Kerry D Olsen

University of Udine, Udine, Friuli Venezia Giulia, Italy

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Publications (149)335.01 Total impact

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    ABSTRACT: IMPORTANCE Metastatic cutaneous malignancies of the head and neck, including cutaneous squamous cell carcinoma (cSCC) and malignant melanoma (MM), are aggressive cancers frequently involving the parotid-area lymph nodes (LNs). In such cases, controversy exists about the extent of surgical resection, with many centers choosing not to remove the parotid deep lobe LNs. OBJECTIVES To determine patterns of intraparotid and neck metastasis, to identify risk factors, and to report outcomes in patients with parotid superficial lobe LN metastasis from cSCC and MM. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed 65 adults from Mayo Clinic in Minnesota who underwent total parotidectomy and neck dissection for metastatic cSCC (n = 42) or MM (n = 23) involving the parotid superficial lobe. INTERVENTIONS Total parotidectomy and neck dissection. MAIN OUTCOMES AND MEASURES The presence and number of parotid deep lobe and neck LNs involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified, and patient outcomes are reported. RESULTS Eleven of 42 patients with cSCC (26%) and 3 of 23 patients with MM (13%) metastatic to the parotid superficial lobe also had parotid deep lobe metastasis. Thirteen of 42 patients with cSCC (31%) and 6 of 23 patients with MM (26%) had positive cervical LN metastasis. Among all patients, 22% (14 of 65) had metastasis to the parotid deep lobe, and 29% (19 of 65) had metastasis to cervical LNs. By univariate analysis, neck metastasis and N2 neck disease were risk factors for metastatic cSCC spread to the parotid deep lobe. Parotid-area local control was excellent in patients with metastatic cSCC (93% [39 of 42]) and MM (100% [23 of 23]). Long-term survival remains poor because distant metastases are common. CONCLUSIONS AND RELEVANCE Metastatic cSCC and MM to the parotid superficial lobe also involve LNs in the parotid deep lobe and neck in a significant and almost equal number of patients. Parotid deep lobe metastasis from cutaneous malignancies portends a poor prognosis. Therefore, patients with superficial parotid gland metastasis should be considered for management with not only neck dissection and adjuvant therapy but also deep lobe parotidectomy.
    JAMA otolaryngology-- head & neck surgery. 04/2014;
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    ABSTRACT: Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.
    Archives of Oto-Rhino-Laryngology 02/2014; · 1.29 Impact Factor
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    ABSTRACT: Objective: Pharyngocutaneous fistulae (PCF) are known to occur in nearly a third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs, quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularised tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. Data sources: English language literature from 2004 to 2013 Review Methods: We searched the English language literature for papers published on the subject from 2004 to 2013. Results: Adequate data was available to identify pooled incidence rates from 7 papers. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by a third. Conclusion: This pooled analysis suggests that there is a clear advantage in using vascularised tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
    The Laryngoscope 01/2014; · 1.98 Impact Factor
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    ABSTRACT: Standard treatment for patients with poor-risk, resected head and neck squamous cell carcinoma (HNSCC) is adjuvant radiation therapy combined with high-dose cisplatin. Many patients are treated with weekly cisplatin; it is not known whether weekly and high-dose cisplatin are equivalent. This study compares the outcomes of patients with locally-advanced HPV-negative HNSCC and HPV/p16-positive oropharynx HNSCC treated with adjuvant chemoradiation therapy with either high-dose or weekly cisplatin. Retrospective review of patients with Stage III/IV HNSCC who had surgery followed by adjuvant chemoradiation therapy at Mayo Clinic, Rochester. HPV and/or p16 status was available for all oropharynx patients. 104 Patients (51 high-dose, 53 weekly) were analyzed. The 3-year overall survival was 84% and 75% for patients who received high dose and weekly cisplatin, respectively (p=0.30). The 3-year recurrence free survival was 71% and 74% in the high dose and weekly cisplatin group, respectively (p=0.95). Patients with HPV/p16-positive oropharynx cancer who received adjuvant chemoradiation therapy with high-dose and weekly cisplatin had three-year overall survival rates of 91% and 86% (p=0.56), and 3-year recurrence free survival of 84% and 82% (p=0.93). Extracapsular extension did not affect prognosis in either group. No significant survival difference was seen between patients with locally advanced HNSCC treated with adjuvant chemoradiation therapy with high-dose or weekly cisplatin, although there was a trend for improved survival with high-dose cisplatin. Weekly cisplatin in the adjuvant setting may be a better treatment for patients with HPV-positive oropharynx cancer to preserve survival and minimize toxicity.
