Oropharyngeal Malignancies Research Articles

Recurrent oropharyngeal cancer: Analysis of surgical treatment outcomes

BACKGROUND The main goal of our research is to introduce transoral robotic surgery and laser resection (TLR) as a considerable way of treating patients with recurrent oropharyngeal malignancies. AIM To develop a foundation of minimally invasive transoral surgical technique for patients with oropharyngeal recurrence. METHODS This study prospectively and retrospectively included patients with recurrent tumors from 2003 to 2018. Subjects were allocated into two groups: (1) Group I; underwent TLR; and (2) Group II (control); underwent open surgeries of varying volume. Evaluation was done with intraoperative blood loss, postoperative infection incidence, and quality of life using the scale for patients with head and neck tumors known as the Functional Assessment of Cancer Therapy-Head & Neck Scale. RESULTS One-hundred and forty one patients were included (103 males and 38 females), in 82 cases (85.4%), a recurrent tumor developed earlier than a year after primary tumor therapy; forty-six were in group I and 69 in group II, age ranging from 18 years to 86 years (average: 57.6 years). The first group showed a statistically significant less amount of blood loss and a decreased incidence of infectious complications (P < 0.05). Additionally, there was a significant difference in functional outcomes (quality of life scores) but no significant difference in survival curves. CONCLUSION In properly elected patients, TLR is not just reasonable but tends to be a favorable alternative for recurrent oropharyngeal cancers compared to the outcomes of the open surgery group.

Exploring the Association between Human Papillomavirus (HPV) and Breast Carcinoma: A review

Anal, cervical, and oropharyngeal malignancies are all known to be caused by the human papillomavirus (HPV). However, its exact function in Breast Cancer (BC) is still up for debate. Findings from a systematic literature search shed light on the possible link between HPV and BC. There could be a connection amongst HPV infection and the development of BC, as several works have shown HPV DNA in breast carcinoma tissues. There has been some conflicting evidence on the nature of the link between HPV and BC; some research has found the virus, while others have not. Different studies have shown different patterns of HPV genotypes in BC tissue; some have identified high-risk genotypes like HPV-16 and HPV-18, while others have shown a broad range of genotypes without any discernible pattern. To explain the significance of HPV in BC cases, better-designed research with bigger sample numbers and rigorous methodology are required.

Assessment of Prevalence and Factors Affecting Trismus in Cases of Oral and Oropharyngeal Malignancies after Complete Treatment

Assessment of Prevalence and Factors Affecting Trismus in Cases of Oral and Oropharyngeal Malignancies after Complete Treatment

Imaging Descriptors of Human Papilloma Virus-mediated and Human Papilloma Virus-negative Oropharyngeal Cancers in Indian Subcontinental Patients

Abstract Background: Nearly 24,000 new cases of oropharyngeal cancers (OPCs) are reported per year in India, constituting 3.9% of cancers in all sites. By 2009, Human papilloma virus (HPV), in particular HPV-16, was established as an etiological factor and even a causative agent in OPCs being associated with up to 70% OPCs. Prior imaging-based studies have described certain differentiating factors between HPV-mediated and HPV-negative OPC, highlighting computed tomography and magnetic resonance characteristics that could help differentiate the two groups. Our study aimed to evaluate any imaging differences between HPV-mediated and non-HPV-mediated oropharyngeal malignancies in the Indian subcontinent population. Methods: Seventy-nine patients from the Indian subcontinent who were referred to a tertiary center in southern India between the period of January 2019 to September 2020 (19 months) were included in the study. Imaging descriptors were documented by blinded radiologists, and univariate and multivariate analysis of various imaging descriptors and imaging differences between HPV-mediated and non-HPV cases were attempted to be identified. Results: We found no statistically significant imaging differences between HPV-mediated and non-HPV-mediated oropharyngeal malignancies. The only epidemiologically significant difference in the two groups was that in women and nonsmokers, HPV-mediated malignancies were more common. Conclusion: HPV-mediated and HPV-negative malignancies have similar primary tumor as well as nodal imaging characteristics. Previously cited differences in the two groups, in Western literature, could not be demonstrated in our population. It implores further research into whether downstaging of treatment and better prognosis of HPV-mediated malignancies is actually applicable in the Indian subcontinent setting.

