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M Robinson - One of the best experts on this subject based on the ideXlab platform.
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pet ct surveillance versus Neck Dissection in advanced head and Neck cancer
The New England Journal of Medicine, 2016Co-Authors: Hisham Mehanna, Wailup Wong, Christopher C Mcconkey, Joy K Rahman, M Robinson, Andrew Hartley, Christopher M Nutting, Ned George Powell, H AlboozAbstract:BackgroundThe role of image-guided surveillance as compared with planned Neck Dissection in the treatment of patients with squamous-cell carcinoma of the head and Neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. MethodsIn this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography–computed tomography (PET-CT)–guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with Neck Dissection performed only if PET-CT showed an incomplete or equivocal response) to planned Neck Dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. ResultsFrom 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the ...
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pet ct surveillance versus Neck Dissection in advanced head and Neck cancer
The New England Journal of Medicine, 2016Co-Authors: Hisham Mehanna, Wailup Wong, Christopher C Mcconkey, Joy K Rahman, M Robinson, Andrew Hartley, Christopher M Nutting, Ned George Powell, H AlboozAbstract:BACKGROUND: The role of image-guided surveillance as compared with planned Neck Dissection in the treatment of patients with squamous-cell carcinoma of the head and Neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. METHODS: In this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography-computed tomography (PET-CT)-guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with Neck Dissection performed only if PET-CT showed an incomplete or equivocal response) to planned Neck Dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. RESULTS: From 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the patients had oropharyngeal cancer, and 75% had tumor specimens that stained positive for the p16 protein, an indicator that human papillomavirus had a role in the causation of the cancer. The median follow-up was 36 months. PET-CT-guided surveillance resulted in fewer Neck Dissections than did planned Dissection surgery (54 vs. 221); rates of surgical complications were similar in the two groups (42% and 38%, respectively). The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group. The hazard ratio for death slightly favored PET-CT-guided surveillance and indicated noninferiority (upper boundary of the 95% CI for the hazard ratio, <1.50; P=0.004). There was no significant difference between the groups with respect to p16 expression. Quality of life was similar in the two groups. PET-CT-guided surveillance, as compared with Neck Dissection, resulted in savings of £1,492 (approximately $2,190 in U.S. dollars) per person over the duration of the trial. CONCLUSIONS: Survival was similar among patients who underwent PET-CT-guided surveillance and those who underwent planned Neck Dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective.
Alfio Ferlito - One of the best experts on this subject based on the ideXlab platform.
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The Evolving Role of Selective Neck Dissection for Head and Neck Squamous Cell Carcinoma
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated wi, 2012Co-Authors: K. Thomas Robbins, Carl E Silver, Jatin P Shah, Alfio Ferlito, Alessandra Rinaldo, Robert P. Takes, Marc Hamoir, Primož Strojan, Avi Khafif, Jesus E. MedinaAbstract:Neck Dissection is an important part of the surgical treatment of head and Neck squamous cell carcinoma (HNSCC). The historical concept of Neck Dissection implied the removal of all lymph node-bearing tissue in the Neck, which began in the late nineteenth century. However, more conservative variations of Neck Dissection have been performed and promoted as well. Anatomic, pathologic, clinical investigations, and prospective studies have demonstrated that the lymphatic dissemination of HNSCC occurs in predictable patterns. Supported by these studies, selective Neck Dissection (SND), which consists of the removal of select levels of lymph nodes in the Neck that have the highest risk of harboring undetected metastases, has become widely accepted in the treatment of the clinically uninvolved Neck. More recently, evidence supports using SND in a therapeutic setting in selected cases of HNSCC with limited metastatic disease. Additionally, even more targeted Dissections referred to as super-selective Neck Dissection have been explored for selected patients undergoing elective node Dissection for supraglottic cancer and as an adjuvant therapy for salvage of residual lymphadenopathy confined to a single Neck level following chemoradiation. In the future, the trend to tailor treatment to individual patients and to limit toxicity and morbidity may further increase the use of SND. The indications have to be guided by further research, in relation with non-surgical treatment options while optimizing oncological effectiveness.
