Publications by authors named "Kerry D Olsen"

108 Publications

Transoral endoscopic vestibular approach for thyroidectomy and parathyroidectomy - From promise to practice.

Am J Otolaryngol 2021 Mar 31;42(5):103022. Epub 2021 Mar 31.

A.R.M. Center of Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel.

Objectives: To describe the evolution and recent series on transoral endoscopic vestibular approach thyroidectomy and parathyroidectomy (TOET/PVA).

Data Sources: PubMed, Google Scholar.

Review Methods: Review of the available English literature.

Results: TOET/PVA may offer several advantages over other remote access thyroidectomy approaches and has been adopted by many centers worldwide with excellent success rates. Indications include benign disease and early thyroid cancer patients. Complication rate is comparable to the trans-cervical approach. The suggested framework has been validated in recent studies and its feasibility confirmed.

Conclusion: TOET/PVA has now been used to treat thousands of patients worldwide due to low cost, short learning curve and excellent cosmetic outcomes. Further studies will be necessary to demonstrate oncologic non-inferiority and also the true value that is added by the approach.
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http://dx.doi.org/10.1016/j.amjoto.2021.103022DOI Listing
March 2021

High-grade Transformation/Dedifferentiation in Salivary Gland Carcinomas: Occurrence Across Subtypes and Clinical Significance.

Adv Anat Pathol 2021 May;28(3):107-118

International Head and Neck Scientific Group, Padua, Italy.

High-grade transformation (HGT) or dedifferentiation has been described in a variety of salivary gland carcinomas, including acinic cell carcinoma, secretory carcinoma, adenoid cystic carcinoma, epithelial-myoepithelial carcinoma, polymorphous adenocarcinoma, low-grade mucoepidermoid carcinoma, and hyalinizing clear cell carcinoma. High-grade (HG) transformed tumors are composed of a conventional low-grade component characterized by specific microscopic and immunohistochemical features for the given entity, intermingled with or juxtaposed to areas of HG morphology. This is usually either poorly differentiated adenocarcinoma, carcinoma not otherwise specified, or undifferentiated carcinoma, in which the original line of differentiation is lost. The HG component is composed of solid nests of anaplastic cells with large vesicular pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. Frequent mitoses and extensive necrosis may be present. The Ki-67 labeling index is consistently higher in the HG component. The molecular genetic mechanisms responsible for HGT of salivary gland carcinomas are largely unknown, though p53 inactivation and human epidermal growth factor receptor 2 overexpression and/or gene amplification have been demonstrated in the HG component in a few examples, the frequency varies for each histologic type. Salivary gland carcinomas with HGT are more aggressive than conventional carcinomas, with a higher local recurrence rate and a poorer prognosis. They have a high propensity for cervical lymph node metastasis suggesting a need for a wider resection and neck dissection. HGT of salivary gland carcinoma can occur either at initial presentation or less commonly at the time of recurrence, sometimes following postoperative radiotherapy. The potential for HGT in almost any type of salivary gland carcinoma warrants a thorough sampling of all salivary gland malignancies to prevent oversight of a HG component.
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http://dx.doi.org/10.1097/PAP.0000000000000298DOI Listing
May 2021

Occlusion of the internal jugular vein in differentiated thyroid carcinoma: Causes and diagnosis.

Eur J Surg Oncol 2021 Feb 22. Epub 2021 Feb 22.

International Head and Neck Scientific Group, Padua, Italy.

Occlusion of the internal jugular vein (IJV) can be observed in thyroid cancer either on preoperative imaging with ultrasound or cross-sectional imaging, particularly contrast-enhanced CT-scan, and can be detected during follow-up when using these same imaging modalities. For thyroid cancer, four different causes of occlusion of the IJV can be identified: venous thrombosis associated with a hypercoagulable state, tumor thrombus in the vein, compression or invasion of the IJV by thyroid disease or lymph node metastases, and fibrotic collapse of the IJV following lateral neck dissection. Clinicians managing patients with thyroid cancer need to be aware of and able to diagnose each of these conditions. The overall patient impact and appropriate management of each will be discussed.
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http://dx.doi.org/10.1016/j.ejso.2021.02.021DOI Listing
February 2021

Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland.

Head Neck 2021 Apr 4;43(4):1088-1096. Epub 2020 Dec 4.

Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Background: Recurrent pleomorphic adenoma (PA) can be a lifelong disease, and rates of subsequent recurrence are high.

Methods: Patients between 2000 and 2015 were identified. Primary outcome was subsequent recurrence after surgical salvage.

