Aug 20, 2015 - Fiyin Sokoya; Joseph Valentino, MD. Objective: 1) Understand the ... Sullivan; Erin L. McKean, MD; Jon P. Pepper, MD;. Lawrence J. Marentette ...
P174
Otolaryngology–Head and Neck Surgery 145(2S)
Based on this, we can suggest the optimal surgical extent of neck dissection for PTC patients with lateral compartment lymph node metastasis. Method: From January 2000 to December 2009, the patient group consisted of 88 patients who underwent total thyroidectomy concomitant therapeutic neck dissection. A total of 86 (97.7%) patients confirmed as having PTC and lateral compartment neck metastasis by pathologic examination were enrolled this study. Results: A total of 86 patients underwent 100 lateral compartment neck dissection. Level IV was found to be the predominant site for lateral compartment lymph node metastasis (83%). Level III, Level II, and Level V were 65%, 54%, 17%, respectively. Level VI lymph node metastasis was found in 84.9% (73/86). Multiple level nodal metastasis was correlated with lymphovascular invasion of PTC. Skip metastasis was correlated with age. Conclusion: In PTC patients with lateral nodal invasion, total thyroidectomy concomitant bilateral central compartment neck dissection and ipsilateral lateral compartment neck dissection including Levels II-V may be the optimal treatment.
POSTERS
Head and Neck Surgery Percutaneous Gastrostomy Complications and the Management of Head and Neck Cancer Thomas J. Gal, MD, MPH (presenter); Fiyin Sokoya; Joseph Valentino, MD Objective: 1) Understand the surgical site morbidity of percutaneous gastrostomy (PEG) in the head and neck cancer population. 2) Understand the implications of PEG morbidity on the therapy for head and neck cancer. Method: A retrospective review was performed on patients with head and neck cancer undergoing PEG in a tertiary care center. Patients treated between 1998 and 2008 were eligible for inclusion. Demographic and oncologic data were recorded. Primary outcome measures were surgical complications and complication type arising from the gastrostomy itself. Results: A total of 153 patients were identified with sufficient data available for review. A total of 61.6% of patients were male. Mean age was 58.1 years. Complications were observed in 28.1% of patients. The most common documented complication was leakage around the gastrostomy site (9.2%). Other observed complications included cellulitis of the abdominal wall (8.5%), abdominal wall abscess (1%), buried or extruded bumper (8%), and non-patent tubes (2.3%). Major complications were documented in 4 patients (2.6%) and included hemorrhage, perforated viscus, and peritonitis. No association of complications of any type with age, gender, tumor site, stage, or surgical service were observed.
Conclusion: Complications resulting from PEG in the head and neck cancer population are for the most part minor, self limited, and likely underreported. Major complications are infrequent but can be significant. Management and treatment implications with regards to head and neck cancer are discussed.
Head and Neck Surgery Placement of NP Airways after Skull Base Tumor Resection Matthew E. Spector, MD (presenter); Stephen Sullivan; Erin L. McKean, MD; Jon P. Pepper, MD; Lawrence J. Marentette, MD Objective: 1) Assess the efficacy of nasopharyngeal (NP) airways in lieu of tracheotomy to prevent tension pneumocephalus after open resection of anterior skull base (ASB) tumors. 2) Determine predictors of tension pneumocephalus in patients undergoing NP airway placement after open resection of ASB tumors. Method: A total of 121 ASB resections (mean age, 48.5 years; M:F 73:47) performed between 1994 to 2009 with documented NP airway placement were identified and charts retrospectively reviewed. Main outcome measures were presence of tension pneumocephalus, while controlling for other clinical parameters (presence of CSF leak, placement of lumbar drain, type of reconstruction). Results: All patients were extubated on the day of surgery and NP airways remained in place for 3 days; no complications from NP airways were seen (eg, nasal septal pressure necrosis, displacement of the tubes). A total of 3 (2.5%) cases of tension pneumocephalus occurred. There were 34 (28%) lumbar drains placed and 14 (12%) CSF leaks. Although only 3 events were recorded, there was a statistically significant difference in the rate of tension pneumocephalus stratified by lumbar drain placement (P = .02), presence of CSF leak (P = .04), and both together (P = .004). Type of reconstruction did not affect rate of tension pneumocephalus (P = 1.0). Conclusion: Resection of anterior skull base tumors does not necessitate prophylactic tracheotomy and use of a nasopharyngeal airway to divert airflow is well tolerated and highly successful. Lumbar drainage, the presence of a CSF leak, or both together may increase the risk of tension pneumocephalus.
Head and Neck Surgery Polymorphous Low-Grade Adenocarcinoma Tim Fife, MD (presenter); Brooks Smith; Joshua Waltonen, MD Objective: We present a series of 18 cases of polymorphous low-grade adenocarcinoma.
Downloaded from oto.sagepub.com by guest on August 20, 2015
