neck wound contamination with oropharyngeal flora. On multivariable regression analysis, oropharyngeal contamination was a significant risk factor for surgical complications (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.96-5.96; P < .001). However, medical complications and mortality were not significantly different between the 2 cohorts. This finding persisted after subgroup analysis, with removal of all thyroidectomy patients from analysis (OR, 2.33; 95% CI, 1.25-4.36; P = .008). Conclusion Using the ACS-NSQIP data set, this study found an increased risk of surgical complications in the setting of contaminated neck dissections. These data should be used for patient risk stratification, informed consent, and to guide further research.

Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006 to 2011 NSQIP Data Sets

Objectives: Studies evaluating complications after neck dissection alone or in conjunction with other procedures are sparse. We looked for predictors of adverse events after neck dissection using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), which tracks 30-day complication rates in patients undergoing surgery at participating centers. Methods: In this retrospective review, 619 patients were identified using CPT codes specific for neck dissection. Clinical factors, comorbidities, epidemiologic factors, and procedure characteristics were analyzed with multiple regression to evaluate relationship to complication rates. Results: Twenty-three percent of patients (142 of 619 patients) underwent neck dissection and experienced either a medical or surgical complication. Factors associated with adverse events included previous cardiac surgery (odds ratio [OR] 3.376, 95% confidence interval [CI] 1.084-10.516, P = .036), dyspnea (OR 2.568, 95% CI 1.06-6.22, P = .037), total work RVUs (OR 1.085, OR 1.041–1.131, P = .001), and anesthesia time (OR 1.005, 95% CI 1-1.009, P = .036). Importantly, smoking, age, ASA class, and prior radiation or chemotherapy were not significant. Injury to accessory nerve and chyle leak are not specifically tracked in NSQIP. Conclusions: This study presents important benchmarks for medical and surgical complication rates, reoperation, and mortality observed with neck dissection in a large nationally abstracted patient sample. Cardiorespiratory morbidity and surgical complexity were found to be major drivers of complications. The true complication rates may be underrepresented due to inadequate tracking of procedure specific complications in NSQIP.

Congenital Hearing Loss and Internal Auditory Canal Anomalies: Imaging Findings and Implications for Management

Objectives: Approximately 20% of patients with congenital sensorineural hearing loss are found to have a radiologically proven inner ear anomaly. Of the inner ear abnormalities, duplication of the internal auditory canal is rare. We sought to describe clinical characteristics and treatment results of patients found to have duplicated internal auditory canal on imaging. Methods: This case series identified patients from over a 2 year period obtained in a random manner from teaching files and daily case material. Imaging findings, clinical characteristics, audiology testing and treatment were reviewed. Results: A total of 7 patients were identified with a total of 12 ears (2 patients had unilateral presentation). Three patients in this series had a history of branchio-oto-renal syndrome. All patients had high-resolution computerized tomography (CT) performed. Two patients had magnetic resonance imaging (MRI) performed. All patients had audiogram evaluation. Six patients had sensorineural hearing loss, and one patient had conductive hearing loss. As hearing loss became more severe as documented by decibels of hearing loss on audiogram, increasing number of middle and inner ear anomalies were found on imaging. Conclusions: This series is one of the largest series to evaluate duplicated internal auditory canal in conjunction with cochlear anomalies. MRI is a useful adjunct to evaluate presence of the cochlear nerve and should be considered in patients undergoing cochlear implantation with findings of duplicated internal auditory canal on CT scan. More severe hearing loss may be indicative of potential for more anomalies found on imaging.