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planned Neck Dissection for patients with complete response to chemoradiotherapy a concept approaching obsolescence
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Alfio Ferlito, Thomas K Robbins, Ashok R Shaha, June Corry, Carl E Silve, Alessandra RinaldoAbstract:The question of efficacy of “planned” Neck Dissection following complete response to chemoradiation of head and Neck cancer is discussed. There is general agreement that preemptive Neck Dissection in patients who present initially with low volume (N1) Neck disease is not necessary. However, routine performance of planned Neck Dissection for patients who present initially with high volume (≥N2) disease remains controversial. The authors reviewed a large number of studies reported in the recent literature and discuss how they affect this debate. Twenty-four of the reviewed studies indicate a benefit in regional control obtained by “planned” Neck Dissection among patients who had bulky Neck disease pretreatment. All these studies are retrospective, they do not assess treatment response prior to surgery, although they do show very good regional control rates. Twenty-six studies demonstrate no benefit from “planned” Neck Dissection after complete clinical response. The reasons for these different conclusions include the development of more effective chemoradiation regimens which have improved the initial locoregional control rates of patients undergoing primary chemoradiation treatment, and improvements in diagnostic technology which have increased ability to detect low volume persistent tumor in the post treatment period. When Neck Dissection is necessary for persistent or recurrent disease, recent studies have shown that selective or superselective Neck Dissection may produce results therapeutically equivalent to those obtained with more extensive procedures, with less morbidity. There is now a large body of evidence, based on long-term clinical outcomes, that patients who have achieved a complete clinical (including radiologic) response to chemoradiation have a low rate of isolated Neck failure, and the continued use of planned Neck Dissection for these patients cannot be justified. © 2009 Wiley Periodicals, Inc. Head Neck, 2010
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consensus statement on the classification and terminology of Neck Dissection
Archives of Otolaryngology-head & Neck Surgery, 2008Co-Authors: Thomas K Robbins, Gregory T. Wolf, Joseph A Califano, Ashok R Shaha, Jesus E. Medina, Alfio FerlitoAbstract:Objective To update the guidelines for Neck Dissection terminology, as previously recommended by the American Head and Neck Society. Participants Committee for Neck Dissection Classification, American Head and Neck Society; representation from the Committee for Head and Neck Surgery and Oncology, American Academy of Otolaryngology–Head and Neck Surgery (T.A.D.). Evidence Review of current literature on Neck Dissection classification. Consensus Process Semiannual face-to-face meetings of the Committee for Neck Dissection Terminology and e-mail correspondence. Conclusions Standardization of terminology for Neck Dissection is important for communication among clinicians and researchers. New recommendations have been made regarding the following: boundaries between levels I and II and between levels III/IV and VI; terminology of the superior mediastinal nodes; and the method of submitting surgical specimens for pathologic analysis.
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selective Neck Dissection iia iii a rational replacement for complete functional Neck Dissection in patients with n0 supraglottic and glottic squamous carcinoma
Laryngoscope, 2008Co-Authors: Alfio Ferlito, Carl E Silver, Alessandra RinaldoAbstract:Introduction: The purpose of this paper is to determine the optimal elective treatment of the Neck for patients with supraglottic and glottic squamous carcinoma. During the past century, various types of Necks Dissection have been employed including conventional and modified radical Neck Dissection (MRND), selective Neck Dissection (SND) and various modifications of SND. Materials and Methods: A number of studies were reviewed to compare the results of MRND and SND in regional recurrence and survival of patients with supraglottic and glottic cancers, as well as the distribution of lymph node metastases in these tumors. Results: Data from seven prospective, multi-institutional, pathologic, and molecular analyses of Neck Dissection specimens, obtained from 272 patients with laryngeal squamous carcinoma and clinically negative Necks, revealed only four patients (1.4%) with positive lymph nodes at sublevel IIB. Data was also collected from three prospective, multi-institutional, pathologic and molecular studies of Neck Dissection specimens which include 175 patients with laryngeal squamous carcinoma (only 2 with subglottic cancer) and clinically negative Necks. Only six patients (3.4%) had positive nodes at level IV. Conclusions: SND of sublevel IIA and level III appears to be adequate for elective surgical treatment of theNeck in supraglottic and glottic squamous carcinoma. Dissection of level IV lymph nodes may not be justified forelective Neck Dissection of stage N0 supraglottic and glottic squamous carcinoma. Bilateral Neck Dissection incases of supraglottic cancer may be necessary only in patients with centrally or bilaterally located tumors.
