D S Soutar

IEO - Istituto Europeo di Oncologia, Milano, Lombardy, Italy

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Publications (97)285.7 Total impact

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    ABSTRACT: Current standard treatment of Pleomorphic Salivary Adenoma (PSA) of the Parotid Gland is by surgical excision. The management of incomplete excision remains undecided with post-operative radiotherapy advocated by some and observation by others.
    Journal of Plastic Reconstructive & Aesthetic Surgery 09/2014; DOI:10.1016/j.bjps.2014.09.030 · 1.47 Impact Factor
  • International Journal of Surgery (London, England) 10/2013; 11(8):644. DOI:10.1016/j.ijsu.2013.06.309 · 1.44 Impact Factor
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    ABSTRACT: The functional integrity of the floor of the mouth (FOM) is essential in maintaining tongue mobility, deglutition, and control and disposal of saliva. The present study focused on reporting oral function using functional intraoral Glasgow scale (FIGS) in patients who had surgical ablation and reconstruction of FOM carcinoma with or without chemo-radiotherapy. The study included patients who had surgical treatment of floor of mouth cancer in two regional head and neck units in Glasgow, UK between January 2006 and August 2007. Patients were assessed using FIGS before surgery, 2 months, 6 months and 1 year after surgery. It is a five-point scale self-questionnaire to allow patients to self-assess speech, chewing and swallowing. The maximum total score is 15 points. The influence of socio-demographic parameters, tumour characteristics and surgical parameters was addressed in the study. A total of 62 consecutive patients were included in the study; 41 (66.1 %) were males and 21 (33.9 %) were females. The patients' mean age at the time of diagnosis was 60.6 years. Fifty (80.6 %) patients had unilateral origin of FOM tumours and 10 (19.4 %) had bilateral origin. Peroral approach was the most common approach used in 35 (56.4 %) patients. The mean preoperative FIGS score was 14. Two months after surgery, it droped to 9.4 then started to increase gradually thereafter and recorded 10.1 at 6 months and 11 at 1 year. Unilateral FOM resection recorded better score than bilateral and lateral FOM tumours than anterior at 1 year postoperatively. Furthermore, direct closure showed better functional outcome than loco-regional and free flaps. The FIGS is a simple and comprehensive way of assessing a patient's functional impairment following surgery in the FOM. Tumour site and size, surgical access, surgical resection and method of reconstruction showed significant influence on oral function following surgical resection. A well-designed rehabilitation programme is required to improve oral function after surgical resection of oral cancer.
    Archives of Oto-Rhino-Laryngology 06/2012; DOI:10.1007/s00405-012-2021-8 · 1.61 Impact Factor
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    ABSTRACT: The role of sentinel node biopsy in head and neck cancer is currently being explored. Patients with positive sentinel nodes were investigated to establish if additional metastases were present in the neck, their distribution, and their impact on outcome. In all, 109 patients (n = 109) from 15 European centers, with cT1/2,N0 tumors, and a positive sentinel lymph node were identified. Kaplan-Meier and univariate and multivariate logistic regression analysis were used to identify variables that predicted for additional positive nodes and their position within the neck. A total of 122 neck dissections were performed in 109 patients. Additional positive nodes were found in 34.4% of cases (42/122: 18 same, 21 adjacent, and 3 nonadjacent neck level). Additional nodes, especially if outside the sentinel node basin, had an impact on outcome. The results are preliminary but suggest that both the number and the position of positive sentinel nodes may identify different prognostic groups that may allow further tailoring of management plans. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 01/2012; 34(11):1580-5. DOI:10.1002/hed.21973 · 2.83 Impact Factor
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    ABSTRACT: The management of the clinically N0 (cN0) neck in patients with oral and oropharyngeal squamous cell carcinomas (SCC) remains controversial. Factors such as patient comorbidity, different personal opinions, pathological factors and other factors modify the treatment decisions. Our primary aim was to determine the management of the cN0 neck in oral and oropharyngeal SCC patients in different institutions in Scotland. The secondary aim was to evaluate the outcome of the patients who had not undergone any treatment of the neck in comparison with those who had undergone elective neck treatment, and also examine factors relating to overall survival in this population. Based on a prospective head and neck cancer audit carried out in Scotland between September 1999 and October 2001, we focused on the management of N0 neck