    Oral Oncology 01/2014; · 2.70 Impact Factor
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    ABSTRACT: Objective To learn more about the potential psychosocial benefits of wellness coaching. Although wellness coaching is increasing in popularity, there are few published outcome studies. Patients and Methods In a single-cohort study design, 100 employees who completed the 12-week wellness coaching program were of a mean age of 42 years, 90% were women, and most were overweight or obese. Three areas of psychosocial functioning were assessed: quality of life (QOL; 5 domains and overall), depressive symptoms (Patient Health Questionnaire-9), and perceived stress level (Perceived Stress Scale-10). Participants were recruited from January 1, 2011, through December 31, 2011; data were collected up to July 31, 2012, and were analyzed from August 1, 2012, through October 31, 2013. Results These 100 wellness coaching completers exhibited significant improvements in all 5 domains of QOL and overall QOL (P<.0001), reduced their level of depressive symptoms (P<.0001), and reduced their perceived stress level (P<.001) after 12 weeks of in-person wellness coaching, and they maintained these improvements at the 24-week follow-up. Conclusion In this single-arm cohort study (level 2b evidence), participating in wellness coaching was associated with improvement in 3 key areas of psychosocial functioning: QOL, mood, and perceived stress level. The results from this single prospective cohort study suggest that these areas of functioning improve after participating in wellness coaching; however, randomized clinical trials involving large samples of diverse individuals are needed to establish level 1 evidence for wellness coaching.
    Mayo Clinic Proceedings. 01/2014;
  • Kerry D Olsen, Matthew D Dacy
    Mayo Clinic Proceedings 01/2014; 89(1):8-15. · 5.79 Impact Factor
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    ABSTRACT: To identify client priorities prior to wellness coaching, and examine motivational improvements for health behaviors on follow-up. Clients completed a wellness questionnaire at baseline (before coaching) and at a 3-month follow-up. Overall, 177 participants (92% female, average age 42.9 (SD 11.2) years) were included in the analysis. Clients indicated priorities for coaching, and levels of importance, confidence, and readiness to change within each domain were compared between baseline and follow-up. Participants identified weight management as their top priority and successfully reduced their BMI. Participants also demonstrated significant improvements in motivation and confidence in most health behavior domains. These results provide further support for the effectiveness of wellness coaching for weight management and for improving motivational readiness for behavior change.
    American journal of health behavior 01/2014; 38(1):83-91. · 1.31 Impact Factor
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    ABSTRACT: Objective: This study aimed to understand participant perspectives of a workplace wellness coaching program. Methods: Semi-structured interviews were conducted with participants (N = 27) who had completed a 3-month program. Results: Qualitative analysis identified themes around the coaching relationship (value of personal connections, collaboration, and account-ability), as well as attitudinal and behavior changes attributed to coaching. Additionally, the data revealed variable initial participant expectations. Conclusion: This study adds to the literature participants' perspectives on what aspects of coaching are most valued and how coaching may impact behavior change. It also uncovered issues around expectations. These findings can inform wellness coach training, and they may also indicate the need for additional measures of coaching effectiveness that include employee-important outcomes.
    Health Behavior and Policy Review. 01/2014; 1(3).
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    ABSTRACT: To prospectively study the effects of an incentivized exercise program on physical activity (PA), quality of life (QOL), and burnout among residents and fellows (RFs) in a large academic medical center. In January 2011, all RFs at Mayo Clinic in Rochester, Minnesota (N=1060), were invited to participate in an elective, team-based, 12-week, incentivized exercise program. Both participants and nonparticipants had access to the same institutional exercise facilities. Regardless of participation, all RFs were invited to complete baseline and follow-up (3-month) assessments of PA, QOL, and burnout. Of the 628 RFs who completed the baseline survey (59%), only 194 (31%) met the US Department of Health and Human Services recommendations for PA. Median reported QOL was 70 on a scale of 1 to 100, and 182 (29%) reported at least weekly burnout symptoms. A total of 245 individuals (23%) enrolled in the exercise program. No significant differences were found between program participants and nonparticipants with regard to baseline demographic characteristics, medical training level, PA, QOL, or burnout. At study completion, program participants were more likely than nonparticipants to meet the Department of Health and Human Services recommendations for exercise (48% vs 23%; P<.001). Quality of life was higher in program participants than in nonparticipants (median, 75 vs 68; P<.001). Burnout was lower in participants than in nonparticipants, although the difference was not statistically significant (24% vs 29%; P=.17). A team-based, incentivized exercise program engaged 23% of RFs at our institution. After the program, participants had higher PA and QOL than nonparticipants who had equal exercise facility access. Residents and fellows may be much more sedentary than previously reported.