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Neck Dissection: then and now.
Auris Nasus Larynx, 2006Co-Authors: Alfio Ferlito, Carl E Silver, Carlos Suárez, Jonas T. Johnson, Marshall Strome, Jatin P Shah, Jesus E. Medina, Luiz Paulo Kowalski, Alessandra Rinaldo, Juan P RodrigoAbstract:The significance of metastatic disease in the lymph nodes of the Neck as a critical independent prognostic factor in head and Neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a systematic approach to en bloc removal of cervical lymph node disease, described in detail by Jawdynski in 1888 and popularized and illustrated by Crile in the early 20th century, provided consistent and more effective treatment, and forms the basis of our current techniques. During the first half of the 20th century, developments included preservation of the accessory nerve in selected cases, elective Neck Dissection performed in association with resection of various primary tumors, bilateral Neck Dissection and limited Neck Dissection. The greatest impetus to the status of radical Neck Dissection came from Martin, whose technique consisted of resection of all lymph nodes from level I-V together with the accessory nerve, internal jugular vein, sternocleidomastoid muscle and various other structures in a single block of resected tissue. Martin's technical precepts were followed until the latter part of the 20th century when modifications in technique began to find general acceptance. The first description of an effective technique of modified radical Neck Dissection was published in Spanish by Suarez, in 1963. This technique, which preserves important structures, such as the internal jugular vein, sternocleidomastoid muscle and accessory nerve, was refined and popularized by various authors who published their results in the English language literature during the period from 1964 through 1990 and beyond. Modified or "functional" Neck Dissection avoids much of the morbidity of radical Neck Dissection while achieving equivalent degrees of control of regional disease in properly selected cases. By the late 20th century, the concept of selective Neck Dissection, consisting of resection of only the nodal groups at greatest risk for metastasis from a given primary site, was studied and developed. These limited Dissections are now widely employed for elective, and in properly selected cases, therapeutic treatment and staging of the Neck, and have been proposed for limited cervical recurrences after various chemoradiation protocols. Prospective studies have demonstrated similar rates of Neck recurrence and survival after elective selective Neck Dissection compared to elective modified radical Neck Dissection. Other modifications and factors applied to treatment of cervical lymph node disease include the use of adjuvant and neo-adjuvant radiation and chemotherapy, a revised system for classification of Neck Dissections, the identification of various adverse prognostic factors such as extracapsular spread and extranodal soft tissue deposits, application of sentinel lymph node biopsy to staging of the Neck, the use of immunohistochemical and molecular techniques for identification of lymph node metastases not detectable by light microscopy, and the possibility of endoscopic Neck Dissection. The authors conclude that Neck Dissection, as evolved over the past century, is a fundamental tool in management of patients with head and Neck cancer, but is still a work in progress.
Alessandra Rinaldo - One of the best experts on this subject based on the ideXlab platform.
