The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction.

BACKGROUND: To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC). METHODS: A retrospective review of a prospectively collected database of all patients with OPSCC diagnosed and treated from 1998 to 2009. Speech, swallowing, and quality of life data were gathered at 3 different evaluation points. HPV status was determined using p16 positivity as a surrogate marker. Univariate and multivariate statistical analyses were performed to identify whether p16 status is a significant predictor of functional outcome and QOL. RESULTS: One hundred twelve patients with OPSCC and known p16 status were treated with primary surgery between 1998 and 2009, with mean age of 56 years. Out of those patients 63 (56%) were p16 positive. Speech intelligibility remained high at 1-year post operation (95.4%). Only 11.5% of the patients required a feeding tube at 1 year after surgery to maintain their daily caloric requirements and the risk of aspiration after surgery was not significant (p = 0.097). There was no statistically or clinically significant difference in speech, swallowing ability, swallowing safety and QOL outcomes between p16-positive and negative OPSCC. CONCLUSIONS: Surgically treated OPSCC patients demonstrate excellent swallowing function and can achieve excellent speech perception. P16 status may not be predictive of functional outcomes or QOL in surgically treated OPSCC.

Outcomes of free flap reconstruction in the elderly.

BACKGROUND: The reconstructive surgeon is often faced with the dilemma of offering free flap reconstruction to the elderly after surgical extirpation in the head and neck due to the perception that this population tolerates these procedures poorly. METHODS: A 42-month retrospective review of all microvascular free flap reconstruction cases from a large head and neck oncology program was reviewed. A series of 278 patients met inclusion criteria and were stratified into 2 age groups: 45 to 64.9 years (n = 177) and ≥65 years (n = 101). RESULTS: There was no significant difference in primary outcomes, anastomotic compromise (p = .36), unsalvageable flaps (p = .46), secondary outcomes, complicated recoveries (p = .29), or deaths within 30 days of surgery (p = .14) between the 2 groups. However, the length of postoperative recovery was increased in the elderly cohort (p = .029). CONCLUSIONS: Given that outcomes were similar between young and elderly patients, surgeons should not restrict the use of free flaps based on their patients' age.

Utility of level VI neck dissection in diagnostic hemithyroidectomies.

BACKGROUND: The utility and safety of level VI central compartment lymph node dissection (LND) for the early detection of lymph node (LN) involvement during diagnostic hemithyroidectomy, for the evaluation of suspicious thyroid nodules, has yet to be established in the literature. METHODS: A retrospective review of all patients who underwent diagnostic hemithyroidectomy with level VI LND from a large head and neck oncology program from October 1, 2001, to May 10, 2009, was performed. RESULTS: A consecutive series of 78 patients were reviewed. Twenty-six patients (29.8%) were diagnosed with malignant neoplasm. All patients with malignant LNs (n  =  5; 6.4%) were diagnosed with papillary carcinoma. On average, 4.8 LNs were found through neck dissection in patients with positive nodes compared to 2.4 LNs in those without lymph node involvement (p  =  .04). No postoperative adverse events in the patient group were attributed to the level VI neck dissection. CONCLUSIONS: In patients undergoing diagnostic hemithyroidectomies, routine level VI LND was able to identify LN metastases in 6.4% of patients. The number of LNs was a strong predictor of positive node disease. Minimal surgical risks are associated with this procedure, and surgeons may avoid the risks of level VI reexploration in subsequent completion thyroidectomy.