Robin L. Wagner

Prognostic factors in mobile tongue and floor of mouth carcinoma

This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the antierior tongue and floor of mouth.

Supraglottic carcinoma: patterns of recurrence.

A retrospective review of 202 patients with supraglottic squamous cell carcinoma and at least 2 years of follow-up was performed. Surgery alone was used to treat 102 patients, and combined therapy in 100 patients. Local-regional failure occurred in 47 (23%) patients. Only 4 patients (2%) developed recurrence at the primary site. The neck was the most common site for recurrent disease (39/47 or 83%), which in 35 patients appeared in the undirected, contralateral side. The risk to the contralateral side of the neck in patients with midline (epiglottic) lesions was similar to that in those with unilateral (aryepiglottic fold) lesions. Supraglottic laryngectomy, when properly selected, did not compromise primary control in the larynx. Radiation therapy was ineffective in controlling metastasis to the contralateral side of the neck in 16 of 99 patients (16 %). Therefore, routine bilateral neck dissection should be considered in the surgical treatment of supraglottic carcinoma for control of regional disease.

Reduced postoperative infections with an immune-enhancing nutritional supplement†

Objectives/Hypothesis: Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery. This study was undertaken to determine if perioperative nutritional supplementation with an immune‐enhancing formula is superior to standard formula in the prevention of postoperative infectious complications. Study Design: This was a prospective, randomized, double‐blind trial comparing perioperative nutritional supplementation with Impact and standard nutritional formulas. Methods: Following stratification, 136 patients undergoing oncologic head and neck surgery were randomly assigned to one of four treatment groups: preoperative/postoperative Impact, postoperative Impact, preoperative/postoperative standard formula, and postoperative standard formula. Outcome measures included laboratory evaluations of nutritional status, infectious and wound healing complications, and duration of hospitalization. Statistical analysis was performed using ξ2 or two‐tailed Fisher Exact Tests, when appropriate. Results: Intent‐to‐treat (P = .02) and actual therapy (P = .04) analyses revealed a significant decrease in the incidence of postoperative infectious complications (all sites) in patients who received Impact. There was no significant difference in wound healing problems or duration of hospitalization. Postoperative measures of nutrition status demonstrated a higher serum albumin (P = .05) in patients who received Impact compared with standard formula. Conclusions: Compared with standard formula, perioperative nutritional supplementation with Impact significantly reduced the incidence of infectious complications. The length of hospitalization was significantly prolonged in patients with postoperative infections, suggesting potential cost savings with the use of immune‐enhancing formulas such as Impact. Key Words: Nutritional supplements, malnutrition, head and neck cancer.

Microlaryngoscopic Surgery for T1 Glottic Lesions: A Cost-Effective Option

Excision of squamous cell carcinoma of the vocal cord using microlaryngoscopy (ML) with or without laser is a cost-effective treatment option in highly selected patients. A retrospective review of 50 cases of invasive and microinvasive squamous cell carcinoma demonstrated a failure rate of 8% (4 patients), all of whom were successfully salvaged by hemilaryngectomy (1 patient) or irradiation (3 patients). Other treatment options for T1 glottic lesions include hemilaryngectomy or radiotherapy, yielding similar cure rates of 95% and 67% to 93%, respectively. Investigation of the potential savings by extrapolating 1992 health care costs into the treatment options for T1 glottic carcinoma resulted in costs of

Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission.

12,956 per patient for ML, while hemilaryngectomy averaged

Antibiotic Prophylaxis in High-Risk Head and Neck Surgery: One-Day vs. Five-Day Therapy

35,616 per patient and radiotherapy netted costs of

Etiologic factors in head and neck wound infections

32,588 per patient. Extrapolating these costs to a theoretic group of 100 patients, ML provided savings of 2.4 million dollars when compared to the other treatment modalities. In selected patients, ML for T1 glottic cancer provides an effective therapeutic modality suited to our cost-conscious environment.

Outcome of Open Surgical Therapy for Glottic Carcinoma

A prospective pneumonia study was conducted simultaneously on head-and-neck surgery wards at two hospitals over 2 years; one hospital had a water supply contaminated with Legionella pneumophila but no record of having had a case of legionella pneumonia, and the other had just decontaminated its water supply because of known endemic nosocomial legionellosis. Special laboratory tests for legionella were done on all cases of nosocomial pneumonia irrespective of clinical impression. Over the first 18 months, the rate of nosocomial legionellosis was 30% at the first hospital and 0% at the second. Patients who underwent laryngectomy did not acquire the disease. Hyperchlorination at the first hospital was followed by a fall (p less than 0.01) in legionella pneumonias. Thus legionella pneumonias can be overlooked if special laboratory tests are not applied routinely, and surgical patients with head-and-neck cancer may be at high risk of nosocomial legionellosis because of the potential for pulmonary aspiration of contaminated water or orophyaryngeal microflora and/or frequent manipulation of the respiratory tract. This study demonstrates the benefits of examining the environment for legionella despite the absence of documented disease.

Comparison of ampicillin/sulbactam versus clindamycin in the prevention of infection in patients undergoing head and neck surgery

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound Infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P >.05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction.

The use of antibiotic prophylaxis does not prevent all postoperative wound infections. The records of 245 patients undergoing major head and neck surgery were reviewed to determine the cause of would infection which developed in 17 patients.