in patients with oral or oropharyngeal SCC. Out of a total of 1,910 patients in the audit, 364 patients with oral or oropharyngeal SCC and cN0 neck were treated with curative intent. The overall survival data was available up to a minimum of 5years, and a detailed clinical follow-up to a minimum of 18months. One hundred patients had no treatment to the neck (observation group). A total of 112 patients received prophylactic neck (chemo)-irradiation without elective neck dissection (END). END was performed for 152 patients (of which 23 were bilateral), and 63 of them received postoperative radiotherapy. Histopathological examination revealed metastases in only 16% of the dissection specimens. In the observation group, six patients (6%) had a recurrence in the neck without any recurrence at the primary site. For the rest of the patients who had any sort of elective neck treatment, the respective figure was also 6% (15/264). Neck imaging was recorded in 186 patients only. There is a wide variation in the management of the cN0 within Scotland. The use of imaging for diagnosis is also variable. A surprisingly low percentage of patients proved to have had metastasis on pathological examination. Despite variations in treatment, neck recurrence was relatively uncommon. This audit demonstrates the need for more defined protocols for the management of the cN0. KeywordsMetastasis-Neck-Carcinoma-Treatment-Survival-Tumour depth
    European Journal of Plastic Surgery 12/2010; 33(6):331-339. DOI:10.1007/s00238-010-0416-6
  • R R Clark, J Shaw-Dunn, D S Soutar
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    ABSTRACT: Malignant cutaneous tumors of the auricle are known to have a high rate of spread to the regional lymph nodes, and, for this reason, removal of the lymph nodes, for diagnostic or therapeutic purposes, is often required. Recent experience with sentinel node biopsy in cutaneous tumors of the head and neck has questioned the traditional lymphatic pathways and prompted a new study. Lymphatic pathways from the auricle were demonstrated by India ink injection of five auricles in three cadavers followed by block dissection and Spalteholz clearing of en bloc specimens. Lymphatics descend adjacent to the mastoid bone periosteum and lie deep to the insertion of the sternocleidomastoid muscle. There are five different locations for sentinel nodes: superficial parotid, anterior mastoid, infra-auricular parotid, deep to sternocleidomastoid, and lateral mastoid. Two of these nodal locations (anterior and lateral mastoid) may be bypassed by anastomotic pathways. We conclude that, first, echelon lymph nodes lie in five different sites, some bypassed by anastomotic lymphatics. Lymphatics from the ear lie close to the mastoid bone and pass deep to the insertion of sternocleidomastoid where they may be difficult to follow. Sentinel lymph node biopsy for cutaneous tumors of the auricle is possible, but the presence of skip metastases should be considered. Clin. Anat., 2010. (c) 2010 Wiley-Liss, Inc.
    Clinical Anatomy 10/2010; 23(7). DOI:10.1002/ca.21015 · 1.16 Impact Factor
  • A Misra, T Shoaib, D Soutar
    Journal of Plastic Reconstructive & Aesthetic Surgery 09/2010; 63(9):e706-8. DOI:10.1016/j.bjps.2010.04.024 · 1.47 Impact Factor
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    ABSTRACT: Sentinel node biopsy (SNB) may represent an alternative to elective neck dissection for the staging of patients with early head and neck squamous cell carcinoma (HNSCC). To date, the technique has been successfully described in a number of small single-institution studies. This report describes the long-term follow-up of a large European multicenter trial evaluating the accuracy of the technique. A total of 227 SNB procedures were carried out across 6 centers, of which 134 were performed in clinically T1/2 N0 patients. All patients underwent SNB with preoperative lymphoscintigraphy, intraoperative blue dye, and handheld gamma probe. Sentinel nodes were evaluated with hematoxylin and eosin (H&E) staining, step-serial sectioning (SSS), and immunohistochemistry (IHC). There were 79 patients who underwent SNB as the sole staging tool, while 55 patients underwent SNB-assisted elective neck dissection. Sentinel nodes were successfully identified in 125 of 134 patients (93%), with a lower success rate observed for floor-of-mouth tumors (FoM; 88% vs. 96%, P = 0.138). Also, 42 patients were upstaged (34%); of these, 10 patients harbored only micrometastatic disease. At a minimum follow-up of 5 years, the overall sensitivity of SNB was 91%. The sensitivity and negative predictive values (NPV) were lower for patients with FoM tumors compared with other sites (80% vs. 97% and 88% vs. 98%, respectively, P = 0.034). Sentinel node biopsy is a reliable and reproducible means of staging the clinically N0 neck for patients with cT1/T2 HNSCC. It can be used as the sole staging tool for the majority of these patients, but cannot currently be recommended for patients with tumors in the floor of the mouth.