Routing of patients with oral and oropharyngeal malignancies in a multidisciplinary university hospital (a single-center study)

Purpose. To study the features of routing and treatment of patients in the multidisciplinary University Clinical Hospital No.1 of The First Sechenov Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Material and methods. A retrospective study was carried out to determine the characteristics of patients who underwent treatment for malignant tumors of oral cavity and/or oropharynx in the Levshin Institute of Cluster Oncology of the Sechenov University during the period from 2016 to 2022. Medical documentation of 188 patients was used for a further comprehensive and detailed study. Results. Malignant neoplasms of the oral cavity were represented by ten localizations of the pathological process, the most common being the tongue – 63 cases (33%). The rarest localization in our study was major salivary gland – 2 cases (1%). 98 (52%) patients presented with stage III to IV oral cavity and oropharygeal cancer, while significantly fewer patients presented with the first stage – 30 (16%). We also found out that active screening of patients who sought medical help for other reasons contributes to the early detection of cancer. The analysis of referral rates revealed that, among the patients hospitalized to University Clinical Hospital No. 1 of the Sechenov University, 28 (15%) patients were outpatients, and 160 (85%) patients referred themselves due to the atypical course of the underlying disease, the presence of concomitant diseases, tumor spread, or as a result of annual active patient involvement campaigns. Conclusion. The incidence of oral and oropharyngeal cancer in Russia tends to increase and varies depending on anatomical localization, risk factors, and gender. The incidence of carcinomas of the oropharyngeal region in men is significantly higher than that in women, especially for oral cavity, tonsils, pharynx, and larynx. The development and implementation of an effective quality management system for patients with oral and oropharyngeal cancer should become one of the priority tasks of healthcare in the Russian Federation. Цель. Изучить особенности маршрутизации и лечения пациентов в многопрофильной Университетской клинической больнице №1 Клинического центра Первого Московского государственного медицинского университета им. И.М. Сеченова. Материал и методы. Проведено ретроспективное исследование заболеваемости пациентов, находящих- ся на лечении злокачественных новообразований (ЗНО) полости рта и/или ротоглотки на базе Института кластерной онкологии им. проф. Л.Л. Левшина ФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава РФ за период с 2016 по 2022 г. Детальному исследованию подверглись 188 историй болезней пациентов. Результаты. ЗНО орофарингеальной области представлены десятью локализациями патологического процесса, наиболее часто встречались ЗНО языка 63 (33,5%). Самая редкая локализация в нашем исследовании связана с ЗНО твердого и мягкого неба – 4 (2%). В ходе исследования было установлено, что у 98 (52%) пациентов рак полости рта и ротоглотки был диагностирован на поздних стадиях (III и IV), в то время как в 90 (48%) случаях рак был выявлен на начальной стадии заболевания (I и II). Также было выявлено, что проведение активного скрининга пациентов, которые обратились за медицинской помощью по другим причинам, способствует раннему обнаружению онкологических заболеваний. Анализ обращаемости выявил, что среди пациентов, госпитализированных в Университетскую клиническую больницу №1 Первого МГМУ им. И.М. Сеченова, число госпитализаций по направлению амбулаторного звена составило 28 (15%) пациентов, в то время как 160 (85%) пациентов обратились в больницу самостоятельно. Причинами самостоятельного обращения стали атипичное течение основного заболевания, отказ от предложенного лечения из-за существующих сопутствующих патологий, распространенность ЗНО в регионе, а также активная кампания по привлечению пациентов, проводимая больницей ежегодно. Заключение. Заболеваемость раком полости рта и ротоглотки в России имеет тенденцию к росту, при этом она варьируется в зависимости от анатомической локализации, факторов риска и пола. У мужчин заболеваемость карциномами орофарингеальной области значительно выше, чем у женщин, особенно в случаях рака полости рта, миндалин, глотки и гортани. Разработка и реализация эффективной системы менеджмента качества для больных ЗНО полости рта и ротоглотки должно стать одной из приоритетных задач здравоохранения в РФ.

Comparative Review of Standardized Incidence Ratio of Nonlymphoid, De Novo Malignancies After Liver Transplant Versus After Kidney Transplant.