    Mayo Clinic Proceedings 12/2013; 88(12):1435-42. · 5.79 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo determine the incidence of level IIB lymph node metastasis in patients with laryngeal or hypopharyngeal squamous cell carcinoma and to evaluate the need for elective and therapeutic neck dissection of level IIB. Study DesignRetrospective cohort study and review of the literature. Methods Patients with laryngeal or hypopharyngeal squamous cell carcinoma (N = 65) were primarily treated with surgery at Mayo Clinic (Rochester, Minnesota) from 2004 through 2010. Neck dissection specimens were analyzed by a pathologist, and metastases to level IIB were reported. In addition, 18 previously published studies, totaling 1,114 neck dissections, were reviewed. ResultsLevel IIB lymph node metastases were present in 4% and 17% of elective and therapeutic neck dissections, respectively. Ipsilateral IIB metastasis was more common than contralateral IIB metastasis in elective and therapeutic neck dissection specimens. Level IIB lymph node metastasis was not significantly associated with level IIA nodal metastasis, level III nodal metastasis, clinical primary tumor stage, clinical nodal stage, or pathologic confirmation of extracapsular spread in either laryngeal or hypopharyngeal squamous cell carcinoma. Conclusions The rate of occult IIB metastasis in laryngeal and hypopharyngeal squamous cell carcinoma is exceedingly low. In a clinically node-negative case, the ipsilateral and contralateral level IIB nodal packet should not be dissected. For clinically node-positive cases, ipsilateral level IIB dissection should be performed; contralateral IIB dissection should be performed only when indicated. Level of Evidence4. Laryngoscope, 123:3032–3036, 2013
    The Laryngoscope 12/2013; 123(12). · 1.98 Impact Factor
  • Kerry D Olsen, Eric J Moore, Jean E Lewis
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    ABSTRACT: IMPORTANCE For parotid lesions, the high accuracy and utility of intraoperative frozen section (FS) pathology, compared with permanent section pathology, facilitates intraoperative decision making about the extent of surgery required. OBJECTIVE To demonstrate the accuracy and utility of FS pathology of parotid lesions as one factor in intraoperative decision making. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of patients undergoing parotidectomy at a tertiary care center. INTERVENTIONS Evaluation of the accuracy of FS pathology for parotid surgery by comparing FS pathology results with those of permanent section. MAIN OUTCOMES AND MEASURES Documented changes from FS to permanent section in 1339 parotidectomy pathology reports conducted from January 1, 2000, through December 31, 2009, included 693 benign and 268 primary and metastatic malignant tumors. RESULTS Changes in diagnosis were found from benign to malignant (n = 11) and malignant to benign (n = 2). Sensitivity and specificity of a malignant diagnosis were 98.5% and 99.0%, respectively. Other changes were for lymphoma vs inflammation or lymphoma typing (n = 89) and for confirmation of or change in tumor type for benign (n = 36) or malignant (n = 69) tumors. No case changed from low- to high-grade malignant tumor. Only 4 cases that changed from FS to permanent section would have affected intraoperative decision making. Three patients underwent additional surgery 2 to 3 weeks later. Overall, only 1 patient was overtreated (lymphoma initially deemed carcinoma). CONCLUSIONS AND RELEVANCE Frozen section pathology for parotid lesions has high accuracy and utility in intraoperative decision making, facilitating timely complete procedures.
