Otolaryngology- Head and Neck Surgery最新文献

{"title":"Long-Term Outcomes After Elective Contralateral Neck Dissection for HPV-Related Oropharyngeal Cancer.","authors":"Ray Y Wang, Molly E Heft Neal, Wade L Thorstad, Hiram A Gay, Anthony J Apicelli, Michael J Moravan, Douglas R Adkins, Peter J Oppelt, Patrik Pipkorn, Jason T Rich, Paul Zolkind, Randal C Paniello, Sidharth V Puram, Ryan S Jackson","doi":"10.1002/ohn.1227","DOIUrl":"10.1002/ohn.1227","url":null,"abstract":"<p><strong>Objective: </strong>Patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), particularly of the base of tongue, have a high rate of occult nodal disease in the contralateral neck. The risk of failure in the contralateral neck is reduced with elective treatment. The optimal treatment strategy to minimize treatment-related toxicity while preserving regional control in the contralateral neck has not been elucidated.</p><p><strong>Study design: </strong>Cross-sectional study of patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Methods: </strong>Patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018 were selected for inclusion. Long-term patient-reported functional outcomes were assessed via telephone at the time of data collection.</p><p><strong>Results: </strong>In total, 64 patients met the criteria for inclusion with a median follow-up of 58.5 months. In total, 56 patients (88%) had a primary cancer within the base of tongue or glossotonsillar sulcus. In total, 12 patients (19%) were found to have occult nodal metastasis in the contralateral neck, of whom 9 received adjuvant contralateral neck radiation. None of the patients who had node-negative contralateral neck dissections went on to receive radiation in the contralateral neck. Two patients (3%) recurred locally, two patients (3%) developed ipsilateral regional recurrence, and four patients (6%) developed distant metastasis. There were no regional recurrences within the contralateral neck. Five-year progression-free survival was 82.0%, whereas 5-year locoregional control was 93.0%. The mean Neck-Dissection Impairment Index was 94.4 with a median interval time of 92 months after surgery.</p><p><strong>Conclusion: </strong>Elective contralateral neck dissection in patients with HPV-related OPSCC provides excellent regional control with minimal long-term functional impairment, and most patients can be spared contralateral neck radiation without compromising oncologic outcomes. This may decrease long-term toxicity related to bilateral neck irradiation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1954-1961"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of Partial Decellularization on Tracheal Chondrocytes and Extracellular Matrix in Airway Reconstruction.","authors":"Lumei Liu, Jazmin Calyeca, Sayali Dharmadhikari, Zheng Hong Tan, Jane Yu, Ada C Sher, Melwan Izem, Sovannarath Pong, Kimberly M Shontz, Tendy Chiang","doi":"10.1002/ohn.1211","DOIUrl":"10.1002/ohn.1211","url":null,"abstract":"<p><strong>Objective: </strong>Partially decellularized tracheal grafts (PDTG) are potential candidates for tracheal replacement as they support neotissue formation without stenosis or rejection. However, the effects of partial decellularization (PD) on extracellular matrix (ECM) and chondrocytes are not currently understood, limiting PDTG translatability for clinical use. We aim to quantify the impact of PD on trachea using mouse and rabbit models.</p><p><strong>Study design: </strong>An animal model.</p><p><strong>Setting: </strong>Research Institute affiliated with a Tertiary Pediatric Hospital.</p><p><strong>Methods: </strong>PDTG and syngeneic tracheal grafts (STG) were implanted orthotopically in mice for 1 month (N = 10/group). Grafts were analyzed with mechanical testing, chondrocyte viability, and protein integrity. We tested the scalability of PDTG at a pediatric scale using a rabbit model at 3- and 6-month timepoints (N = 3/timepoint). Histologic and radiographic analyses were performed to assess chondrocyte viability and neotissue formation. Rabbit PDTG and native chondrocytes were isolated and cultured assessing PD effect on proliferation.</p><p><strong>Results: </strong>PD of mouse trachea eliminated all epithelial cells, maintained chondrocyte viability, and did not reduce graft mechanical properties or ECM proteins. Overall, collagen and glycosaminoglycans had similar expression and integrity in PDTG and STG. PDTG retained graft patency and supported epithelialization and vascularization. Like mice, PD of rabbit trachea achieved these goals, but had increased radiodensity. Unlike mice, rabbit PDTG had greater chondrocyte and ECM loss in vivo. Unique to rabbits, PD reduced chondrocyte proliferation in vitro compared to native chondrocytes.