De novo malignancies are the most common cause of death after solid-organ transplant. Here, we aimed to summarize standard incidence ratios of de novo malignancies after liver and kidney transplant within the same geographical locations, compare these ratios among differenttypes of de novo malignancies after liver and kidney transplant, and elucidate differences in de novo malignancies between liver and kidney transplant recipients. We performed a systematic review to identify studies on standard incidence ratios of de novo malignancies after liver and kidney transplant in the United Kingdom, Sweden, South Korea, and Taiwan. Four articles reported standard incidence ratios of de novo malignancies in 14 016 liver transplant recipients (mean follow-up 4.3 ± 0.7 y) and 48179 kidney transplant recipients (mean follow-up 6.1 ± 2.1 y). Mean ratios of oropharyngeal, pulmonary, colorectal, renal, and breast malignancies were 5.3, 1.6, 1.9, 1.8, and 1.1,respectively, after liver transplant and 3.2, 1.7, 1.5, 17.0, and 1.3, respectively, after kidney transplant. Mean ratios of bladder, cervixuterus, and stomach de novo malignancies were 1.8, 2.0, and 2.9, respectively, after liver transplant and 13.0, 1.9, and 1.9,respectively, after kidney transplant. Mean ratios of prostatic and esophageal malignancies were 1.6 and 1.8 after liver transplant and 1.2 and 1.1 after kidney transplant. Mean ratio of ovarian cancer was 1.2 and 2.9, respectively, after liver and kidney transplant. Low-frequency and lower standard incidence ratios were observed for testicular, ovarian and central nervous system malignancies after kidney and liver transplant. Standard incidence ratios of oropharyngeal and hepatic malignancies were higher after liver transplant compared with kidney transplant. After kidney transplant, standardized ration for renal malignancy were 9.4 times and bladder malignancies were 7.2 times higher compared with liver transplant recipients.

Chemokine Receptor-4 Targeted PET/CT Imaging with 68Ga-Pentixafor in Head and Neck Cancer-A Comparison with 18F-FDG and CXCR4 Immunohistochemistry.

Head and neck squamous cell carcinoma (HNSCC) is common, and its incidence is increasing, particularly in HIV-infected individuals who present with more aggressive disease. Despite aggressive treatment, the prognosis remains poor because of resistance to chemoradiation therapy. So far, studies report very low [68Ga]Ga-Pentixafor avidity in HNSCC. This study investigated the diagnostic performance of CXCR4-directed imaging of carcinoma of the oral cavity, oropharynx, and nasopharynx with positron emission tomography/computed tomography (PET/CT) using the radiolabelled chemokine ligand [68Ga]Ga-Pentixafor and explored its ability to quantify CXCR4 expression in vivo. In this prospective cross-sectional study, twenty-three (23) patients aged 52.9 ± 10.4 (19.6), 17 males and 6 females with primarily diagnosed (n = 17) or pre-treated (n = 6) SCC of the oral cavity (OCSCC, n = 11), oropharynx (OPSCC, n = 9), nasopharynx (NPSCC, n = 2) and unknown primary (n = 1) underwent imaging with [68Ga]Ga-Pentixafor-PET/CT. In 16/23 patients 2-[18F]fluoro-2-deoxy-D-glucose ([18F]F-FDG) served as a standard reference. All lesions were visually rated using a 5-point Likert scale. For both tracers, maximum standardized uptake values (SUVmax) and the total lesion uptake (TLU) were recorded and compared using the Wilcox-signed rank test. In addition, the tumor-to-background ratios were derived using the liver (TLR), spleen (TSR), and posterior cervical muscles (TMR) as background. The relationships between the SUVs of the two tracers were assessed using the Spearman correlation. CXCR4 immunohistochemistry (IHC) staining was correlated with 68Ga-Pentixafor-PET/CT in 21/23 patients. Ninety-one percent (21/23) of tumors were visually detected on [68Ga]Ga-Pentixafor; however, [68Ga]Ga-Pentixafor was less intense compared with [18F]F-FDG-PET. Quantitative analysis showed higher [18F]F-FDG SUVmax in comparison with [68Ga]Ga-Pentixafor (16 ± 6.7 vs. 5.8 ± 2.6 g/mL, p = 0.011) and SUVmean (9.3 ± 4.1 vs. 3± 1.6 g/mL, p < 0.001) and TBR 4.9 ± 2.3 vs. 2.36 ± 1.4 p = 0.014. Nasopharyngeal cancer demonstrated more intense tracer accumulation than oropharyngeal and oral cavity malignancies. CXCR4 IHC staining was positive in 15/21 patients, and there was a statistically significant correlation between IHC staining and [68Ga]Ga-Pentixafor SUVmean r = 0.5 p = 0.027, and performance status r = 0.83 p = 0.0104. In conclusion, although [68Ga]Ga-Pentixafor cannot replace [18F]F-FDG as a diagnostic tool because of its lower avidity, the correlation between CXCR4 targeted 68Ga-Pentixafor PET imaging and CXCR4 IHC staining indicates the potential of 68Ga-Pentixafor as an effective tool for selecting patients who may benefit from therapies targeting CXCR4. In addition, [68Ga]Ga-Pentixafor has no physiological brown fat uptake, which often obscures cervical lesions on [18F]F-FDG PET/CT imaging.

