The Experts below are selected from a list of 963 Experts worldwide ranked by ideXlab platform
William R. Carroll - One of the best experts on this subject based on the ideXlab platform.
-
transoral robotic surgery for oropharyngeal and tongue cancer in the united states
Laryngoscope, 2015Co-Authors: Thomas K. Chung, Eben L. Rosenthal, Scott J Magnuson, William R. CarrollAbstract:Objectives/Hypothesis To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. Study Design Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. Methods Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. Results TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial Pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial Pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P < 0.001), higher charge ($98,228 vs. $67,317, P < 0.001), higher cost ($29,365 vs. $20,706, P < 0.001), higher rates of tracheostomy and gastrostomy tube placement, and more wound and bleeding complications. TORS was associated with a higher rate of dysphagia (19.5% vs. 8.0%, P < 0.001). The lower cost of TORS remained significant in the major-to-extreme severity of illness group but was associated with higher complication rates when compared to open cases of the same severity of illness. A similar analysis of TORS partial glossectomy for base of tongue tumors had similar cost and length of stay benefits, whereas TORS partial glossectomy for anterior tongue tumors revealed longer hospital stays and no benefit in charge or cost compared to open. Conclusions Early data demonstrate a clinical and cost benefit in TORS partial Pharyngectomy and partial glossectomy for the base of tongue but no benefit in partial glossectomy of the anterior tongue. It is likely that anatomic accessibility and extent of surgery factor into the effectiveness of TORS. Level of Evidence 2c. Laryngoscope, 125:140–145, 2015
-
Transoral robotic surgery for oropharyngeal and tongue cancer in the United States.
The Laryngoscope, 2014Co-Authors: Thomas K. Chung, Eben L. Rosenthal, J. Scott Magnuson, William R. CarrollAbstract:Objectives/Hypothesis To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. Study Design Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. Methods Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. Results TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial Pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial Pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P
William I. Wei - One of the best experts on this subject based on the ideXlab platform.
-
surgical treatment of advanced staged hypopharyngeal cancer
Advances in oto-rhino-laryngology, 2019Co-Authors: William I. Wei, Jimmy Yu Wai ChanAbstract:It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the airway and the swallowing passage. Careful planning of surgery is important to ensure good outcome of treatment and prevent complications, some of which may be fatal. The shape of the hypopharynx resembles that of a funnel, with a wide circumference above in continuity with the oropharynx, and a small circumference below where it joins with the cervical oesophagus. As a result, while small tumours require the partial removal of the hypopharynx, large tumours, especially those involving the post-cricoid region, warrant a complete, circumferential Pharyngectomy. For tumours that invade the cervical esophagus, transcervical approach is still feasible, and this is facilitated by the removal of the manubrium, allowing access to the tumour and resection with clear margins. In the presence of synchronous tumours lower down in the esophagus, pharyngo-laryngo-esophagectomy is indicated. Successful reconstruction of defects after tumour extirpation allows proper wound healing and early delivery of adjuvant radiotherapy. It is also important to ensure quick recovery of the long-term swallowing function. It ranges from the use of the soft tissue flap with skin island that is sutured as a patch to the remnants of the pharyngeal mucosa, to the use of a visceral flap, such as the free jejunal flap, to repair the circumferential Pharyngectomy defects. The treatment protocol is personalized according to the extent of the tumour and the characteristics of the patients.
-
Pharyngeal entry through the vallecula.
The Laryngoscope, 2004Co-Authors: William I. WeiAbstract:The authors describe a technique of entry into the vallecula with the guide of a small Deaver retractor inserted transorally, beyond the tongue base, into the vallecula. The tip of the Deaver directs the surgeon to the pharyngotomy site and allows pharyngeal entry and access without damaging structures in the region. This technique is particularly useful in total laryngectomy with or without Pharyngectomy and is applicable whenever entry to the pharynx through the vallecula is indicated.