</p><p><strong>Conclusion: </strong>Despite similar pre-implantation metrics to the successful mouse model and support of neotissue formation, human-scale PDTG demonstrated greater chondrocyte and ECM loss.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2026-2037"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intersection of Race, Ethnicity, and Sex on Postoperative Complications in Otolaryngology.","authors":"Tatiana Ferraro, Sean M Lee, Abdulla K Ahmed, Sana Smaoui, Esther Lee, Punam Thakkar, Neelima Tummala","doi":"10.1002/ohn.1203","DOIUrl":"10.1002/ohn.1203","url":null,"abstract":"<p><strong>Objective: </strong>Racial and ethnic patient health disparities are well-documented within surgical specialties; however, an intersectional lens studying the combined impact of multiple identities has not been evaluated in this context. We aim to explore the multiplicative effect of race, ethnicity, and sex on postoperative complications across a variety of otolaryngologic procedures.</p><p><strong>Study design: </strong>Cross-sectional analysis of retrospective data.</p><p><strong>Setting: </strong>A multi-institutional cohort using National Surgical Quality Improvement Program (NSQIP) data from 2010 to 2021.</p><p><strong>Methods: </strong>The 100 most common NSQIP cases conducted by otolaryngologists between 2010 and 2021 were included. Primary outcomes included 30-day surgical complications and medical complications. Propensity-weighted data were fitted to logistic regression models, and pairwise post hoc comparisons were performed for each race and ethnicity contrast within each sex.</p><p><strong>Results: </strong>Of 146,461 patients included in the final analysis, the majority identified as white (82.6%) and non-Hispanic (NH; 92.35%). Black NH males had 2.15 times higher odds of experiencing any complication than Asian NH males (OR = 2.15, 95% confidence interval [CI] [2.05, 2.26], P < .001). White Hispanic males were half as likely to experience complications compared to black Hispanic males (OR = 0.50, 95% CI [0.37, 0.70], P = .002). White Hispanic females were 68% less likely to experience surgical complications compared to black Hispanic females (OR = 0.32, 95% CI [0.23, 0.46], P < .001).</p><p><strong>Conclusion: </strong>We demonstrate that black male patients experience increased adverse surgical outcomes despite accounting for multiple relevant comorbidities. These findings contribute to the growing literature on intersectionality, providing a strong argument for prospective strategies to address inequities of surgical care in otolaryngology.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1943-1953"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Presurgical Second-Touch Visits on Delays in Initiating Adjuvant Radiation Therapy.","authors":"Antonio A Bon-Nieves, Naomi C Wang, Sarah F Wagoner, Rahul Alapati, Maria Feucht, Uma Ramesh, Rohit Nallani, Emma Rea, Colleen Sommer, Amelia S Lawrence, Kevin J Sykes, Kiran Kakarala, Yelizaveta Shnayder, Andrés M Bur, Chelsea S Hamill","doi":"10.1002/ohn.1194","DOIUrl":"10.1002/ohn.1194","url":null,"abstract":"<p><strong>Objective: </strong>Patients with head and neck squamous cell carcinoma (HNSCC) often encounter delays in starting postoperative radiotherapy (PORT), leading to worse outcomes. We investigated whether attending second-touch visits-appointments after the initial clinic visit and before surgery to address treatment-related questions and follow-up expectations-with an advanced practice provider (APP) is associated with reduced PORT delays.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary referral center.</p><p><strong>Methods: </strong>Adult patients with HNSCC who underwent free flap surgery and PORT between 2020 and 2022 were included. All patients were offered a second-touch visit. The primary outcome was PORT delay, defined as treatment initiation >42 days after surgery. Clinicodemographic and treatment-related data were collected at baseline and at the last known follow-up.</p><p><strong>Results: </strong>Of the 104 patients included, 57.7% attended a second-touch visit. Attendance was associated with receiving radiotherapy (RT) in an academic setting (65.0% vs 40.9%, P = .015) and fewer PORT delays (56.7% vs 79.5%, P = .015). Multivariable analysis revealed a 70% reduction in odds of PORT delay for those attending second-touch visits (adjusted odds ratio [aOR] = 0.298, 95% CI 0.103-0.866, P = .026). PORT delay was more likely in patients with RT in a community setting (aOR = 3.783, 95% CI 1.284-11.146, P = .016), wound complications (aOR = 5.149, 95% CI 1.363-19.460, P = .016), and a higher comorbidity index (aOR = 1.407, 95% CI 1.012-1.957, P = .042).