Peter T. Dziegielewski

Radiotherapy for benign head and neck paragangliomas: A 45-year experience

Paragangliomas of the head and neck are rare, slow‐growing, generally benign tumors of neuroendocrine cells associated with the peripheral nervous system that commonly involve the carotid body, jugular bulb, vagal ganglia, and temporal bone. Treatment options include surgery, radiotherapy (RT), stereotactic radiosurgery (SRS), and observation. This article briefly reviews our 45‐year institutional experience treating this neoplasm with RT.

Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm free flap.

OBJECTIVEnTo report swallowing outcomes and biomechanical properties of the base of the tongue (BOT) and the posterior pharyngeal wall (PPW) in patients who undergo surgical reconstruction with the beavertail modification of radial forearm free flap after primary resection of BOT cancer.nnnDESIGNnProspective cohort study with a 1-year minimum follow-up performed between October 1, 2001, and August 31, 2005.nnnSETTINGnTertiary care facility.nnnPATIENTSnPatients diagnosed as having primary carcinoma of the BOT were treated with primary surgical resection and reconstruction followed by radiotherapy. Inclusion criteria were collection of videofluoroscopic swallowing study (VFSS) data before and 1 year after surgery. Forty-one patients were treated during a 5-year period, and 20 were included in the final analysis.nnnINTERVENTIONSnReconstruction of BOT defects with the beavertail modification of radial forearm free flap followed by postoperative radiation.nnnMAIN OUTCOME MEASURESnAspiration score, pharyngeal residue score, and biomechanical analysis of BOT and PPW mobility were performed using images from VFSSs. Both the BOT and PPW positions were measured from 2 static bony landmarks.nnnRESULTSnOf the 20 patients in the final analysis, 19 (95%) were able to swallow safely at 1 year. Mobility of the BOT after surgery was reduced in all postoperative VFSS data. Anteroposterior dimension or bulk of the BOT was preserved. No significant difference was found in PPW mobility.nnnCONCLUSIONSnThe beavertail modification of the radial forearm free flap is a good reconstructive option after BOT cancer extirpation. The procedure preserves the bulk of the BOT after cancer treatment and maintains adequate BOT-PPW apposition. This allows structures such as the pharyngeal, oral, and suprahyoid musculature to contract and generate the necessary force to propel the food bolus through the oropharynx, resulting in a safe swallow.

Predictors and costs of readmissions at an academic head and neck surgery service.

Health care metrics, such as readmission rates, are being scrutinized to improve quality and decrease cost of care. The purpose of this study was to determine the rate, predictors, and costs of 30‐day unplanned readmissions (30dURs) in patients who undergo head and neck surgery.

Transoral robotic surgery (TORS) for laryngeal and hypopharyngeal cancers

Transoral robotic surgery (TORS) is increasingly used in laryngeal/hypopharyngeal cancer surgery. Ablative procedures described in these anatomical sites include: (i) supraglottic laryngectomy, (ii) total laryngectomy, (iii) glottic cordectomy, and (iv) partial pharyngectomy. TORS supraglottic laryngectomy remains the most commonly performed of these procedures. Initial oncologic and functional outcomes with these procedures are promising and comparable to other treatment options. As robotic instrumentation technology advances a rise in TORS laryngeal/hypopharyngeal surgery is anticipated. J. Surg. Oncol. 2015;112:702–706.

Endoscopic vidian neurectomy: a prospective case series.

Chronic refractory vasomotor rhinitis (VMR) is a debilitating condition that causes significant impairment of quality of life. The purpose of this study is to investigate the efficacy and potential side effects of endoscopic vidian neurectomy as treatment for patients with VMR.