Artificial intelligence in maxillofacial and facial plastic and reconstructive surgery.

To provide a current review of artificial intelligence and its subtypes in maxillofacial and facial plastic surgery including a discussion of implications and ethical concerns. Artificial intelligence has gained popularity in recent years due to technological advancements. The current literature has begun to explore the use of artificial intelligence in various medical fields, but there is limited contribution to maxillofacial and facial plastic surgery due to the wide variance in anatomical facial features as well as subjective influences. In this review article, we found artificial intelligence's roles, so far, are to automatically update patient records, produce 3D models for preoperative planning, perform cephalometric analyses, and provide diagnostic evaluation of oropharyngeal malignancies. Artificial intelligence has solidified a role in maxillofacial and facial plastic surgery within the past few years. As high-quality databases expand with more patients, the role for artificial intelligence to assist in more complicated and unique cases becomes apparent. Despite its potential, ethical questions have been raised that should be noted as artificial intelligence continues to thrive. These questions include concerns such as compromise of the physician-patient relationship and healthcare justice.

Clinical evaluation of a machine learning-based dysphagia risk prediction tool

PurposeThe rise of digitization promotes the development of screening and decision support tools. We sought to validate the results from a machine learning based dysphagia risk prediction tool with clinical evaluation.Methods149 inpatients in the ENT department were evaluated in real time by the risk prediction tool, as well as clinically over a 3-week period. Patients were classified by both as patients at risk/no risk.ResultsThe AUROC, reflecting the discrimination capability of the algorithm, was 0.97. The accuracy achieved 92.6% given an excellent specificity as well as sensitivity of 98% and 82.4% resp. Higher age, as well as male sex and the diagnosis of oropharyngeal malignancies were found more often in patients at risk of dysphagia.ConclusionThe proposed dysphagia risk prediction tool proved to have an outstanding performance in discriminating risk from no risk patients in a prospective clinical setting. It is likely to be particularly useful in settings where there is a lower incidence of patients with dysphagia and less awareness among staff.

Transoral robotic surgery with free flap reconstruction: Functional outcomes of 241 patients at a single institution.

Transoral robotic surgery (TORS) for oropharyngeal malignancy optimizes oncologic outcomes while preserving functionality. This study identifies patterns of functional recovery after TORS with free flap reconstruction (FFR). Retrospective cohort study at a tertiary care center of patients with primary oropharyngeal tumors treated with TORS with FFR between 2010 and 2022. Patients were categorized into: adjuvant chemoradiation or radiation, or no adjuvant therapy (NAT). Functional outcomes were measured by functional oral intake scale (FOIS). 241 patients were included. FOIS declined at first postoperative appointment (median = 7.0 to 2.0, IQR = [7.0, 7.0], [2.0, 4.0]), and progressively improved to 6.0 (5.0, 6.0) after 1 year, with NAT having the highest FOIS (7.0, p < 0.05). Predictors of poor long-term FOIS included RT and hypoglossal nerve (CN XII) involvement (p < 0.05). TORS with FFR leads to good long-term function with minimal intake restrictions. Radiation therapy and CN XII involvement increase risk of worse functional outcomes.