</p><p><strong>Conclusion: </strong>Attendance of a second-touch visit and RT at a tertiary medical center significantly reduced the likelihood of PORT delay. These findings underscore the importance of APP-driven patient navigation in improving timely care and outcomes for patients with HNSCC.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1980-1987"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Botulinum Toxin Type A Timing Efficacy in Patients With Synkinesis After Bell's Palsy.","authors":"Abdurrahman Al-Awady, Vivek Annadata, Ryan Sicard, Avanish Yendluri, Joshua Rosenberg, Mingyang Gray","doi":"10.1002/ohn.1205","DOIUrl":"10.1002/ohn.1205","url":null,"abstract":"<p><strong>Objective: </strong>This study examines whether the timing of botulinum toxin type A (BoNTA) treatments affects outcomes in patients with synkinesis, a sequela of Bell's Palsy characterized by disconjugate facial muscle movement.</p><p><strong>Study design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>An urban academic medical center.</p><p><strong>Methods: </strong>We reviewed the charts of synkinesis patients treated from 2016 to 2022. Data included procedural notes, intervention dates, and scores from the House-Brackmann (HB), Facial Clinimetric Evaluation (FaCE), Synkinesis Assessment Questionnaire (SAQ), and Facial Grading System (FGS).</p><p><strong>Results: </strong>Sixty-seven patients (median age 54 years, average palsy duration 5.7 years) received BoNTA. Patients treated within 12 months (n = 28), 13 to 24 months (n = 12), and after 24 months (n = 23) showed no significant differences in changes to HB, FaCE, or SAQ scores. However, patients treated within 1 year had significantly higher FGS improvement (36.3) than the other groups (P = .03).</p><p><strong>Conclusion: </strong>While FaCE, HB, and SAQ scores showed no significant differences, early BoNTA treatment within 1 year significantly improved FGS scores, indicating better outcomes. Therefore, early treatment is ideal for optimal response.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1897-1903"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canal Cholesteatomas: Proposed Guidelines Based on Otologic Practices at a Tertiary Care Center.","authors":"Jan Ynav Quiz, Arunima Vijay, Braeden Lovett, Lauren Mueller, Rex Haberman","doi":"10.1002/ohn.1189","DOIUrl":"10.1002/ohn.1189","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze disease and treatment patterns at a tertiary care center and propose guidelines for the management of canal cholesteatomas.</p><p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>This study involves patients diagnosed and treated with external auditory canal cholesteatomas (EACC) from January 1, 2010, to January 1, 2021 at the University of Florida, a tertiary care center.</p><p><strong>Methods: </strong>Inclusion criteria included a diagnosis of EACC with at least 1 follow-up visit after diagnosis. Patient demographics, risk factors, etiology if acquired, EACC characteristics such as location and staging, and treatment modality were recorded and analyzed. The primary outcome was a recurrence of disease.</p><p><strong>Results: </strong>Out of the 175 patients reviewed, 90 patients and 100 ears met the criteria. Most patients were treated with surgery (81%, N = 81) as opposed to medical management (ie, serial debridement). While there were no factors that were significant for higher odds of surgical intervention, all Stage IV (n = 9) and superior canal wall locations (n = 8) were treated with surgery. Mastoidectomy was more likely to be performed in higher staged cholesteatomas (χ² = 13.41, P = .0012) and posterior canal cholesteatoma location (odds ratio [OR] = 11.20, P = .0001), whereas anterior (OR = 0.11, P = .0390) and inferiorly located EACCs (OR = 0.22, P = .0169) had more odds of being treated with canalplasty/tympanoplasty. Recurrence was seen up to 4.78 years after surgery.</p><p><strong>Conclusion: </strong>Disease location and staging and patient factors should be considered in the shared management decision-making of EACC treatment. Surveillance duration should be up to 5 years.