Results: Twenty-seven of 84 patients developed a subsequent recurrence. Risk factors for subsequent recurrence included a higher number of previous recurrences (P < .01), worse preoperative facial nerve function (P < .01), and deep parotid lesion(s) (P < .01). Interval since last surgery was protective (P < .01), specifically >10 years since last surgery (P < .01). For patients with a >10-year interval since their last surgery, the subsequent recurrence-free rate at 10 years follow-up was 80.2% vs 31.8%.

Conclusions: For patients presenting with a >10-year interval since their last surgery, subsequent recurrence rates are low, which may allow for as needed surveillance recommendations. For patients presenting with recurrent PA and ≤10 years since their last surgery, a closer surveillance is warranted.
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http://dx.doi.org/10.1002/hed.26570DOI Listing
April 2021

Management of the Neck in Well-Differentiated Thyroid Cancer.

Curr Oncol Rep 2020 Nov 14;23(1). Epub 2020 Nov 14.

International Head and Neck Scientific Group, Padua, Italy.

Purpose Of Review: In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer.

Recent Findings: Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
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http://dx.doi.org/10.1007/s11912-020-00997-6DOI Listing
November 2020

Prognostic role of intraparotid lymph node metastasis in primary parotid cancer: Systematic review.

Head Neck 2021 Mar 9;43(3):997-1008. Epub 2020 Nov 9.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Background: The prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear.

Methods: Nineteen retrospective and noncomparative cohort studies, published between 1992 and 2020, met the inclusion criteria and included 2202 patients for this systematic review.

Results: The pooled prevalence of the P in adult patients in the unselected studies was 24.10% (95% confidence interval = 17.95-30.25). The number of P+ lymph nodes per patient was counted in only three studies and ranged from 1 to 11. The 5-year recurrence-free survival rate based on Kaplan-Meier analysis varied from 83% to 88% in P- patients compared to 36% to 54% in P+ patients. The average hazard ratio for tumor recurrence in patients with P+ compared to P- was 2.67 ± 0.58.

Conclusions: P+ is an independent negative prognostic factor in primary parotid gland cancer and should be included into the treatment planning.
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http://dx.doi.org/10.1002/hed.26541DOI Listing
March 2021

Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma.

Head Neck 2021 Feb 12;43(2):419-427. Epub 2020 Oct 12.

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Background: In patients presenting with recurrent pleomorphic adenoma (rPA), clinical evaluation can fail to recognize carcinoma ex PA (cxPA). We aim to identify the risk factors for cxPA.

Methods: This is a single institution retrospective case-control study from 2000 to 2015. CxPA was diagnosed based on surgical pathology. Demographics, clinical, and social histories were collected.

Results: A number of 13/106 (12.3%) patients were diagnosed with cxPA, of which only 4/13 (31%) had clinical features suspicious for malignancy. Compared to benign rPA, factors associated with cxPA included age >50 (odds ratio [OR] 6.67, 95% confidence interval [CI]: 1.71-25.98, P < .01), >10 pack-years of smoking history (OR 3.36, 95% CI: 1.01-11.14, P = .04), and the largest tumor being >2 cm on pathology (OR 4.42, 95% CI: 1.14-17.10, P = .03).

Conclusions: In patients presenting with rPA, risk factors for malignant transformation include age >50, significant smoking history, and tumors larger than 2 cm. Clinical signs of malignancy such as rapid growth or pain are not always present.
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http://dx.doi.org/10.1002/hed.26489DOI Listing
February 2021

Case for staged thyroidectomy.

Head Neck 2020 10 6;42(10):3061-3071. Epub 2020 Aug 6.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Recent modifications in the management of well-differentiated thyroid cancer have resulted in significant alterations in clinical approach. Utilizing a series of preoperative and postoperative risk factors involving both the patient and the disease pathology, we offer the term "staged thyroidectomy" to help organize these risk factors for patients and the endocrine team to optimize management. This approach is intended to incorporate our latest nuanced understanding of certain endocrine pathology and may serve to optimize patient outcomes.
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http://dx.doi.org/10.1002/hed.26393DOI Listing
October 2020

Papillary Thyroid Cancer-Aggressive Variants and Impact on Management: A Narrative Review.

Adv Ther 2020 07 1;37(7):3112-3128. Epub 2020 Jun 1.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Introduction: Aggressive variants of papillary thyroid cancer (PTC) have been described with increasing frequency. These variants include diffuse sclerosing variant, tall cell variant, columnar cell variant, solid variant, and hobnail variant.