Utility of video fluoroscopic swallow study in advancing oral diet post TORS for oropharyngeal malignancies

ObjectiveTORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this study explores both subjective and objective swallowing outcomes. Study designRetrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023. SettingSingle tertiary referral center. MethodsPostoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2. ResultsAt an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS. ConclusionEarly post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.

Influence of diet and nutrition on oral health – A review

Diet plays an important role in oral health as well as the overall health of the body. Across the world, several dietary patterns are practiced. Oral diseases including dental caries, periodontal disease, tooth loss, oral mucosal lesions, and oropharyngeal malignancies, are serious issues for public health across the world. An improper diet can lead to many problems in the oral cavity. Diet alters both the hard and soft tissues of the oral cavity. A person’s psychological, social, and emotional well-being is greatly influenced by their experience with pain, missing, discolored, or damaged teeth. Dental decay eventually results in tooth loss, which affects the ability to chew and causes people to avoid hard and fibrous meals including fruits, vegetables, and healthy grains. This review mainly focuses on the influence of dietary patterns on oral health status by analyzing the prevalence of dental caries, tooth wear, and periodontal status in the oral cavity. There is clear evidence of an association between dietary intake and oral diseases, intake of more fruits in the case of vegetarians has an impact on the formation of dental caries and also in tooth wear. In addition to that, nutritional deficiency also plays an important role in causing oral diseases.

Cancer screening with multicancer detection tests: A translational science review.

Multicancer detection (MCD) tests use a single, easily obtainable biospecimen, such as blood, to screen for more than one cancer concurrently. MCD tests can potentially be used to improve early cancer detection, including cancers that currently lack effective screening methods. However, these tests have unknown and unquantified benefits and harms. MCD tests differ from conventional cancer screening tests in that the organ responsible for a positive test is unknown, and a broad diagnostic workup may be necessary to confirm the location and type of underlying cancer. Among two prospective studies involving greater than 16,000 individuals, MCD tests identified those who had some cancers without currently recommended screening tests, including pancreas, ovary, liver, uterus, small intestine, oropharyngeal, bone, thyroid, and hematologic malignancies, at early stages. Reported MCD test sensitivities range from 27% to 95% but differ by organ and are lower for early stage cancers, for which treatment toxicity would be lowest and the potential for cure might be highest. False reassurance from a negative MCD result may reduce screening adherence, risking a loss in proven public health benefits from standard-of-care screening. Prospective clinical trials are needed to address uncertainties about MCD accuracy to detect different cancers in asymptomatic individuals, whether these tests can detect cancer sufficiently early for effective treatment and mortality reduction, the degree to which these tests may contribute to cancer overdiagnosis and overtreatment, whether MCD tests work equally well across all populations, and the appropriate diagnostic evaluation and follow-up for patients with a positive test.

A Review and Comparative Analysis of Transoral Surgical Treatment versus Conservative Management in Early-Stage Oropharyngeal Cancer.

Oropharyngeal cancer requires a comprehensive evaluation of treatment options, including surgery, radiation therapy, and chemotherapy. It is crucial to customize these treatments based on the stage of the tumor and the overall health of the patient, enabling personalized or combined approaches. Transoral surgical techniques have regained popularity due to the advancements and limitations of non-surgical strategies. The potential influence of surgical procedures on patients' quality of life highlights the need for careful intervention selection; among them, the transoral approach has proven to be especially beneficial for early-stage oropharyngeal neoplasms. To explore potential treatments for early-stage oropharyngeal malignancies, this study carefully reviews the literature, using information from papers, current research, and global databases. The review protocol commenced on November 2023. A comprehensive search of the PUBMED database was undertaken, employing pertinent terms associated with oropharyngeal, transoral surgery or radiotherapy, robotic surgery, and chemotherapy. Treating early-stage oropharyngeal neoplasms is particularly intriguing due to the multitude of variables influencing treatment decisions, leading to ongoing debates in specialized literature. Regardless of the chosen approach, maintaining a high quality of life is crucial. To assess this, standardized questionnaires from the European Organization for Research and Treatment of Cancer were employed, revealing superior outcomes for patients solely undergoing surgical intervention. Additionally, in the realm of specialized literature, cases of HPV-positive oropharyngeal neoplasms are recognized for their heightened radiosensitivity and more favorable long-term prognosis. Surgical intervention and radiotherapy are the main treatment options for oropharyngeal cancer, and they can be used separately or together for maximum effectiveness. Amid ongoing discussions, determining the superior effectiveness between the two options continues to be a matter of debate. This study provides a comprehensive analysis, offering valuable perspectives for future discussions. Neoplasm in the oropharynx can be effectively treated using transoral microsurgery.

