Gerard O'Leary

South Infirmary Victoria University Hospital, Corcaigh, Munster, Ireland

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Publications (14)20.78 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Background The purpose of the present study was to investigate risk factors for local recurrence (LR) and death after total laryngectomy, with particular emphasis on pattern of LR (stomal versus pharyngeal / base of tongue), and impact of preceding tracheostomy. Methods Retrospective review of 75 consecutive total laryngectomies for cancer of larynx. Results Nineteen patients underwent preoperative tracheostomy, which was a significant risk factor for LR (p=0.04). With regard to pattern of LR, preoperative tracheostomy (p=0.03) and pathological nodal status (pN+) (p=0.04) were significant for stomal, but not pharyngeal recurrence; whereas positive margins (p=0.01) was significant for pharyngeal, but not stomal recurrence. Preoperative tracheostomy, pN+, lymphovascular invasion, and positive margins were all significant for survival. Conclusions Preoperative tracheostomy continues to be a significant adverse prognosticator in patients undergoing total laryngectomy. Our findings also suggest distinct causative factors for different patterns of post laryngectomy LR. Head Neck, 2014
    Head & Neck 03/2014; · 2.83 Impact Factor
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    ABSTRACT: Background: Hypocalcaemia is common in the initial period after total laryngectomy. The purpose of the present study was to study the incidence of and risk factors for post-laryngectomy hypocalcaemia at our institution. Study Design: Retrospective review of 65 consecutive total laryngectomies. Methods: Clinical data and calcium levels for the first postoperative week were collected. Biochemical hypocalcaemia was defined as any corrected calcium level of < 2.0 mmol/l in the first postoperative week. Severe hypocalcaemia was defined as a calcium of < 1.8 mmol/l, or symptoms of hypocalcaemia. Risk factors for hypocalcaemia were studied. Results: Five cases were excluded due to concomitant abdominal surgery (3); preoperative hypocalcaemia (1); and no postoperative calcium levels (1). 43% of patients had postoperative biochemical hypocalcaemia. On univariate analysis, bilateral neck dissection was significant for hypocalcaemia (p=0.02), with pT4 classification having borderline significance (p=0.07). On multivariate analysis, bilateral neck dissection (p=0.02) and salvage surgery were significant (p=0.03), with pT4 stage again having borderline significance (p=0.05). Extent of thyroidectomy, extent of pharyngectomy, and preoperative tracheostomy were not significant. Fifteen patients (25%) had severe hypocalcaemia. There were no significant risk factors for severe hypocalcaemia identified. Conclusions: Hypocalcaemia is common after total laryngectomy, particularly in the post-radiotherapy setting and in patients undergoing bilateral neck dissection. Preservation of one thyroid lobe does not appear to significantly reduce the risk.
    The Laryngoscope 10/2013; · 1.98 Impact Factor
  • Naveed Basheeth, Gerard O'Leary, Patrick Sheahan
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    ABSTRACT: IMPORTANCE Optimum management of the clinically negative neck in the presence of primary site recurrence of laryngeal or hypopharyngeal cancer remains unclear. OBJECTIVE To examine the incidence of occult cervical nodal metastatic disease in patients undergoing salvage laryngectomy with necks clinically staged as N0 at the time of recurrence and to define the role of elective neck dissection in this population with regard to risk of complications and oncologic outcomes. DESIGN Retrospective study of patients treated from 1996 through 2011. SETTING Academic teaching hospital. PARTICIPANTS All patients undergoing salvage total laryngectomy for squamous cell carcinoma of larynx or hypopharynx after failed initial radiotherapy or chemoradiotherapy with radiographically N0 neck at time of recurrence. MAIN OUTCOMES AND MEASURES Primary outcome measure was incidence of cervical nodal metastases detected by means of pathological examination of elective neck dissection specimens. Secondary outcome measures were incidence of major postoperative complications and regional cancer control. RESULTS Forty-five patients were included. Thirty-eight underwent elective unilateral (20) or bilateral (18) ND at the time of laryngectomy. Three patients (8%) had occult metastases (3 of 56 dissected heminecks [5%]). The incidence of major wound complications was significantly greater in patients undergoing bilateral ND (12 of 18 [67%]) than in patients undergoing unilateral or no ND (8 of 27 [30%]) (P = .03). There was no significant difference in regional control according to whether bilateral, unilateral, or no ND was performed. CONCLUSIONS AND RELEVANCE The incidence of occult metastatic disease in N0 necks in patients undergoing salvage surgery after radiotherapy is low. Neck dissection in this population does not seem to have a significant impact on regional cancer control. The need for elective ND, particularly bilateral ND, should be balanced against possible increased risk of morbidity in this group.
    JAMA otolaryngology-- head & neck surgery. 08/2013; 139(8):790-6.
  • Naveed Basheeth, Gerard O'Leary, Patrick Sheahan