    Annals of Surgical Oncology 09/2010; 17(9):2459-64. DOI:10.1245/s10434-010-1111-3 · 3.94 Impact Factor
  • Richard R Clark, David S Soutar, Keith D Hunter
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    ABSTRACT: Squamous cell carcinoma (SCC) of the auricle has a high risk of metastatic spread, which is associated with high mortality. Identification of patients with a high risk of lymph node metastases would allow prophylactic treatment to the draining lymph nodes, but there are no established clinical or histopathological criteria to predict which tumours have a high risk of metastasis. The aim was to determine such criteria. The study was a retrospective analysis of the clinical and histological features of 229 cases of SCC of the auricle, with a minimum of 2 years' clinical follow-up. Overall, lymph node metastases were present in 24 cases (10.5%). Of the patients with metastatic disease 66.7% died, despite multi-modality treatment. Tumours with a depth of invasion >8 mm or a depth of invasion between 2 and 8 mm in conjunction with evidence of destructive cartilage invasion, lymphovascular invasion or a non-cohesive invasive front had a high risk of metastasis (56% and 24%, respectively). Patients with high-risk tumours, as assessed histopathologically, should be considered for prophylactic therapy to or staging of the regional lymph nodes.
    Histopathology 07/2010; 57(1):138-46. DOI:10.1111/j.1365-2559.2010.03593.x · 3.30 Impact Factor
  • Oral Oncology Supplement 07/2009; 3(1):86-86. DOI:10.1016/j.oos.2009.06.175
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    ABSTRACT: The occurrence of micrometastases (MMs) and isolated tumour cells (ITCs) in oral sentinel lymph node (SLN) biopsy is poorly known, and the definitions and clinical significance of MMs and ITCs in SLN biopsy are controversial. We compared the UICC/TNM definitions of MMs and ITCs with our previously published sentinel node protocol to assess how the adoption of the UICC/TNM criteria would affect the staging of nodal micrometastatic disease. Of 107 patients who had a SLN biopsy and pathology at 150 microm intervals, 35 with metastatic tumour were included. Eighty-six SLNs were reassessed using the UICC/TNM definitions for MMs and ITCs. Findings were linked to the final pathology in the subsequent neck dissection. Initial H&E sections showed metastases in 24 patients (in 34 out of 61 SLN), 8 of whom (9 SLNs) had MMs. Additional step serial sections revealed metastatic deposits in a further 11 patients (15 out of 25 SLNs were positive) which were reassessed as MMs (6 patients) or ITCs (5 patients). Subsequent neck dissection revealed additional metastases in 46% of patients with MM, whilst one of the ITC patients had subsequent neck metastases (20%). Despite some limitations, the UICC/TNM classification provides an objective, uniform method of detecting MMs and ITC's. Unlike in cases with ITC, metastases in other non-SLNs were common when a micrometastasis was detected in a SLN, indicating need for further treatment of the neck.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 02/2009; 35(5):532-8. DOI:10.1016/j.ejso.2008.12.014 · 2.56 Impact Factor
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    ABSTRACT: The main constituents of the deep circumflex iliac artery (DCIA) flap are a rim of iliac crest and an overlying paddle of skin. Taylor et al. believed that both constituents were adequately supplied by the DCIA, but in some of our recent DCIA flaps, the bone has survived while the skin has undergone necrosis. We believe that this is because the skin is supplied mainly by the superficial circumflex iliac artery (SCIA). To test this hypothesis, three DCIA flaps, with both the DCIA and SCIA, were raised from three unembalmed cadavers. The DCIA pedicle was injected with a mass of black latex, while the SCIA was injected with a mass of green latex. The flaps were rendered transparent using the Spalteholz method. In each flap, black latex filled vessels close to the rim of bone. Green latex filled vessels in the skin paddle. No black latex was seen in the skin paddle, nor was green latex seen in the bone segment. There was no apparent anastomosis between the two systems. The DCIA mainly supplies the bone and the SCIA the skin, but the DCIA is not always adequate to supply both. When raising a flap of bone and skin from the iliac crest region, surgeons should consider raising both the deep and superficial circumflex arteries.