Ten-year (2009–2019) epidemiological study of head and neck, salivary glands and upper aerodigestive tract cancers, and overall survival outcomes in the Northern Territory of Australia

BackgroundHead and neck, salivary glands and aerodigestive tract cancers (HNACs) rank sixth in cancer incidence in Australia, posing significant public health and economic challenges. However, data on HNACs in the...

Differences in geometric patterns of failure in human papillomavirus (HPV)-associated and HPV-non-associated oropharyngeal cancer after definitive radiotherapy.

The aim of this study was to evaluate and compare the spatial pattern of locoregional recurrences in patients diagnosed with HPV-associated and HPV-non-associated oropharyngeal SCC (OPSCC) treated with definitive radiotherapy. Patients who had locoregional recurrence following definitive intensity-modulated radiation therapy were identified at a single tertiary institution. Target volumes were delineated according to the latest consensus international guidelines. Recurrences were classified into five categories based on radiotherapy dose distribution and target volume, using a previously validated methodology; type A (central high dose), type B (peripheral high dose), type C (central elective dose), type D (peripheral elective dose), and type E (extraneous dose). The types of failure were compared between p16-positive and p16-negative tumors using the Pearson chi-square test. Fifty-eight locoregional recurrences were observed in 36 patients. The majority of recurrences were in nodal locations (66%, 38/58). Among these, 34 (59%) were classified as type A, 6 (10%) as type B, 9 (15%) as type C, 5 (9%) as type D, and 4 (7%) as type E failure. A significant difference was found in the types of failure between p16-positive and p16-negative tumors (X2 9.52, p = 0.044). p16-negative tumors were more likely to have recurrences in a peripheral location compared to p16-positive tumors (32% vs. 7%). p16-positive tumor were more likely to have extraneous recurrences (17% vs. 0%). Our study results identified a significant difference in patterns of locoregional failure among patients diagnosed with oropharyngeal cancer following consensus-based tumor delineation and modern radiotherapy. Further confirmatory pattern of failure studies are required to enable greater individualization of radiotherapy for patients diagnosed with oropharyngeal malignancy in the future.

Virtual Surgical Planning Facilitates Surgical Resection in Mandibular Osteoradionecrosis and Optimize Reconstructive Outcomes

Background: Mandibular osteoradionecrosis (ORN) is a devastating complication of radiotherapy for oropharyngeal malignancy. Despite advancements in ORN treatment, risk of ORN recurrence remains high following surgical resection. Virtual surgical planning (VSP) for ORN treatment is an evolving application that may not only inform bony reconstruction but also therapeutic surgical margins, which remain inconclusively defined in the literature. Methods: A retrospective review was performed of 25 cases in which patients underwent VSP-guided resection of mandibular ORN followed by immediate free fibula flap reconstruction. Surgical margins of 1-cm from radiologically evident disease were taken. VSP accuracy was quantified by comparing measured anatomic parameters between the virtually planned outcomes and the final outcomes on postoperative imaging. Statistical analyses were performed to assess associations between preoperative factors and postoperative complications including ORN recurrence. Results: The mandibular body was most frequently affected by ORN in this series of patients. Among risk factors, only the presence of a preoperative orocutaneous fistula was predictive of a complication, specifically partial flap failure (β = 1.41; P = .013). Intended anatomic parameters were achieved with the exception of the intergonial distance (x difference = 0.53 cm; P = .03). Finally, there were no cases of ORN recurrence after a mean follow-up of 27.4 months. Conclusions: VSP of free fibula flaps for mandibular reconstruction following ORN is a valid tool for effecting accurate anatomical outcomes. Furthermore, we demonstrate that a 1-cm margin around radiographically evident ORN may effectively implement a curative outcome free from relapse.