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    ABSTRACT: Introduction: Pharyngocutaneous fistula is a serious complication of total laryngectomy. Our objective was to study predisposing factors at our institution. Methods: Retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumours or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded. Results: Seventy-four cases met inclusion criteria. 25.7% developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% versus 11.1%, p=0.05). Among salvage laryngectomies, performance of laryngectomy within one year of completion of radiotherapy (p=0.006), and performance of concomitant bilateral neck dissection (p=0.02), were significant risk factors for development of fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumour subsite, and initial T-stage, were not significant. Conclusions: Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy Head Neck, 2013.
    Head & Neck 04/2013; · 2.83 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: Fine-needle aspiration (FNA) cytology is well established in the diagnosis of thyroid nodules. However, false-negative rates for malignancy of 3% to 10% are reported. The purpose of the present study was to investigate the impact of nodule size and follicular variant of papillary carcinoma (FVPTC) on false-negative FNA rates in thyroid nodules and on malignancy rates in nodules with indeterminate cytology. STUDY DESIGN: Retrospective study. METHODS: A total of 765 consecutive ultrasound-guided FNAs were reviewed. Histological correlation was available in 262 cases. RESULTS: The overall sensitivity of FNA for malignancy was 84%, and the false-negative rate 9.1%. Nodules ≥3 cm were significantly more likely to ultimately be diagnosed as cancer by histology than nodules <3 cm (14% vs. 6.8%, P = .006); however, they were also significantly more likely to undergo surgery than smaller nodules (P < .0001). Among the surgical series, the false-negative rate was 10.9% in nodules ≥3 cm and 6.1% in nodules <3 cm (P = .71). Most false negatives were due to FVPTC. FVPTC was significantly more likely to be missed by preoperative cytology than conventional or other variants of papillary carcinoma (P < .001). Among cases with indeterminate cytology, nodule size and Thy-3f versus Thy-3a subclassification did not have any significant impact on likelihood of malignancy. CONCLUSIONS: The sensitivity of FNA for detection of FVPTC is reduced compared to conventional papillary carcinoma. The impact of nodule size is not significant. Laryngoscope, 2012.
    The Laryngoscope 01/2013; · 1.98 Impact Factor
  • Fergal Glynn, Sinead Brennan, Gerard O'Leary
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    ABSTRACT: The detection of distant metastases or synchronous primary tumours at initial presentation, or at recurrence in patients with head and neck squamous cell carcinoma (HNSCC), frequently alters the selection of therapy in these patients. A number of series report appreciably high rates for these lesions. This study evaluated 108 computed tomography (CT) scans and chest radiographs (CXR) of the thorax, in 80 patients presenting with HNSCC over a 4 year period. There were three clinical settings; (a) at original diagnosis n = 61, (b) clinical evidence of local/regional recurrence n = 19 (c) suspicion of recurrence due to neck symptomatology n = 28. CT thorax detected two out of 61 (3%) distant metastases at the initial diagnosis stage (both were either stage III or IV) and one out of 19 (5%) patients evaluated at the time of loco/regional recurrence. CXR failed to reveal evidence of pulmonary metastases in the two patients at initial diagnosis stage, but correctly identified pulmonary metastases in the loco-regional recurrence patient. There was no thoracic malignancy detected in the surveillance CT scans, and no synchronous second primary tumour detected during the study. CT is known to be more sensitive than conventional CXR in detecting thoracic pathology in HNSCC patients, however, we feel CT is of limited value in stage I or II disease. We no longer carry out routine staging CT scans of the thorax in patients presenting with stage I or II HNSCC, or with neck symptomatology with no clinical evidence of recurrence.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 11/2006; 263(10):943-5. · 1.46 Impact Factor
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    ABSTRACT: Solitary fibrous tumor is an uncommon spindle cell neoplasm that is believed to be of mesenchymal origin. Rarely does it originate in the oral cavity, and only 1 case of this lesion in the floor of the mouth has been previously reported. We describe a new case of solitary fibrous tumor arising from the soft tissues of the floor of the mouth.
    Ear, nose, & throat journal 08/2006; 85(7):437-9. · 1.03 Impact Factor
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    Neville P Shine, Gerard O'Leary, Simon P Blake
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    ABSTRACT: To review the clinical presentation and computed tomography (CT) imaging characteristics of all parotid lymphomas diagnosed at the study institution over a 7-year period. Retrospective chart review of parotid lymphomas diagnosed between 1997 and 2004. A total of 121 patients with parotid lesions were identified. After retrospective chart review, a total of 10 patients with histologically proven parotid lymphoma were included in the study, 8 of whom had CT scans available for assessment. Ten patients with histologically proven lymphoma of the parotid gland were identified from among 121 patients with parotid neoplasms, an incidence in this series of 8.3%. All lymphomas were of non-Hodgkin's type. All patients presented with a painless unilateral parotid swelling. Most patients had a short history of less than 4 months' duration, of whom 3 presented with a rapidly evolving swelling of less then 1 month's duration. No patient had a background of Sjögren's disease or any other autoimmune disorders. The commonest finding noted on CT was of a unilateral, single mass of relative soft-tissue homogeneity with poorly