-
Tracheostomal Stenosis After Immediate Tracheoesophageal Puncture
Archives of otolaryngology--head & neck surgery, 1991Co-Authors: William I. Wei, W. F. Lau, Kam H. LamAbstract:• The incidence of tracheostomal stenosis in a group of patients after total laryngectomy with or without Pharyngectomy plus immediate tracheoesophageal or tracheogastric puncture was compared with that of a control group without puncture. The stenosis rate of the puncture group was significantly higher than that of the control group (19% vs 6%). The other probable etiologic factors for stomal stricture were similar in both groups. Analysis of the risk factors in the puncture group suggested a higher tendency of stenosis in females (43% vs 16%) and in patients receiving postoperative radiotherapy (29% vs 14%), although the difference failed to reach statistical significance. ( Arch Otolaryngol Head Neck Surg . 1991;117:662-665)
Thomas K. Chung - One of the best experts on this subject based on the ideXlab platform.
-
transoral robotic surgery for oropharyngeal and tongue cancer in the united states
Laryngoscope, 2015Co-Authors: Thomas K. Chung, Eben L. Rosenthal, Scott J Magnuson, William R. CarrollAbstract:Objectives/Hypothesis To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. Study Design Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. Methods Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. Results TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial Pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial Pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P < 0.001), higher charge ($98,228 vs. $67,317, P < 0.001), higher cost ($29,365 vs. $20,706, P < 0.001), higher rates of tracheostomy and gastrostomy tube placement, and more wound and bleeding complications. TORS was associated with a higher rate of dysphagia (19.5% vs. 8.0%, P < 0.001). The lower cost of TORS remained significant in the major-to-extreme severity of illness group but was associated with higher complication rates when compared to open cases of the same severity of illness. A similar analysis of TORS partial glossectomy for base of tongue tumors had similar cost and length of stay benefits, whereas TORS partial glossectomy for anterior tongue tumors revealed longer hospital stays and no benefit in charge or cost compared to open. Conclusions Early data demonstrate a clinical and cost benefit in TORS partial Pharyngectomy and partial glossectomy for the base of tongue but no benefit in partial glossectomy of the anterior tongue. It is likely that anatomic accessibility and extent of surgery factor into the effectiveness of TORS. Level of Evidence 2c. Laryngoscope, 125:140–145, 2015
-
Transoral robotic surgery for oropharyngeal and tongue cancer in the United States.
The Laryngoscope, 2014Co-Authors: Thomas K. Chung, Eben L. Rosenthal, J. Scott Magnuson, William R. CarrollAbstract:Objectives/Hypothesis To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. Study Design Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. Methods Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. Results TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial Pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial Pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P
Young Soo Rho - One of the best experts on this subject based on the ideXlab platform.
-
Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma
The Laryngoscope, 2014Co-Authors: Eun-jae Chung, Il-seok Park, Sang-hyo Lee, So Hye Baek, Sung Jin Cho, Young Soo RhoAbstract:Objectives/Hypothesis The aim of this study was to analyze the prevalence and distribution of histologic cervical lymph node metastases in medial wall pyriform sinus squamous cell carcinoma (SCC). Study Design Retrospective study of medical records. Methods We reviewed the medical records of 68 medial wall pyriform sinus SCC patients who underwent bilateral neck dissection for primary treatment with curative intent. Thirty-nine patients underwent central compartment neck dissection. Primary tumor was removed using conservative laryngeal surgery with partial Pharyngectomy in 39 cases, near total/total laryngectomy with partial Pharyngectomy in 24 cases, and total laryngoPharyngectomy in five cases. Results The overall N+ contralateral lymph nodes rate on pathology was 14.7%. The rate of contralateral occult cases was 5.2%. Advanced primary (T3–4) and nodal (N2b–3) disease, and primary lesion across the midline were correlated with contralateral nodal metastasis. Multivariate analysis revealed that a primary lesion across the midline was an independent factor for contralateral neck nodal metastasis. The rate of level VI node metastasis was 16.2%. The disease-specific survival rate was significantly different according to level VI node metastasis (71% vs. 40%). Pyriform sinus apex invasion and extralaryngeal spread were correlated with level VI nodal metastasis. Multivariate analysis revealed that pyriform sinus apex invasion was an independent factor for level VI nodal metastasis. Conclusions Contralateral nodal metastasis was less frequent than expected. Bilateral neck dissection is mandatory for primary lesion across the midline. Ipsilateral level VI lymph node should be removed in pyriform sinus apex invasion cases. Level of Evidence 4. Laryngoscope, 124:882–887, 2014
-
OP134: Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma: When do contralateral and paratracheal node dissection necessary?