Stage at Presentation and Factors Associated with Late Diagnosis of Head and Neck Malignancies at Bugando Medical Center, Mwanza, Tanzania

Background: Head and neck malignancies are often diagnosed at a late stage in sub-Saharan Africa including Tanzania, thus resulting in a generally poor prognosis. The reason for this sad experience is not known. This study was undertaken in our local setting, to describe the stage at presentation and factors associated with late diagnosis of head and neck malignancies at Bugando Medical Centre, Mwanza, Tanzania. Methods: This was analytical cross sectional study involving all patients confirmed to have head and neck malignances at Bugando Medical Center from February to June 2019. Results: Out of 60 patients enrolled in the study, 35(58.3%) were males and 25(41.7%) were female making a male to female of 1.4:1. The mean age was 56 [range, 12-89] years. Majority of patients, 44(73.3%) presented with advanced (late) stage of the disease, with stage III been the most prevalent stage accounting for 49.3% of cases. Only one (1.7%) patient had stage I tumor involving the oral cavity. Distant metastasis was documented in only 16.7% of cases. The oropharynx was the most common anatomical site for head and neck malignancies (n=18, 30%). Patients with oropharyngeal malignancies were associated with late-stage presentation whereas those with laryngeal malignancies were associated with early-stage presentation. Patient-related factors such as rural residence (p-value = 0.048) and use of local herbs (p-value = 0.001) were significantly associated with advanced (late) tumor stage at presentation. The level of health care facility first visited (p-value = 0.876) and the number of referrals (p-value =0.579) were not significantly associated with late stage at presentation. Conclusion: This study demonstrated that the head and neck malignancies are not uncommon at Bugando Medical Center and the majority of patients present late with advanced stage cancer. Therefore, increasing awareness among rural residence regarding head and neck malignancies and their symptoms, and training ......

Associations between depression and cancer risk among patients with diabetes mellitus: A population-based cohort study.

The co-occurrence of depression and diabetes mellitus has been linked to an increased risk of developing cancer. This study aimed to investigate whether depression further amplifies the risk of cancer among individuals with diabetes. This population-based matched cohort study utilized Taiwan's National Health Insurance claims database. A total of 85,489 newly diagnosed diabetic patients with depressive disorders were selected, along with 427,445 comparison subjects. The matching process involved age, sex, and the calendar year of diabetes onset. The average follow-up duration for the two cohorts was 6.4 and 6.5 years, respectively. The primary outcome of interest was the occurrence of overall cancer or cancer at specific anatomical sites. The adjusted hazard ratios for overall cancer incidence were 1.08 (95% CI, 1.05-1.11). For site-specific cancers, depression exhibited significant associations with oropharyngeal, esophageal, liver, gynecological, prostate, kidney, and hematologic malignancies among patients with diabetes. Notably, a severity-response relationship was observed, indicating that patients with recurrent episodes of major depressive disorders exhibited a higher incidence of cancer compared to those diagnosed with dysthymia or depressive disorder not otherwise specified. Furthermore, the strength of the association between depression and cancer risk was more pronounced among younger patients with diabetes as opposed to older adults. However, no significant relationship was observed between adherence to antidepressant treatment and cancer risk. The findings of this study indicate a significant association between depression and an elevated risk of cancer among individuals diagnosed with diabetes. Future investigations should replicate our findings, explore the effects of pharmacological and non-pharmacological treatments on cancer risk, and identify the underlying mechanisms.

“If I had a robot.”

Optimal case selection is critical to success in any robotic surgical treatment plan. In the Western world, transoral robotic surgery (TORS) is often employed as a de-escalation strategy in the evolving treatment of HPV-associated oropharyngeal malignancies. Since the orator trials [1,2] endorsed an overall superiority of radiotherapy for treating oropharyngeal cancers, there has been growing skepticism about its rampant and indiscriminate use in head and neck cancers. The current perspective article positions TORS in its evidence base and calibrates it to our routine practice.