defined, indistinct tumour margins. Associated loco-regional lymphadenopathy was identified in 2 cases, 1 clinically and another radiologically; multiple ipsilateral lesions were noted in 2 cases. No cases of contralateral disease were observed. Lymphoma has a clinical presentation similar to other neoplasms arising within the parotid gland. A unilateral, non-tender swelling was a universal finding. A history of less than 4 months may suggest the possibility of lymphoma. CT scanning is a useful adjunctive investigation to determine the site and extent of the disease, loco-regional nodal status and contralateral gland and neck status. Multifocality and associated adenopathy are associated with, but not exclusive to, parotid lymphoma. Although poor tumour boundary definition on CT imaging is a strong predictor of malignancy, no pathognomonic finding specific for lymphoma has been identified. The potential diagnosis of parotid lymphoma should be considered in all patients who present with a parotid mass.
    South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 06/2006; 44(2):60, 62-4. · 0.36 Impact Factor
  • Neville P Shine, Simon P Blake, Gerard O'Leary
    Archives of Otolaryngology - Head and Neck Surgery 05/2005; 131(4):367, 369. · 1.78 Impact Factor
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    ABSTRACT: Fine needle aspiration biopsy (FNAB) is now well established in the assessment of cervical masses. The purpose of the present study is to review the efficacy of this procedure, as well as to identify any pitfalls that may limit its usefulness. One hundred and ninety aspirations of neck masses performed over a recent five-year period were reviewed. The definitive diagnosis of the mass was determined in each case by review of the patients' case notes. Thirty seven per cent of all neck lumps were malignant. The most common cause for a false-negative result, in the case of a carcinomatous mass when an adequate sample had been obtained, was a cystic neoplasm. One quarter of all cystic lateral cervical masses not considered suspicious for malignancy by FNAB turned out to be malignant. Repeating FNAB in cases where the original result is negative for carcinoma may increase the sensitivity of FNAB in the detection of cystic carcinomas.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 07/2004; 2(3):152-6. · 1.97 Impact Factor
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    ABSTRACT: Adenosquamous carcinoma is a very rare tumor that is characterized pathologically by the simultaneous presence of distinct areas of adenocarcinoma and squamous cell carcinoma. Only 15 cases in the oral cavity are reported in the literature, most occurring in middle-aged and elderly males. Pain is a commonly reported presenting symptom and may be related to the frequent presence of perineural invasion. Most cases have been treated surgically. However, early recurrence and death due to disease are common. We report an exceptional case occurring in a 22-year-old female. The tumor was associated with dysplasia of both minor salivary gland ductal epithelium and surface mucosal epithelium. Perineural invasion was also present. The patient was treated with combined surgery and radiotherapy and remained well for 9 months before developing locoregional recurrence and ultimately succumbing to the disease.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 11/2003; 260(9):509-12. · 1.46 Impact Factor
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    ABSTRACT: Seventeen patients presenting with a cystic cervical metastasis were identified after either having undergone excision of a cyst, initially diagnosed as a branchial cyst but subsequently found to be malignant, or after having had fluid aspirated from a neck mass that ultimately proved to be malignant while undergoing fine needle aspiration biopsy. Patients had primary cancer documented at a variety of primary sites, including hypopharynx (3 patients), oropharynx (2 patients), lower lip (2 patients), nasopharynx, supraglottis, oral cavity, and prostate (1 patient each). Six cases (35%) remained occult. In nearly half of the cases (8 of 17), there was no evidence of the primary cancer at presentation. In the same period, 25 branchial cysts were encountered, giving an incidence of unsuspected carcinoma in cervical cysts of 24% (8 of 33). In contrast to previous studies in which smaller numbers of patients underwent the procedure, we found fine needle aspiration to be very helpful in the assessment of these lesions, having a sensitivity of 73% in diagnosing malignancy.
    Otolaryngology Head and Neck Surgery 11/2002; 127(4):294-8. · 1.73 Impact Factor
  • I J Keogh, G O'Leary
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    ABSTRACT: The case of an 18-year-old patient who developed critical upper airway compromise after central tongue piercing is presented. Otolaryngologists must be aware of the many potential complications of tongue piercing and their management.
    The Journal of Laryngology & Otology 04/2001; 115(3):233-4. · 0.68 Impact Factor
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    ABSTRACT: A 45-year-old gentleman presented with a diffuse left neck mass. Surgical exploration revealed a large lipomatous lesion. Histological examination identified this to be a neural fibrolipoma. This is the first reported case of this lesion in the neck.
    The Journal of Laryngology & Otology 04/2000; 114(3):231-2. · 0.68 Impact Factor

Publication Stats

50 Citations
537 Views
20.78 Total Impact Points

Institutions

  • 2013–2014
    • South Infirmary Victoria University Hospital
      Corcaigh, Munster, Ireland
  • 2001–2006
    • South Infirmary-Victoria Hospital
      Corcaigh, Munster, Ireland