    European Journal of Plastic Surgery 12/2008; 31(6):311-314. DOI:10.1007/s00238-008-0297-0
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    Journal of Plastic Reconstructive & Aesthetic Surgery 10/2008; 62(3):421-3. DOI:10.1016/j.bjps.2008.05.038 · 1.47 Impact Factor
  • R R Clark, D S Soutar
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    ABSTRACT: Squamous cell carcinoma arising on the auricle is believed to metastasise to the regional lymph nodes more frequently than comparable tumours at other sites. Metastatic spread of these tumours is associated with a poor outcome but there is no clear consensus of opinion on how to identify patients at risk of metastatic spread and treat them. A systematic review database search of Medline and Embase was conducted with cross referencing of articles. The metastatic rate is 11.2% with spread to the parotid and upper deep cervical chain most common. Eighty-five per cent of metastases develop within 12 months and 98% within 24 months, although follow up was limited to 12 to 36 months in most cases. Death occurs in 6.2% of cases (about half of the patients who develop metastases) usually due to failure of loco-regional control. Depth of invasion, tumour size, degree of cellular differentiation and incomplete primary excision margins may be useful in identifying lesions most at risk of metastasising but there is insufficient evidence at present to allow targeted neck dissections.
    Journal of Plastic Reconstructive & Aesthetic Surgery 08/2008; 61(10):1140-7. DOI:10.1016/j.bjps.2008.04.036 · 1.47 Impact Factor
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    ABSTRACT: The number of harvested lymph nodes when performing sentinel lymph node (SLN) biopsy remains controversial. The aim of this study was to examine the maximum number of nodes to be harvested for histopathological analysis. We also wanted to determine if the level of radioactivity within a SLN or its size were indicators for the likelihood of nodal metastases. The SLNs from 34 neck dissection specimens from patients with T1/T2 N0 oral and oropharyngeal carcinomas were included. Altogether 76 SLNs were measured for radioactivity and lymph node dimensions and volume. Tumour was identified in 16 of 76 nodes (positive nodes), and the remaining 60 nodes were free from tumour (negative nodes). In 9 of 16 cases, metastases were in the hottest node. Two patients had more than one positive SLN: the first and fourth hottest in one and the second and fourth hottest nodes in another contained tumour. However, all patients would have been staged accurately if only the hottest three sentinel nodes had been retrieved. Lymph nodes that contained tumour had a greater maximum diameter than non-metastatic SLNs. To stage the neck accurately, only the three hottest lymph nodes required sampling.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 07/2008; 265 Suppl 1:S19-23. DOI:10.1007/s00405-007-0548-x · 1.61 Impact Factor
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    ABSTRACT: Background The aim of this study was to ascertain which factors determine success of sentinel node biopsy (SNB).Methods We conducted a retrospective review of 121 patients with head and neck squamous cell carcinoma undergoing SNB to stage the neck. All patients underwent the triple-diagnostic procedure of preoperative lymphoscintigraphy, intraoperative blue dye, and a gamma probe. Factors contributing to failure of SNB were identified.ResultsSNB was unsuccessful in 12 of 121 patients (10%). Seven of the 12 patients had cT1/cT2 tumors, and 6 of these were located in the floor of mouth. SN identification was more likely to be successful in patients with cN0 necks, but this did not reach statistical significance (92% vs 84%, p = .268). Factors associated with failure included T classification (p = .01), tumor site (p = .05), and negative preoperative lymphoscintigraphy (p = .0174).Conclusion Successful sentinel lymph node harvest is related to primary tumor site, T classification, and the presence of nodes on preoperative lymphoscintigraphy. © 2008 Wiley Periodicals, Inc. Head Neck, 2008
    Head & Neck 07/2008; 30(7):858 - 862. DOI:10.1002/hed.20787 · 2.83 Impact Factor