    JAMA otolaryngology-- head & neck surgery. 10/2013;
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    ABSTRACT: IMPORTANCE With an increasing incidence of oropharyngeal carcinoma and prevalence of transoral surgical techniques, postoperative bleeding, with its associated risk factors, deserves evaluation. OBJECTIVE To classify and review postoropharyngectomy hemorrhage rates and associated risk factors. DESIGN, SETTING, AND PARTICIPANTS Single-institution, multicenter retrospective medical chart review analyzing surgical procedures in 906 patients treated with transoral surgery for oropharyngeal carcinoma at a tertiary care, academic referral center from 1994 to 2012. Tumor stage, previous treatment, resection method, and transcervical external carotid branch ligation were analyzed in relationship to postoperative hemorrhage rate, and severity. A novel classification system was created, grading bleeding episodes as minor, intermediate, major, or severe based on management method and related sequelae. RESULTS Postoperative bleeding occurred in 5.4% of patients (49 of 906) with 67.3% of these (33 of 49) requiring operative intervention. Severe bleeding episodes were very rare (1.1% of patients). Transcervical external carotid system vessel ligation was performed with the primary resection in 15.6% of patients with no overall difference in bleeding rate or severity of bleeding in patients who underwent ligation vs those who did not (P = .21 and P = .66, respectively). Vessel ligation was performed more frequently in patients with a higher T stage (P = .002). In previously treated patients, severity of bleeding was decreased if vessels were ligated (P > .05). Higher T-stage tumors had a higher bleeding rate (P = .02). Bleeding rates were similar between those treated with laser (5.6%) and robotic (5.9%) oropharyngectomy (P = .80); however, patients with significantly higher T-stage tumors were treated with laser vs robot techniques (P < .001). CONCLUSIONS AND RELEVANCE Transoral resection of oropharyngeal carcinoma is safe, and severe life-threatening hemorrhage is rare. Although transcervical vessel ligation did not result in an overall decrease in bleeding rate, there is a trend toward reduced postoropharyngectomy bleeding severity with ligation. We recommend ligation for higher T-stage tumors, primary tonsil tumors, and patients undergoing revision surgery.
    JAMA otolaryngology-- head & neck surgery. 10/2013;
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    ABSTRACT: High stress is a prevalent problem in the worksite. To reduce stress, improve productivity, reduce absenteeism, and lower healthcare costs, many companies offer exercise classes or stress management programmes. Although physical activity is an important component of stress management, few worksites have integrated physical activity into their comprehensive stress reduction programmes. The purpose of this single-arm pilot project was to examine the potential effectiveness of an integrated exercise (studio cycling) and cognitive-behavioural stress management programme. Eighty-four adults, 75% female, mostly aged 40+ years, participated in an integrated 12-week cycling studio and cognitive-behavioural stress management programme. Participants experienced a significant and clinically meaningful reduction on the Perceived Stress Scale (p < 0.01), rating of current stress level and confidence to manage stress at the programme's end and at a 1-month follow-up. Participants also reported having significantly improved overall health, improved nutritional habits, higher physical activity level, greater confidence in their ability to follow a healthy diet, higher spiritual well-being, improved sleep, receiving more support for maintaining healthy living and improved quality of life at the completion of the 12-week programme and 1-month follow-up. These findings provide further support for an integrated exercise and stress management programme. Copyright © 2013 John Wiley & Sons, Ltd.
    Stress and Health 07/2013; · 1.04 Impact Factor
  • Kerry D Olsen, Eric J Moore
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    ABSTRACT: Deep lobe parotidectomy is an important management approach for highgrade primary parotid cancers that metastasize to the deep lobe nodes and for cancers that metastasizes to the deep parotid from a site outside the parotid. This paper reviews the rationale for deep lobe parotidectomy with facial nerve preservation for these parotid cancers. Deep lobe parotid involvement was reviewed in 27 patients. Twelve patients had primary parotid tumors that metastasized to the deep lobe, and 15 had tumors outside the parotid that metastasized to deep parotid nodes. Deep lobe parotidectomy should be considered in patients with a highgrade primary parotid tumor, a cancer that metastasizes to a superficial intraparotid node, or a primary parotid malignancy that metastasizes to a superficial parotid node or a neck node.
