Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Pandemics/prevention & control , COVID-19/economics , COVID-19/epidemiology , COVID-19/transmission , Canada/epidemiology , Commerce , Contact Tracing , Disease Transmission, Infectious/prevention & control , Humans , Masks , Mass Vaccination , Physical Distancing , Quarantine , Risk Factors , SARS-CoV-2 , TravelABSTRACT
BACKGROUND: Extracapsular spread (ECS) of lymph node metastases is associated with poor prognosis and is an indication for adjuvant chemoradiotherapy. Accurately identifying ECS using imaging may allow us to recommend primary chemoradiotherapy to avoid trimodality treatment. We investigated the accuracy of staging CT in diagnosing ECS in P16 + oropharyngeal squamous cell carcinoma (OPSCC). METHODS: Patients with pathologically determined cervical nodal metastases from P16 + OPSCC were included. Two blinded radiologists scored images to predict the presence of ECS in comparison to histopathology. RESULTS: Eighty patients with a total of 91 specimens were evaluated. Pathologic ECS was identified in 53.8% of the patients. Sensitivity and specificity of CT for the two observers were 56.5% and 60.9%, and 73.3% and 66.7%, respectively. The presence of perinodal stranding was found to be significantly associated with pathological ECS. CONCLUSION: Computed tomography displays consistently high specificity, which may be used to rule out the presence of extracapsular spread in cervical nodal metastases of P16 + oropharyngeal squamous cell carcinoma.
Subject(s)
Head and Neck Neoplasms/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Oropharyngeal Neoplasms/diagnostic imaging , Squamous Cell Carcinoma of Head and Neck/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Head and Neck Neoplasms/pathology , Humans , Lymph Nodes/diagnostic imaging , Male , Middle Aged , Neck , Oropharyngeal Neoplasms/pathology , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Squamous Cell Carcinoma of Head and Neck/pathologyABSTRACT
Transoral robotic surgery (TORS) provides improved access to head and neck subsites resulting in well-validated functional and oncological outcomes, but access to and cost of robotic platforms can limit their use. Evidence suggests TORS is increasingly being adopted globally, but there is a paucity of data on the adoption and diffusion of TORS in Australia and New Zealand. A cross-sectional analysis was performed. An online survey was distributed to otolaryngologists and head and neck surgeons through three different Australian and New Zealand specialty membership databases. A 5-point Likert scale based on a Unified Theory of Acceptance and Use of Technology (UTAUT) model was incorporated to assess barriers and facilitators to adoption. 77 respondents completed the survey. 43.6% of head and neck surgeons had performed TORS. The most common cases were lateral oropharyngectomy (35.9%), base of tongue resection (33.3%), tongue base mucosectomy (28.2%), supraglottic laryngectomy (15.4%) and TORS for obstructive sleep apnoea (12.8%). Perceived barriers to adoption were high costs, access to and availability of the robotic platform and limited training opportunities. This study provides evidence of adoption of TORS in Australia and New Zealand; however, there is a perception that significant barriers to adoption persist. Results from this study may help guide decisions on how we train and license surgeons in the era of this technology.
Subject(s)
Head and Neck Neoplasms/surgery , Otolaryngologists , Procedures and Techniques Utilization/statistics & numerical data , Robotic Surgical Procedures/statistics & numerical data , Surgeons , Surveys and Questionnaires , Adult , Australia/epidemiology , Cross-Sectional Studies , Female , Humans , Laryngectomy/methods , Laryngectomy/statistics & numerical data , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/statistics & numerical data , New Zealand/epidemiology , Pharyngectomy/methods , Pharyngectomy/statistics & numerical data , Procedures and Techniques Utilization/trends , Robotic Surgical Procedures/education , Tongue/surgeryABSTRACT
The Marchildon and Sherar (2018) paper provides some useful insights: the role of primary care, improved approaches to physician compensation and the importance of accountability and governance. But their approach of focusing on doctors, including their compensation, misses the boat. Canada's healthcare system needs a major overhaul to improve integration and reward good performance for patient care going beyond medical practitioner compensation.
