Aug 26, 2015 - disagreement, surgical findings supported the ultrasound results. ... are similar between transoral robotic surgery (TORS) and definitive ...
P173
Poster Presentations
Need for Level V Neck Dissection in T3-T4 Oral Squamous Cell Carcinoma Muhammad S. Marfani (presenter) Objectives: (1) Recognize the frequency of level V neck node involvement in T3-T4 oral squamous cell carcinoma. (2) Analyze the need of level V neck dissection with N0 - N1 neck in T3-T4 oral squamous cell carcinoma (SCC). Methods: Noninterventional, descriptive study from January 2011 to August 2012 at Dow University of Health Sciences & Civil Hospital Karachi, Pakistan, a tertiary care teaching hospital. Sampling was nonprobability and purposive. Histopathologically proven cases of squamous cell carcinoma of oral cavity with T3-T4 lesion and N0-N1 neck on basis of clinical examination and computed tomography scan findings were included in this study. All patients underwent modified radical neck dissection type-I along with excision of the primary growth. Results: Forty-nine patients fulfilling selection criteria were assessed on the basis of histopathological reports. At level I, metastatic lymph nodes were positive in 12 patients; 4 had positive nodes at level II and 2 each at level III and IV. However, none were positive at level V. Primary lesion was involving cheek in 40 and tongue in 9 cases. Histopathology
revealed moderately differentiated SCC in 33 and well-differentiated SSC in 16 patients. Conclusions: Our study suggests that level V neck dissection is not needed in oral SCC with N0-N1 neck even in T3-T4 lesions. However, as the sample size is small, further study with a larger number of cases is required to establish future guidelines for the extent of neck node clearance in oral cancer. Oncologic Outcomes in Patients with Oropharyngeal Squamous Cell Carcinoma Treated with TORS versus Definitive CRT Diane C. Ling (presenter); Bhavana S. Vangara; Peyman Kabolizadeh, MD, PhD; David A. Clump, MD, PhD; Robert L. Ferris, MD; Seungwon Kim, MD; Umamaheswar Duvvuri, MD Objectives: It has been postulated that treatment outcomes are similar between transoral robotic surgery (TORS) and definitive chemoradiation (CRT) for patients with oropharyngeal squamous cell carcinomas (OPSCC). We compared oncologic outcomes between OPSCC patients treated with definitive CRT and those treated with TORS only. Methods: An observational comparison study was performed on 23 patients treated with TORS without adjuvant therapy and 33 patients treated with definitive CRT between July 2005 and December 2013. All patients had early stage disease with T0-T2 and N0-N2. Median age was 57 (range: 36-82) years and 80.4% of patients were male, which was similar between groups. Human papillomavirus (HPV)+ disease was present in 70.0% of TORS and 33.3% of CRT patients, although HPV status was not tested in 63.6% of the CRT patients. Results: Median follow-up was 22.5 months (range, 0.33-83.4 months). Local failure rate for the entire cohort was 7.1% (9.1% for definitive CRT, 4.3% for TORS, P = .85). Overall regional failure rate was 3.6% (3.0% for definitive CRT, 4.3% for TORS, P = .48). Overall distant failure rate was 5.4% (9.1% for definitive CRT, 0.0% for TORS, P = .24). Two-year actuarial diseasefree survival (DFS) was 86.7% for definitive CRT patients and 80.0% for patients treated with TORS alone (P = .69). Conclusions: Definitive CRT and TORS alone offer similar rates of locoregional control, distant control, and DFS in patients with early stage OPSCC. Further studies are needed to assess the effect of CRT and TORS on quality of life in this patient population. Oncologic Outcomes of Robotic Thyroidectomy: 5 Years’ Experience Kyung Tae, MD, PhD (presenter); Yong Bae Ji, MD, PhD; Chang Myeon Song, MD; Seung Hwan Lee; Chul Won Park, MD, PhD Objectives: The feasibility and early surgical outcomes of robotic thyroidectomy have been reported. However, its oncologic outcomes are not well established. The aim of this study is to evaluate oncologic outcomes of robotic thyroidectomy
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Head and Neck
context of single hospital system. (2) Stratify the group of patients who underwent directed excision by the accuracy of preoperative localization studies, and whether intraoperative techniques impacted cure, and at what resource costs. Methods: In this retrospective chart review, patients were identified by searching all parathyroid-related procedures that took place at our institution from January 1, 2002, to December 31, 2013. Information related to the aims of the study, including demographics, operative details, and laboratory values were recorded, and imaging studies were reviewed by the senior investigator. Results: Of those patients with preoperative localization and directed excision, the preoperative studies most predictive of cure were a combination of Sestamibi parathyroid scan and surgeon-performed ultrasound. When these were in disagreement, surgical findings supported the ultrasound results. Intraoperative parathyroid hormone rapid assay was helpful in predicting cure, but added 68 minutes to the operating time on average. Most patients were surgically cured, and of the few patients with persistent high parathyroid hormone levels, vitamin D deficiency was the primary associated lab abnormality. Conclusions: Analysis of techniques that predict a surgical cure allowed the development of a best practices algorithm that includes the following: (1) Obtain 2 preoperative localization studies, including a surgeon-performed ultrasound; (2) Obtain preoperative vitamin D levels and supplement as indicated; and (3) Reserve intraoperative parathyroid hormone assay only for those patients who do NOT have 2 corroborating localization studies.