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The Evolving Role of Selective Neck Dissection for Head and Neck Squamous Cell Carcinoma
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated wi, 2012Co-Authors: K. Thomas Robbins, Carl E Silver, Jatin P Shah, Alfio Ferlito, Alessandra Rinaldo, Robert P. Takes, Marc Hamoir, Primož Strojan, Avi Khafif, Jesus E. MedinaAbstract:Neck Dissection is an important part of the surgical treatment of head and Neck squamous cell carcinoma (HNSCC). The historical concept of Neck Dissection implied the removal of all lymph node-bearing tissue in the Neck, which began in the late nineteenth century. However, more conservative variations of Neck Dissection have been performed and promoted as well. Anatomic, pathologic, clinical investigations, and prospective studies have demonstrated that the lymphatic dissemination of HNSCC occurs in predictable patterns. Supported by these studies, selective Neck Dissection (SND), which consists of the removal of select levels of lymph nodes in the Neck that have the highest risk of harboring undetected metastases, has become widely accepted in the treatment of the clinically uninvolved Neck. More recently, evidence supports using SND in a therapeutic setting in selected cases of HNSCC with limited metastatic disease. Additionally, even more targeted Dissections referred to as super-selective Neck Dissection have been explored for selected patients undergoing elective node Dissection for supraglottic cancer and as an adjuvant therapy for salvage of residual lymphadenopathy confined to a single Neck level following chemoradiation. In the future, the trend to tailor treatment to individual patients and to limit toxicity and morbidity may further increase the use of SND. The indications have to be guided by further research, in relation with non-surgical treatment options while optimizing oncological effectiveness.
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planned Neck Dissection for patients with complete response to chemoradiotherapy a concept approaching obsolescence
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Alfio Ferlito, Thomas K Robbins, Ashok R Shaha, June Corry, Carl E Silve, Alessandra RinaldoAbstract:The question of efficacy of “planned” Neck Dissection following complete response to chemoradiation of head and Neck cancer is discussed. There is general agreement that preemptive Neck Dissection in patients who present initially with low volume (N1) Neck disease is not necessary. However, routine performance of planned Neck Dissection for patients who present initially with high volume (≥N2) disease remains controversial. The authors reviewed a large number of studies reported in the recent literature and discuss how they affect this debate. Twenty-four of the reviewed studies indicate a benefit in regional control obtained by “planned” Neck Dissection among patients who had bulky Neck disease pretreatment. All these studies are retrospective, they do not assess treatment response prior to surgery, although they do show very good regional control rates. Twenty-six studies demonstrate no benefit from “planned” Neck Dissection after complete clinical response. The reasons for these different conclusions include the development of more effective chemoradiation regimens which have improved the initial locoregional control rates of patients undergoing primary chemoradiation treatment, and improvements in diagnostic technology which have increased ability to detect low volume persistent tumor in the post treatment period. When Neck Dissection is necessary for persistent or recurrent disease, recent studies have shown that selective or superselective Neck Dissection may produce results therapeutically equivalent to those obtained with more extensive procedures, with less morbidity. There is now a large body of evidence, based on long-term clinical outcomes, that patients who have achieved a complete clinical (including radiologic) response to chemoradiation have a low rate of isolated Neck failure, and the continued use of planned Neck Dissection for these patients cannot be justified. © 2009 Wiley Periodicals, Inc. Head Neck, 2010
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selective Neck Dissection iia iii a rational replacement for complete functional Neck Dissection in patients with n0 supraglottic and glottic squamous carcinoma
Laryngoscope, 2008Co-Authors: Alfio Ferlito, Carl E Silver, Alessandra RinaldoAbstract:Introduction: The purpose of this paper is to determine the optimal elective treatment of the Neck for patients with supraglottic and glottic squamous carcinoma. During the past century, various types of Necks Dissection have been employed including conventional and modified radical Neck Dissection (MRND), selective Neck Dissection (SND) and various modifications of SND. Materials and Methods: A number of studies were reviewed to compare the results of MRND and SND in regional recurrence and survival of patients with supraglottic and glottic cancers, as well as the distribution of lymph node metastases in these tumors. Results: Data from seven prospective, multi-institutional, pathologic, and molecular analyses of Neck Dissection specimens, obtained from 272 patients with laryngeal squamous carcinoma and clinically negative Necks, revealed only four patients (1.4%) with positive lymph nodes at sublevel IIB. Data was also collected from three prospective, multi-institutional, pathologic and molecular studies of Neck Dissection specimens which include 175 patients with laryngeal squamous carcinoma (only 2 with subglottic cancer) and clinically negative Necks. Only six patients (3.4%) had positive nodes at level IV. Conclusions: SND of sublevel IIA and level III appears to be adequate for elective surgical treatment of theNeck in supraglottic and glottic squamous carcinoma. Dissection of level IV lymph nodes may not be justified forelective Neck Dissection of stage N0 supraglottic and glottic squamous carcinoma. Bilateral Neck Dissection incases of supraglottic cancer may be necessary only in patients with centrally or bilaterally located tumors.