Oral Oncology, 2013Co-Authors: Eun-jae Chung, Dong Jin Lee, Il-seok Park, Kee-hwan Kwon, Young Soo RhoAbstract:Purpose The aim of this study was to analyze the prevalence and distribution of histologic cervical lymph node metastases in medial wall pyriform sinus squamous cell carcinoma (SCC). Material and methods Sixty-eight medial wall pyriform sinus SCC patients were retrospectively analyzed in this study. All patients underwent bilateral therapeutic/elective neck dissection. Thirty-nine patients underwent central compartment neck dissection. Eleven patients underwent retropharyngeal lymph node (RPLN) dissection. Primary tumor was removed using conservative laryngeal surgery with partial Pharyngectomy in 39 cases, near total/total laryngectomy with partial Pharyngectomy in 24 cases, and total laryngoPharyngectomy in five patients. Results The overall N-positive contralateral lymph nodes rate on pathology was 14.7%. The rate of contralateral occult cases was 5.2%. Contralateral nodal metastasis was not significantly associated with disease-specific survival. Multivariate analysis revealed that primary lesion across the midline was an independent factor for contralateral neck nodal metastasis. The rate of level VI node metastasis was 16.2%. The disease-specific survival rate was significantly different according to level VI node metastasis (71% vs 40%). In multivariate analysis, pyriform sinus apex invasion was an independent factor for level VI nodal metastasis. RPLN metastasis was confirmed by pathological analysis in two of the 11 (18.2%) subjects. Conclusions Contralateral nodal metastasis was less frequent than expected. Bilateral neck dissection is mandatory for primary lesion across the midline. Ipsilateral level VI lymph node should be removed in pyriform sinus apex invasion case. We recommend elective RPLN dissection in case with posterior pharyngeal wall invasion.
Eben L. Rosenthal - One of the best experts on this subject based on the ideXlab platform.
-
transoral robotic surgery for oropharyngeal and tongue cancer in the united states
Laryngoscope, 2015Co-Authors: Thomas K. Chung, Eben L. Rosenthal, Scott J Magnuson, William R. CarrollAbstract:Objectives/Hypothesis To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. Study Design Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. Methods Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. Results TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial Pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial Pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P < 0.001), higher charge ($98,228 vs. $67,317, P < 0.001), higher cost ($29,365 vs. $20,706, P < 0.001), higher rates of tracheostomy and gastrostomy tube placement, and more wound and bleeding complications. TORS was associated with a higher rate of dysphagia (19.5% vs. 8.0%, P < 0.001). The lower cost of TORS remained significant in the major-to-extreme severity of illness group but was associated with higher complication rates when compared to open cases of the same severity of illness. A similar analysis of TORS partial glossectomy for base of tongue tumors had similar cost and length of stay benefits, whereas TORS partial glossectomy for anterior tongue tumors revealed longer hospital stays and no benefit in charge or cost compared to open. Conclusions Early data demonstrate a clinical and cost benefit in TORS partial Pharyngectomy and partial glossectomy for the base of tongue but no benefit in partial glossectomy of the anterior tongue. It is likely that anatomic accessibility and extent of surgery factor into the effectiveness of TORS. Level of Evidence 2c. Laryngoscope, 125:140–145, 2015
-
Transoral robotic surgery for oropharyngeal and tongue cancer in the United States.
The Laryngoscope, 2014Co-Authors: Thomas K. Chung, Eben L. Rosenthal, J. Scott Magnuson, William R. CarrollAbstract:Objectives/Hypothesis To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. Study Design Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. Methods Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. Results TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial Pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial Pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P