The effects of geography on survival in patients with oral cavity squamous cell carcinoma

OBJECTIVEnTo assess the survival outcomes of oral cavity squamous cell carcinoma (OCSCC) by differing geographical location.nnnMETHODSnDemographic, pathologic, treatment, and survival data was obtained from OCSCC patients from 1998-2010 in Alberta, Canada. 554 patients were included from 660 OCSCC patients. Overall, disease-specific, and disease-free survivals were estimated with Kaplan-Meier and Cox regression analyses. Patients were grouped by geographic locations.nnnRESULTSnPatients from urban locations had improved overall, disease-specific, and disease-free survival compared to rural locations (p<0.05). Two and five year estimates of overall survival were significantly higher in the urban cohort at 84% and 78%, versus rural with 48% and 44%, respectively (p<0.05). Disease-specific and disease-free survival rates were also superior in the urban group (p<0.05). Diagnosis to treatment time for all 3 geographical groups was not found to be statistically significant (p>0.05).nnnCONCLUSIONnThis study shows that patients with OCSCC living in urban settings have improved survival compared to rural groups.

Transoral robotic surgery for carcinoma of unknown primary in the head and neck

Multiple diagnostic and treatment paradigms exist for the management of carcinoma of unknown primary (CUP) metastatic to cervical lymph nodes. Transoral robotic surgery (TORS) has emerged as a modality for diagnosis and treatment of CUP, optimizing identification and resection of the primary tumor, although also preventing chemotherapy in a subset of patients. This article presents the authors treatment paradigm and reviews the literature supporting the use of TORS in the management of CUP. J. Surg. Oncol. 2015;112:697–701.

Transoral robot-assisted carbon dioxide laser surgery for hypopharyngeal cancer

Transoral robotic surgery (TORS) has been used as a novel procedure for the resection of laryngopharyngeal cancers with promising outcomes. There are several studies proposing the benefit of combining TORS with a carbon dioxide (CO2) laser in resecting upper aerodigestive tract tumors. The purpose of this study was to illustrate transoral robot‐assisted carbon dioxide laser surgery (TORS‐L) for hypopharyngeal cancers.

Feasibility and clinical outcomes of transoral robotic surgery and transoral robot-assisted carbon dioxide laser for hypopharyngeal carcinoma.

AbstractTransoral robotic surgery (TORS) has been used as a novel procedure for squamous cell carcinoma of the laryngopharyngeal cancers with encouraging outcomes. The safety, feasibility, and efficacy regarding this approach have previously been demonstrated. There are several studies proposing the benefit of combining TORS with carbon dioxide (CO2) laser in resecting upper aerodigestive tract tumors. We report a series of patients with hypopharyngeal carcinoma treated with primary TORS with or without the flexible carbon dioxide (CO2) laser. All TORS resections were completed without any intraoperative complication. None required conversion to an open procedure. Clinical outcomes in this preliminary analysis indicate that magnified view, 3D visualization with the wristed instruments and tremor reduction technology of robotic experience, allow en bloc resection of early stage hypopharyngeal cancers. TORS with CO2 laser is a promising, minimally invasive surgical alternative for the treatment of hypopharyngeal tumors with comparable oncologic outcomes.

Radiation therapy for nasal vestibule squamous cell carcinoma: a 40-year experience.

We evaluated the treatment of squamous cell carcinoma (SCC) of the nasal vestibule. Eighty-six patients were treated with radiotherapy (RT) and 13 patients received surgery and RT. The mean follow-up was: 9.7xa0years (range 4xa0months–35.9xa0years). The 5- and 10-year outcomes were: local control (LC), 88 and 82xa0%; local–regional control (LRC), 78 and 73xa0%; freedom from distant metastases (FFDM), 96 and 96xa0%; cause-specific survival (CSS), 91 and 86xa0%; and overall survival, 75 and 51xa0%. The 5- and 10-year LC rates for patients treated with RT were 94 and 89xa0% overall. A multivariate analysis was performed. Tumor size predicted LC, LRC, OS, and CSS. Overall stage predicted LRC. RT cures most patients with T1–T2 and favorable T4 SCCs with acceptable toxicity. RT and surgery result in improved likelihood of cure for patients with advanced T4 lesions.