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Neck Dissection: then and now.
Auris Nasus Larynx, 2006Co-Authors: Alfio Ferlito, Carl E Silver, Carlos Suárez, Jonas T. Johnson, Marshall Strome, Jatin P Shah, Jesus E. Medina, Luiz Paulo Kowalski, Alessandra Rinaldo, Juan P RodrigoAbstract:The significance of metastatic disease in the lymph nodes of the Neck as a critical independent prognostic factor in head and Neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a systematic approach to en bloc removal of cervical lymph node disease, described in detail by Jawdynski in 1888 and popularized and illustrated by Crile in the early 20th century, provided consistent and more effective treatment, and forms the basis of our current techniques. During the first half of the 20th century, developments included preservation of the accessory nerve in selected cases, elective Neck Dissection performed in association with resection of various primary tumors, bilateral Neck Dissection and limited Neck Dissection. The greatest impetus to the status of radical Neck Dissection came from Martin, whose technique consisted of resection of all lymph nodes from level I-V together with the accessory nerve, internal jugular vein, sternocleidomastoid muscle and various other structures in a single block of resected tissue. Martin's technical precepts were followed until the latter part of the 20th century when modifications in technique began to find general acceptance. The first description of an effective technique of modified radical Neck Dissection was published in Spanish by Suarez, in 1963. This technique, which preserves important structures, such as the internal jugular vein, sternocleidomastoid muscle and accessory nerve, was refined and popularized by various authors who published their results in the English language literature during the period from 1964 through 1990 and beyond. Modified or "functional" Neck Dissection avoids much of the morbidity of radical Neck Dissection while achieving equivalent degrees of control of regional disease in properly selected cases. By the late 20th century, the concept of selective Neck Dissection, consisting of resection of only the nodal groups at greatest risk for metastasis from a given primary site, was studied and developed. These limited Dissections are now widely employed for elective, and in properly selected cases, therapeutic treatment and staging of the Neck, and have been proposed for limited cervical recurrences after various chemoradiation protocols. Prospective studies have demonstrated similar rates of Neck recurrence and survival after elective selective Neck Dissection compared to elective modified radical Neck Dissection. Other modifications and factors applied to treatment of cervical lymph node disease include the use of adjuvant and neo-adjuvant radiation and chemotherapy, a revised system for classification of Neck Dissections, the identification of various adverse prognostic factors such as extracapsular spread and extranodal soft tissue deposits, application of sentinel lymph node biopsy to staging of the Neck, the use of immunohistochemical and molecular techniques for identification of lymph node metastases not detectable by light microscopy, and the possibility of endoscopic Neck Dissection. The authors conclude that Neck Dissection, as evolved over the past century, is a fundamental tool in management of patients with head and Neck cancer, but is still a work in progress.
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Elective and therapeutic selective Neck Dissection.
Oral oncology, 2005Co-Authors: Alfio Ferlito, Carl E Silver, Ashok R Shaha, Jatin P Shah, Alessandra Rinaldo, Christine G. Gourin, Gary L. Clayman, Luiz P. Kowalski, K. Thomas Robbins, Carlos SuárezAbstract:Selective Neck Dissection is a modification of the more comprehensive modified radical or radical Neck Dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective Neck Dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective Neck Dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective Neck Dissection, its application in the clinically negative but histologically node-positive Neck and the extended application of selective Neck Dissection in patients with clinical evidence of nodal disease are discussed.