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2038-2045"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Stepwise Technology-Based Audiometry With Rapid Results (STARR) Protocol in Minnesota Elementary Schools.","authors":"Autefeh Sajjadi, Morgan McBride, Kimberly Guettler, Stephanie Janasko, Staci House, Cesley Bergsten, Nobles Antwi, Madeline Marker, Soorya Todatry, Stacey Rabusch, Rebecca Maher, Brianne Roby, Abby C Meyer, Andrew Redmann, Sivakumar Chinnadurai, Asitha D L Jayawardena","doi":"10.1002/ohn.1192","DOIUrl":"10.1002/ohn.1192","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to understand the utility of a stepwise technology-based audiometry with rapid results (STARR) school screening protocol.</p><p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Setting: </strong>Six elementary schools in a single school district in Minnesota.</p><p><strong>Methods: </strong>Students at 6 elementary schools in Minnesota participated in the STARR protocol and underwent initial technology-based hearing screening, followed by additional comprehensive automated audiometry with insert earphones and point-of-care otoscopy if they were referred. Results were reviewed by an otolaryngologist remotely, and parents received treatment recommendations based on these findings.</p><p><strong>Results: </strong>A total of 454 (81% of eligible) students were screened and 27 students (5.9%) referred. On average, the initial screening took 55 seconds (standard deviation [SD] = 22) for those who passed and 116 seconds (SD = 55) for those who were referred. Comprehensive audiometry screening took 163 seconds (SD = 27) for those who passed and 252 seconds (SD = 100) for those who referred. A team of 6 screeners could screen a class of 30 students in 30 minutes. The total number of nursing encounters required to ensure a student saw a provider after a referral was reduced using the STARR protocol (2.47 encounters per referral) compared to traditional audiometric screening (3.39 encounters per referral) (P < .01).</p><p><strong>Conclusion: </strong>The STARR protocol is a feasible and efficient method of screening in public schools that can reduce false referral rate, provide parents with more information at the point of referral, and reduce nursing burden.</p><p><strong>Implications for practice: </strong>Technology-based hearing screenings should be considered in school settings as a means to provide more patient and family-centered hearing health care. Further research is necessary to understand how the STARR protocol influences loss to follow-up rates after failed hearing screening.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1919-1926"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Flap Failure: Etiology and Management.","authors":"Matthew B Studer, Skylar H Trott, Sara Yang, Farshid Taghizadeh, Mark K Wax","doi":"10.1002/ohn.1193","DOIUrl":"10.1002/ohn.1193","url":null,"abstract":"<p><strong>Objective: </strong>Late free flap failure is an unusual setback for patients; we investigated the etiology and management of late flap failure.</p><p><strong>Study design: </strong>Single-institution retrospective review of 1959 free flaps from 2010 to 2023 for head and neck defects.</p><p><strong>Setting: </strong>Tertiary Academic Medical Center.</p><p><strong>Methods: </strong>Late failure was defined as initial detection of vascular compromise on postoperative day 6+, who went on to have total or partial flap loss. Variables included age, subsite, medical history, complications, day of detection, failure etiology, and treatment. Late failure cohort was compared to a cohort of 499 patients with long-term flap survival and 37 patients with early flap failure. Oregon Health and Science University (OHSU) Institutional Review Board (IRB) approval obtained; study number IRB00003898.</p><p><strong>Results: </strong>Thirty-one patients had late failure (1.6%). Twenty-five (80.6%) had total flap failure; six (19.4%) had partial failure. The majority (17, 54.8%) were associated with a postoperative complication (infection, fistula, wound dehiscence, or hematoma) which contributed to flap compromise. Average time until detection was 11 days. Patients had two or more reoperations in 21 cases (67.7%); rotational flaps were most common (19, 61.3%) followed by a second free flap (9, 29%). In comparing the late failure and long-term flap survival cohorts, late failure patients had a higher proportion of having had at least one intraoperative pedicle revision (41.9% vs 15.4%, odds ratio [OR] = 3.96 [95% confidence interval (CI) 1.86-8.41]); early flap failure patients had similar pedicle revision rates to late failure patients. Late failure patients had more postoperative infections than early failure patients (41.9% vs 18.9%, OR = 3.10 [95% CI 1.04-9.20]).