    Archives of Oto-Rhino-Laryngology 07/2013; · 1.29 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine the incidence of level IIB lymph node metastasis in patients with oropharyngeal squamous cell carcinoma (OPSCC) and to evaluate the necessity of level IIB dissection for elective and therapeutic neck dissections. STUDY DESIGN: Retrospective cohort study. METHODS: Patients with OPSCC (N = 348) were surgically managed at our institution from 2004 through 2010. Neck dissection specimens were reviewed by a pathologist, and level IIB metastases were analyzed with respect to clinical and pathologic data. RESULTS: Level IIB lymph node metastases were present in 2.5% and 25% of elective and therapeutic neck dissections, respectively. Level IIA metastasis, clinical tumor stage, clinical nodal stage, extracapsular spread, and primary tumor location in the tonsil were significantly associated with level IIB metastasis. CONCLUSIONS: This study uniquely demonstrated a statistically significant association between clinical tumor stage and tonsil subsite with level IIB metastasis in OPSCC. Considering the predicted incidence of nodal metastasis, we conclude that level IIB neck dissection can be omitted in early stage (T1 or T2) clinically node negative (cN0) OPSCC. In patients with a cN0 neck and advanced OPSCC (T3 or T4), primary tumor in the tonsil, or ipsilateral clinically node positive (cN(+) ) and contralateral cN0 neck, level IIB dissection should be considered. Level IIB dissection should be performed routinely in patients with cN(+) OPSCC. LEVEL OF EVIDENCE: 4. Laryngoscope, 2013.
    The Laryngoscope 05/2013; · 1.98 Impact Factor
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    ABSTRACT: Despite remarkable advances in the care of patients with laryngeal cancer over the past several decades, including a growing awareness of therapeutic complications and attention to quality of life, little is known about the causes of mortality in this population. In addition to the laryngeal malignancy itself, acute and late or chronic treatment-associated causes, second primary cancers, intercurrent disease and psychosocial factors are all responsible for patient morbidity and mortality. We examine the current literature related to the causes of death in patients with laryngeal cancer, in the hope of guiding future interventions to improve the longevity and quality of life of individuals with this cancer.
    Archives of Oto-Rhino-Laryngology 04/2013; · 1.29 Impact Factor
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    ABSTRACT: To investigate presenting signs and symptoms, preoperative workup, operative therapy, and morbidity of benign and malignant lipomatous lesions of the parotid gland. Medical literature review and retrospective chart review for all patients who underwent surgery for lipomatous lesions of the parotid gland at our institution from 1959 to 2009. Seventy patients underwent surgery for such lesions. Histologic sections were stained with hematoxylin-eosin and reviewed, and clinical information was obtained from hospital medical records for each case. Forty-nine patients (70.0%) were male and 21 (30.0%) female (mean age, 49.9 years). Of the lesions, 43 (63.2%) were intraparotid, 25 (36.8%) periparotid, 69 (98.6%) unilateral, and 1 (1.4%) bilateral (average size, 3.7 cm). Fifty-nine patients were treated with superficial or partial superficial parotidectomy, 10 were treated with total parotidectomy, and one was treated with parapharyngeal space dissection. Complications included six cases (8.6%) of facial paresis or paralysis and two cases of hematoma. No lesions recurred. We present the largest series, to our knowledge, of lipomatous lesions of the parotid gland. These masses, although rare, should be considered in the evaluation of a parotid mass. This series provides insight into the clinical presentation, diagnostic evaluation, and surgical treatment of parotid lipomatous lesions. Surgical extent depends on lesion location in the gland. Lipomatous masses can be effectively treated surgically with low morbidity and high cure rates. Laryngoscope, 2013.
    The Laryngoscope 03/2013; 123(3):651-6. · 1.98 Impact Factor
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    ABSTRACT: Abstract Purpose. There is limited documentation regarding the potential quality of life (QOL) benefits associated with use of a worksite wellness center. Therefore, the aim of this study was to examine the relationship between potential QOL change and use of a worksite wellness center during a 12-month period. Design. Analysis of an annual QOL wellness center member survey and wellness center use during a 12-month time period. Setting. A worksite wellness center. Participants. A total of 1151 employee wellness center members, average age of 39.5 years, 69.7% female, and 43.5% reported being overweight. Intervention. Members of the worksite wellness center have access to a range of fitness options, including exercise classes, water aerobics, an indoor track, strength training, and aerobic conditioning equipment. Additionally, nutritional classes are offered, and there is a wellness café. For resiliency, members can participate in wellness coaching or a stress-reduction group program. Method. Participants completed a baseline QOL survey and a second QOL survey 1 year later. An electronic entry system tracked use of the wellness center. Results. Participants were divided into four wellness center use quartiles: low users (less than once every 2 weeks), below-average users, above-average users, and high users (two to three visits per week). High users reported experiencing improvements in their physical QOL (p < .0001) compared with the low users. Additionally, low users experienced a greater decline in their mental QOL (p = .05) compared with high users. Conclusion. In a large sample of employees, use of a wellness center during a 12-month period was associated with benefits for physical QOL. QOL is an important domain of wellness; therefore, in addition to measuring physiologic changes, examining potential QOL changes may be another important outcome measure for wellness centers.
