Sei Young Lee

Management of Contralateral N0 Neck in Tonsillar Squamous Cell Carcinoma

Objectives: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory during initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management.

Chondrosarcoma of the Head and Neck

Chondrosarcoma of the head and neck region is a rare disease, representing approximately 0.1% of all head and neck neoplasms. The 5-year survival rate of chondrosarcoma is 70-80%, showing relatively good prognosis; however, it is known to progress slowly and eventually cause multiple metastases. In this study, we reviewed chondrosarcoma cases experienced at Yonsei University Medical College during the last 15 years to investigate its clinical characteristics and treatment outcome. The medical records of 8 patients who were diagnosed with chondrosarcoma of the head and neck region and underwent surgical treatment between December 1990 and December 2002 were retrospectively reviewed. The primary sites were sinus, mastoid, jugular foramen and thyroid cartilage. In all patients, the initial treatment modality was surgery, and postoperative radiation therapy was performed in 4 cases. The pathological findings showed chondrosarcoma in 7 cases and mesenchymal chondrosarcoma in 1 case. The treatment outcome resulted in 3 cases of recurrence, of which 2 cases were treated successfully and the other case expired of disease, indicating a survival rate of 87.5%. In the case that resulted in death, complete excision could not be achieved. Therefore, we concluded that wide excision is a beneficial initial treatment of this rare disease.

Oncological and functional outcomes of transoral robotic surgery for oropharyngeal cancer

In this prospective study we analysed the oncological and functional results of transoral robotic surgery (TORS) to find out if it was suitable as a minimally invasive treatment for oropharyngeal cancer. Between April 2008 and September 2011, 39 patients with oropharyngeal cancer were treated by TORS. We assessed overall and disease-free survival by the Kaplan-Meier test, and we used videopharyngography and the functional outcome swallowing scale (FOSS) to evaluate swallowing. We used nasometry to estimate hypernasality, and acoustic waveform analysis to evaluate the voice. Thirty-seven patients (95%) had histologically clear margins of resection. Overall survival at 2 years was 96% and disease-free survival 92%. An oral diet was tolerable after a mean of 6 (range 1-18) days. No serious swallowing difficulties were seen on the videopharyngogram. Thirty-six of 38 patients could swallow well (97%) with FOSS scores ranging from 0 to 2 (1 patient had a poor score but was able to take an oral diet after postural training). Voices were maintained close to the normal range on the acoustic waveform analysis. The oncological and functional results of TORS were quite acceptable for the treatment of oropharyngeal cancer. TORS is a valid treatment for selected patients with oropharyngeal cancer.

Comparison of oncologic and functional outcomes after transoral robotic lateral oropharyngectomy versus conventional surgery for T1 to T3 tonsillar cancer

We performed transoral robotic surgery (TORS) or conventional surgery via a transoral or mandibulotomy approach in patients with tonsillar cancer and prospectively analyzed the oncologic outcomes and functional recovery of the 3 groups.

Surgical techniques and treatment outcomes of transoral robotic supraglottic partial laryngectomy.

The objective of this prospective study was to confirm the validity of transoral robotic supraglottic partial laryngectomy as a conservation surgery for treating supraglottic cancer.

Nuclear localization of Nm23-H1 in head and neck squamous cell carcinoma is associated with radiation resistance.

Although radiation resistance is a primary issue in radiation therapy, attempts to find predictors of radiation resistance have met with little success. The authors therefore aimed to determine predictors for radiation resistance to improve the prognosis of head and neck squamous cell carcinoma (HNSCC).

Expression of Matrix Metalloproteinases and Their Inhibitors in Squamous Cell Carcinoma of the Tonsil and Their Clinical Significance

Objectives To investigate expressions of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in squamous cell carcinoma of the tonsil and to correlate expression profiles with clinicopathological characteristics. Methods Paraffin blocks were obtained from 45 tonsil squamous cell carcinoma (SCC) patients, who underwent surgery as an initial treatment between 1994 and 2004, and from 20 normal controls. Expressions of MMP-2, MMP-9, MMP-13, TIMP-1, and TIMP-2 were investigated immunohistochemically. Results The expressions of MMPs (except MMP-2) and TIMPs were found to be significantly different in tonsil SCC and normal control tissues. Furthermore, MMP-13 expression was found to be correlated with tumor invasion (P=0.05), and the expressions of MMP-9 and TIMP-1 with nodal metastasis (P=0.048, 0.031). No relation was found between MMP or TIMP expression and recurrence. However, MMP-9 expression was found to be significantly associated with 5-year survival in tonsil SCC patients by multivariate analysis (hazard ratio, 3.853; P=0.013). Conclusion Significant overexpressions of multiple MMPs and TIMPs were found in tonsil SCC tissues. Furthermore, our findings suggest that MMP-9 expression might be a useful prognostic factor.

A novel technique for the resection of the symptomatic lingual thyroid: transoral robotic surgery.

BACKGROUND Treatment of the symptomatic lingual thyroid is typically accomplished through surgical resection using a transcervical approach, which carries a high risk of treatment-related morbidity and leaves a visible scar on the neck. In order to reduce morbidity and eliminate visible scarring, this study utilized transoral robotic surgery (TORS) in performing lingual thyroidectomy. METHODS Between October 2009 and October 2010, three patients with symptomatic lingual thyroid were enrolled in this prospective study. Primary symptoms included dysphagia (two patients) and hemorrhage (one patient). A da Vinci robotic system (Intuitive Surgical, Inc., Sunnyvale, CA) was used to perform TORS in all patients. A face-up 30° endoscope was inserted through the oral cavity, and two instruments were positioned on either side of the endoscope. We evaluated the robotic set-up time, operating time, volume of blood loss, surgery-related complications, postoperative symptomatic improvement, and cosmetic results. RESULTS The transoral robotic lingual thyroidectomy was successfully performed in all patients. The mean operating time was 43 minutes (range 35-50 minutes), and an average of 11 minutes (range 10-15 minutes) was required to set up the robotic system. All patients were satisfied with their cosmetic results and the improvement of their symptoms after the operation. There were no perioperative complications or significant bleeding. The average volume of blood loss during the operation was 25 mL. CONCLUSIONS The use of TORS for lingual thyroidectomy was both technically feasible and safe, suggesting that it may be considered a viable alternative to other invasive surgical approaches in patients with symptomatic lingual thyroid.

Is human papillomavirus a causative factor of glottic cancer

OBJECTIVES Human papillomavirus (HPV) infection is controversial as a causative factor of head and neck cancers despite the relatively high frequency of HPV infection in extragenital organ cancers. We aimed to clarify whether HPV directly affects the oncogenesis and biologic behavior of glottis cancer (GC). METHODS Paraffin block was obtained from 95 patients who were diagnosed as GC and 15 normal controls. HPV genotyping chip, real-time polymerase chain reaction (PCR) was used for identification of prevalence, phenotype, and physical status of HPV. We compared results with the clinicopathological parameters of GC patients. RESULTS HPV was detected in 7.4% (7 of 95) of GC patients, whereas 0% (0 of 15) of controls. Of the HPV-positive tumors in GCs, HPV-16 was the single most common type and HPV-16 prevalence rate was 57.1% (4 of 7). Among the HPV-16 infected GCs, integration of HPV-16 was found only in one case (1 of 4). There was no significant difference in HPV prevalence between GC and controls and HPV had no significant relation with any clinicopathologic parameters of GC patients. CONCLUSION HPV infection may not be a causative factor in the oncogenesis and biologic behavior of GC.

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.