Methods: We have performed a review of the more aggressive variants of PTC with respect to main characteristics, histological and molecular features, and the consequences that the knowledge of these variants should have in the treatment of the patients.

Results: At the present time, we do not know the prognostic value of these aggressive PTC variants. The extent of the surgical treatment and adjuvant therapy necessary should be decided on the basis of the extent of the tumor at presentation and the opinion of experienced clinicians.

Conclusion: These aggressive variants should be known by clinicians, to avoid underdiagnosis, and treated according to the latest recommendations in the literature.
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http://dx.doi.org/10.1007/s12325-020-01391-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467416PMC
July 2020

Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review.

Cancers (Basel) 2020 Apr 24;12(4). Epub 2020 Apr 24.

International Head and Neck Scientific Group, 35100 Padua, Italy.

Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved.

Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis.

Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4-23.4) and 8.0% (95% CI 2.7-13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0-6.1%), 2.0% (95% CI 0.9-3.1) and 0.4% (95% CI 0-1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0-1.3).

Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3-4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
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http://dx.doi.org/10.3390/cancers12041059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225965PMC
April 2020

Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline.

Eur Arch Otorhinolaryngol 2020 Jul 8;277(7):1855-1874. Epub 2020 Apr 8.

International Head and Neck Scientific Group, Padua, Italy.

Purpose: Facial nerve electrodiagnostics is a well-established and important tool for decision making in patients with facial nerve diseases. Nevertheless, many otorhinolaryngologist-head and neck surgeons do not routinely use facial nerve electrodiagnostics. This may be due to a current lack of agreement on methodology, interpretation, validity, and clinical application. Electrophysiological analyses of the facial nerve and the mimic muscles can assist in diagnosis, assess the lesion severity, and aid in decision making. With acute facial palsy, it is a valuable tool for predicting recovery.

Methods: This paper presents a guideline prepared by members of the International Head and Neck Scientific Group and of the Multidisciplinary Salivary Gland Society for use in cases of peripheral facial nerve disorders based on a systematic literature search.

Results: Required equipment, practical implementation, and interpretation of the results of facial nerve electrodiagnostics are presented.

Conclusion: The aim of this guideline is to inform all involved parties (i.e. otorhinolaryngologist-head and neck surgeons and other medical specialists, therapeutic professionals and the affected persons) and to provide practical recommendations for the diagnostic use of facial nerve electrodiagnostics.
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http://dx.doi.org/10.1007/s00405-020-05949-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286870PMC
July 2020

"Filler-ins" to Physicians: History of the Otolaryngology Training Program at Mayo Clinic.

Mayo Clin Proc Innov Qual Outcomes 2020 Feb 8;4(1):76-89. Epub 2020 Jan 8.

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN.

The first officially recognized otolaryngology resident at Mayo Clinic started training in 1908. In the following years, the residency program evolved through emerging national standards and regulations for medical education, declining and resurgent interest in the specialty, and radical changes in otolaryngology as a practice. This article details the growth of the Mayo Clinic otolaryngology residency program, often in the words of the pioneering physicians involved in the process, from "filler-ins" for the staff to today's nationally recognized program.
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http://dx.doi.org/10.1016/j.mayocpiqo.2019.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010977PMC
February 2020

Thyroid Surgery: Whose Domain Is It?

Adv Ther 2019 10 10;36(10):2541-2546. Epub 2019 Aug 10.

International Head and Neck Scientific Group, Padua, Italy.

In the United States of America (US), most departments of otorhinolaryngology head and neck surgery have been performing thyroid surgery for many years. In contrast to the US, thyroid surgery is still dominated by general surgeons in most European countries. In numerous university centers, there continues to be friction regarding thyroid surgery. The focus of this editorial is to demonstrate that there is objective data in the literature to suggest that otorhinolaryngologists with appropriate training in head and neck surgery are well suited to perform the entire spectrum of thyroid surgery. The question of who is qualified to perform thyroid surgery is not determined by the basic specialty certification of the surgeon-general or otolaryngology; rather it depends on the training, skill and experience in surgery of the neck, of post-surgical and post-irradiated necks, and of neighboring structures.
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http://dx.doi.org/10.1007/s12325-019-01048-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822823PMC
October 2019

Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus-Associated Oropharynx Squamous Cell Carcinoma.

J Clin Oncol 2019 08 4;37(22):1909-1918. Epub 2019 Jun 4.

1Mayo Clinic, Rochester, MN.

Purpose: The purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL).

Patients And Methods: MC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL.

Results: Accrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement.

Conclusion: Aggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.
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http://dx.doi.org/10.1200/JCO.19.00463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098832PMC
August 2019

Management of the facial nerve in parotid cancer: preservation or resection and reconstruction.