</p><p><strong>Conclusion: </strong>Patients with late free flap failure require multiple operations for debridement and secondary reconstruction. Patients with both late and early failure are more likely to have had intraoperative pedicle revision. Postoperative infection is more common in late flap failure than early flap failure.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1882-1887"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Extent of Surgical Management for Low-Grade Parotid Malignancies: A SEER Analysis.","authors":"Katelyn S Rourk, Gabriela A Calcano, Hawa M Ali, Amy E Glasgow, Elizabeth B Habermann, Daniel L Price, Kendall K Tasche, Kathryn M Van Abel, Eric J Moore, Linda X Yin","doi":"10.1002/ohn.1305","DOIUrl":"https://doi.org/10.1002/ohn.1305","url":null,"abstract":"<p><strong>Objective: </strong>Low-grade parotid malignancies have high overall survival rates; however, controversy remains about the appropriate extent of surgery. We aim to explore the trends in the extent of parotidectomy performed over time in low-grade parotid malignancies in the United States, with a hypothesis that there has been a trend towards less aggressive surgery.</p><p><strong>Study design: </strong>Retrospective cohort study of all low-grade (grade I) acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC) in the Surveillance, Epidemiology, and End Results (SEER) from 2004 to 2020.</p><p><strong>Setting: </strong>Geographic areas served by SEER.</p><p><strong>Methods: </strong>Trends were assessed using Cochran-Armitage tests and logistic regression; Kaplan-Meier survival curves were used to analyze overall and cancer-specific survival, and chi-square tests were used to analyze patient characteristics.</p><p><strong>Results: </strong>In total, 1288 patients were identified (916 MEC; 372 ACC). Most patients (n = 772, 60%) were non-Hispanic white, with an average age of 50.6 years and had a slight female predominance (1.58:1). Most of the cohort presented with tumor stage T1 or T2 (84%), N0 (90.1%), and M0 (96.9%). Treatment with total parotidectomy decreased significantly (34.6 vs 17.7%, P = .02) whereas sacrificing the facial nerve (FN) slightly decreased (20 vs 15.7%, P = .1). A significant increase in N0 patients (71%-94%, P < .0001) was observed, whereas T staging remained stable (61%-64%, P = .3). Overall, both ACC and MEC had excellent cancer-specific survival.</p><p><strong>Conclusion: </strong>Over the last 17 years, there has been a significant de-escalation in the extent of parotidectomy for low-grade parotid malignancy in the United States.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the 7th and 8th Editions of AJCC Staging System for Hypopharyngeal Cancer Undergoing Surgery.","authors":"Heng-Yu Haley Lin, Chia-Fan Chang, Tsung-Lun Lee, Yen-Bin Hsu, Shyh-Kuan Tai, Muh-Hwa Yang, Ling-Wei Wang, Pen-Yuan Chu","doi":"10.1002/ohn.1311","DOIUrl":"https://doi.org/10.1002/ohn.1311","url":null,"abstract":"<p><strong>Objective: </strong>The prognostic accuracy of the American Joint Committee on Cancer (AJCC) 8th staging system for hypopharyngeal cancer remains uncertain. We aim to assess its survival prediction accuracy and compare it with the 7th edition.</p><p><strong>Study design: </strong>Retrospective investigation of prospective data.</p><p><strong>Setting: </strong>Single-institution tertiary referral center.</p><p><strong>Methods: </strong>A cohort of 200 patients with hypopharyngeal squamous cell carcinoma who underwent surgical intervention as primary treatment between 2007 and 2019 was analyzed. We evaluated overall survival (OS) and disease-specific survival (DSS) using the Kaplan-Meier method and the log-rank test for each AJCC edition. The Akaike information criterion (AIC) was used to assess prognostic prediction performance.</p><p><strong>Results: </strong>The median follow-up was 67 months (29-100 months). In total, 93% of the patients (N = 186) underwent at least one side of neck dissection. In total, 41% of patients (N = 82) were upstaged as per the AJCC 8th, all resulting from the redistribution of N stage. Survival curves for DSS were better distinguished for stages I, II, and IVb in the AJCC 8th edition, yet an overlap was observed between stages III and IVa. The combination of extranodal extension (ENE) and cervical metastasis level well-differentiated the survival curves for OS and DSS. The AJCC 8th system outperformed the 7th, with lower AIC values for OS (1092 vs 1098) and DSS (654 vs 666).</p><p><strong>Conclusion: </strong>The AJCC 8th edition improves survival prediction in hypopharyngeal cancer compared to the 7th, especially with the inclusion of ENE status and nodal metastasis classification revisions.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}