Hisham Mehanna - One of the best experts on this subject based on the ideXlab platform.
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pet ct surveillance versus Neck Dissection in advanced head and Neck cancer
The New England Journal of Medicine, 2016Co-Authors: Hisham Mehanna, Wailup Wong, Christopher C Mcconkey, Joy K Rahman, M Robinson, Andrew Hartley, Christopher M Nutting, Ned George Powell, H AlboozAbstract:BackgroundThe role of image-guided surveillance as compared with planned Neck Dissection in the treatment of patients with squamous-cell carcinoma of the head and Neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. MethodsIn this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography–computed tomography (PET-CT)–guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with Neck Dissection performed only if PET-CT showed an incomplete or equivocal response) to planned Neck Dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. ResultsFrom 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the ...
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pet ct surveillance versus Neck Dissection in advanced head and Neck cancer
The New England Journal of Medicine, 2016Co-Authors: Hisham Mehanna, Wailup Wong, Christopher C Mcconkey, Joy K Rahman, M Robinson, Andrew Hartley, Christopher M Nutting, Ned George Powell, H AlboozAbstract:BACKGROUND: The role of image-guided surveillance as compared with planned Neck Dissection in the treatment of patients with squamous-cell carcinoma of the head and Neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. METHODS: In this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography-computed tomography (PET-CT)-guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with Neck Dissection performed only if PET-CT showed an incomplete or equivocal response) to planned Neck Dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. RESULTS: From 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the patients had oropharyngeal cancer, and 75% had tumor specimens that stained positive for the p16 protein, an indicator that human papillomavirus had a role in the causation of the cancer. The median follow-up was 36 months. PET-CT-guided surveillance resulted in fewer Neck Dissections than did planned Dissection surgery (54 vs. 221); rates of surgical complications were similar in the two groups (42% and 38%, respectively). The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group. The hazard ratio for death slightly favored PET-CT-guided surveillance and indicated noninferiority (upper boundary of the 95% CI for the hazard ratio, <1.50; P=0.004). There was no significant difference between the groups with respect to p16 expression. Quality of life was similar in the two groups. PET-CT-guided surveillance, as compared with Neck Dissection, resulted in savings of £1,492 (approximately $2,190 in U.S. dollars) per person over the duration of the trial. CONCLUSIONS: Survival was similar among patients who underwent PET-CT-guided surveillance and those who underwent planned Neck Dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective.
Gary R Hoffman - One of the best experts on this subject based on the ideXlab platform.
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maximizing shoulder function after accessory nerve injury and Neck Dissection surgery a multicenter randomized controlled trial
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2015Co-Authors: Aoife C Mcgarvey, Gary R Hoffman, Peter G Osmotherly, Pauline ChiarelliAbstract:ABSTRACTBackground.Shoulder pain and dysfunction after Neck Dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown.Methods.A total of 59 Neck Dissection participants were prospectively recrui
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physiotherapy for accessory nerve shoulder dysfunction following Neck Dissection surgery a literature review
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2011Co-Authors: Aoife C Mcgarvey, Peter G Osmotherly, Pauline Chiarelli, Gary R HoffmanAbstract:Background: Neck Dissection is an operation that can result in accessory nerve injury. Accessory nerve shoulder dysfunction (ANSD) describes the pain and impaired range of motion that may occur following Neck Dissection. The aim of this review was to establish the level of evidence for the effectiveness of physiotherapy in the postoperative management of ANSD. Methods: A literature search of physiotherapy and ANSD using Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Cochrane Library databases was undertaken. Results: Physiotherapy has been shown to be well tolerated in this patient group following surgery. However, few studies exist as to the effect of physiotherapy on ANSD. Conclusions: There is a need for research to investigate the effects of early, appropriate physiotherapy on the development of ANSD following Neck Dissection surgery. Such a study has the potential to improve the functional outcome and quality of life in this patient group, and ultimately to promote best practice guidelines for management. © 2010 Wiley Periodicals, Inc. Head Neck, 2011