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    ABSTRACT: The aim of this study was to determine whether tumor depth affects upstaging of the clinically node-negative neck, as determined by sentinel lymph node biopsy with full pathologic evaluation of harvested nodes including step-serial sectioning (SSS) and immunohistochemistry (IHC). One hundred seventy-two patients with cT1/2 N0 squamous cell carcinoma (SCC) of the oral cavity/oropharynx undergoing primary resection and either sentinel node biopsy (SNB) or SNB-assisted neck dissection as a staging tool for the cN0 neck. Harvested nodes were examined with hematoxylin-eosin staining, SSS, and IHC. Patients upstaged by SSS/IHC were denoted pN1mi. One hundred one of 172 patients were staged pN0, with 71 (41%) patients upstaged. Increasing tumor depth was associated with higher likelihood of upstaging (P < .001). Tumor depth showed a positive correlation with nodal stage according to TNM classification (P < .001). Tumor depth greater than 4 mm appears to be the most appropriate cutoff for risk stratification, although tumors in the oropharynx may require a lower value. Tumor depth is an important prognostic factor for patients with SCC of the oral cavity or oropharynx. Tumors greater than 4 mm are associated with greater risk of upstaging; however, this optimum cutoff value may vary between primary tumor sites.
    The Laryngoscope 04/2008; 118(4):629-34. DOI:10.1097/MLG.0b013e31815e8bf0 · 2.03 Impact Factor
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    ABSTRACT: Sternoclavicular joint hypertrophy is anecdotally reported as a common sequela to radical neck dissection. It is postulated that sternoclavicular joint hypertrophy is a result of a combination of spinal accessory nerve division and sternocleidomastoid muscle resection during radical neck dissection. However, we noticed that sternoclavicular joint hypertrophy can occur following functional neck dissection with preservation of the spinal accessory nerve, the sternocleidomastoid muscle and the internal jugular vein. Regardless of the aetiological factors that can lead to sternoclavicular joint hypertrophy, we believe that plain radiography and ultrasound examination of the joint, with or without fine needle aspiration or core biopsy may rule out bone metastasis with no need for further investigations. We wish to present a case of sternoclavicular joint hypertrophy following functional neck dissection to highlight the point that sternoclavicular joint hypertrophy is not solely related to division of the spinal accessory nerve and/or the sternocleidomastoid muscle.
    European Journal of Plastic Surgery 03/2008; 31(1):25-27. DOI:10.1007/s00238-007-0186-y
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    ABSTRACT: Arterial anatomy of the lateral orbital and cheek region and subsequently of the "peri-zygomatic perforator arteries" flap is described, based upon the dissection of the 24 human cadaver head halves. Each specimen was dissected in subdermal, first fascial and deep level. The subdermal vascular network of lateral orbital and cheek region, its orientation and contributing arteries were studied. Origin, perforation sites and diameters of transverse facial, zygomaticoorbital, zygomaticofacial and zygomaticotemporal arteries were also described and measured. Our findings support the view that the cheek island flap used for lower eyelid is a reverse flow axial pattern flap. It includes arterioles of the transverse facial artery, which are part of the subdermal vascular plexus and are uniformly longitudinally oriented. The flap receives its blood supply via perforators of the zygomaticoorbital, zygomaticofacial and zygomaticotemporal arteries, which are connected via their terminal branches with transverse facial artery.
    Surgical and Radiologic Anatomy 03/2008; 30(1):17-22. DOI:10.1007/s00276-007-0277-2 · 1.33 Impact Factor
  • British Journal of Oral and Maxillofacial Surgery 12/2007; 45(8). DOI:10.1016/j.bjoms.2007.08.013 · 1.13 Impact Factor

Publication Stats

2k Citations
285.70 Total Impact Points

Institutions

  • 2007
    • IEO - Istituto Europeo di Oncologia
      • Division of Head and Neck Surgery
      Milano, Lombardy, Italy
  • 2006
    • Università degli Studi di Messina
      Messina, Sicily, Italy
  • 2004
    • University of Oxford
      Oxford, England, United Kingdom
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2003
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 1993
    • Beatson Institute for Cancer Research
      Glasgow, Scotland, United Kingdom