    American journal of health promotion: AJHP 02/2013; · 2.37 Impact Factor
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    ABSTRACT: The aim of this retrospective study was to describe the oncologic and functional results of treating oropharyngeal squamous cell carcinoma with transoral robotic surgery and neck dissection as monotherapy. A review was performed, including all patients who underwent transoral robotic surgery and neck dissection as the only means of therapy for oropharyngeal carcinoma from March 2007 to July 2009 at a single tertiary care academic medical center. We reviewed all cases with ≥24-month follow-up. Functional outcomes included tracheostomy dependence and oral feeding ability. Oncologic outcomes were stratified by human papillomavirus (HPV) status and tobacco use and included local, regional, and distant disease control, as well as disease-specific and recurrence-free survival. Eighteen patients met study criteria. Ten patients (55.6%) were able to eat orally in the immediate postoperative period, and 8 (44.4%) required a temporary nasogastric tube for a mean duration of 13.6 days (range 3 to 24 days) before returning to an oral diet. No patient required placement of a gastrostomy tube, and all patients are tracheostomy-tube-free. Among the HPV-positive nonsmokers (12/18, 66.7%), Kaplan-Meier estimated 3-year local, regional, and distant control rates were 90.9%, 100%, and 100%, respectively. Kaplan-Meier estimated disease-specific survival and recurrence-free survival were 100% and 90.9%, respectively. No complications occurred.This study suggests that carefully selected patients with HPV-positive oropharyngeal carcinoma can be effectively treated with surgery alone with excellent functional and oncologic outcomes.
    Ear, nose, & throat journal 02/2013; 92(2):76-83. · 1.03 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: Assess the role of retropharyngeal lymph node dissection in oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS). STUDY DESIGN: Prospective case series. METHODS: Retrospective analysis of 72 patients with oropharyngeal squamous carcinoma treated with transoral oropharyngectomy, neck dissection, and retropharyngeal node dissection. RESULTS: Eight of 55 (14.5%) patients with tonsil primaries had retropharyngeal metastases in contrast to none with tongue base primaries. The presence of pathologically positive retropharyngeal nodes was associated with clinical tumor (T) (P=.002) and node (N) stage (P=.007), preoperative computed tomography (CT) (P<.001), and positron emission tomography (PET)-CT scan (P<.001). The negative predictive value of early T (Tx,1-2) and N stage (N0-N2a) was 91.7% and 100%, respectively. Preoperative CT and PET-CT both yielded a positive predictive value of 100%, while the negative predictive value of imaging was optimized to 95.3% when these modalities were combined. CONCLUSIONS: In patients with tonsil cancer the risk of retropharyngeal metastases is negligible in the presence of clinically T1-2, N0-N2a disease and negative CT and PET-CT. We estimate that 40% of patients meet these criteria and may safely forego treatment of the retropharyngeal nodes. Approximately 10% of patients will have positive imaging and we recommend retropharyngeal node dissection at the time of surgery to treat macroscopic disease. In the remaining patients at risk for retropharyngeal node involvement, adjuvant radiotherapy is generally indicated based on other adverse features, and these nodes may be incorporated into the treatment field. LEVEL OF EVIDENCE: 4. Laryngoscope, 2013.
    The Laryngoscope 01/2013; · 1.98 Impact Factor

Publication Stats

2k Citations
335.01 Total Impact Points

Institutions

  • 2012–2013
    • University of Udine
      • Department of Medical and Biological Sciences
      Udine, Friuli Venezia Giulia, Italy
  • 1989–2013
    • Mayo Foundation for Medical Education and Research
      • • Department of Otolaryngology-Head and Neck Surgery
      • • Department of Laboratory Medicine
      • • Department of Radiation Oncology
      Rochester, MI, United States
    • Mayo Clinic - Rochester
      • • Department of Otorhinolaryngology
      • • Department of Radiation Oncology
      Rochester, Minnesota, United States
  • 2011
    • Institute of Oncology Ljubljana
      Lubliano, Ljubljana, Slovenia
  • 2010
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 1994–1996
    • Mayo Clinic - Scottsdale
      Scottsdale, Arizona, United States
    • University of Minnesota Rochester
      Rochester, Minnesota, United States