Eur Arch Otorhinolaryngol 2018 Nov 28;275(11):2615-2626. Epub 2018 Sep 28.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Purpose: Management of the facial nerve is instrumental in the surgical treatment of parotid cancer.

Methods: A literature search was conducted using PubMed and ScienceDirect database. A total of 195 articles were finally included into the analysis, based on relevance, scientific evidence and actuality.

Results: In the majority of cases the facial nerve is not involved by tumor. In these cases, identification and preservation of the nerve, in addition to complete tumor removal, are essential for successful surgery. When the nerve is infiltrated by tumor, the affected portion of the nerve must be resected as part of radical parotidectomy. Primary nerve reconstruction or other reanimation techniques give the best long-term functional and cosmetic results. A comprehensive diagnostic evaluation with current imaging and electrophysiological studies will provide the surgeon with the best knowledge of the relationship of the facial nerve to the tumor. Several standardized methods are helpful in finding, dissecting and preserving the nerve during parotid cancer surgery. When radical parotidectomy is indicated, the initial diagnostic work-up can assist in defining the need for adjuvant postoperative therapy and facial reanimation. The aim of rehabilitation is to restore tone, symmetry, and movement to the paralyzed face.

Conclusions: The surgical management of facial paralysis has undergone many improvements in recent years. This review gives an overview of recent advances in the diagnostic work-up, surgical techniques and any necessary rehabilitation of the facial nerve in parotid cancer surgery.
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http://dx.doi.org/10.1007/s00405-018-5154-6DOI Listing
November 2018

Transoral robotic surgery for oropharyngeal carcinoma: Surgical margins and oncologic outcomes.

Head Neck 2018 04 12;40(4):747-755. Epub 2018 Jan 12.

Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota.

Background: This study presents oncologic outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal squamous cell carcinoma (SCC).

Methods: Three hundred fourteen patients undergoing TORS ± adjuvant therapy for oropharyngeal SCC from May 1, 2007, to May 31, 2015, are analyzed.

Results: Median follow-up was 3.3 years (interquartile range [IQR] 1.8-5.3 years; range 1 day to 9.3 years). Estimated locoregional recurrence-free survival, distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) rates (95% confidence interval [CI] number still at risk) at 5 years after surgery were 92% (88-95; 92), 90% (86-94; 92), 86% (82-92; 98), and 94% (91-97; 98), respectively. Negative margins were achieved in 98% of cases. The adult comorbidity evaluation (ACE)-27 comorbidity index, human papillomavirus (HPV) status, pathologic N classification, and number of attempts to clear margins were associated with death due to cancer (P = .003, P = .002, P = .030, and P = .002, respectively).

Conclusion: The need to take ≥2 margins to achieve resection portends an increased risk of locoregional recurrence and death due to disease in oropharyngeal SCC.
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http://dx.doi.org/10.1002/hed.25055DOI Listing
April 2018

Improving Resiliency in Healthcare Employees.

Am J Health Behav 2018 01;42(1):39-50

DeDepartment of General Internal Medicine and Complementary and Integrative Medicine, Mayo Clinic, Rochester, MN, USA.

Objectives: The high prevalence of stress at the workplace has been well documented; however, few studies have investigated the efficacy of worksite resiliency programs. Therefore, the objec- tive of this project was to examine the impact of a worksite resilience training program on improving resiliency and health behaviors in healthcare employees.

Methods: Between 2012 and 2016, 137 adult wellness center members of a healthcare institution participating in a single-arm cohort study of a 12-week resiliency training program were assessed at baseline, end of intervention, and at 3-month follow-up.

Results: Statistically significant (p ≤ .01) improvements were seen at the end of the intervention and extending to 3 months follow-up for resiliency, perceived stress, anxiety level, quality of life, and health behaviors.

Conclusions: These results support the premise that worksite programs designed to improve resiliency in healthcare employees have efficacy in improving resiliency, quality of life and health behaviors. Given the importance of stress and burnout in healthcare employees, future randomized studies are warranted to determine more clearly the impacts of this type of resiliency intervention for improving the wellness of healthcare workers.
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http://dx.doi.org/10.5993/AJHB.42.1.4DOI Listing
January 2018

Challenges Facing the Aging Surgeon.

Authors:
Kerry D Olsen

Mayo Clin Proc 2017 12 15;92(12):1741-1742. Epub 2017 Nov 15.

Joseph I. and Barbara J. Ashkins Professor of Surgery Division of Medical Otolaryngology Mayo Clinic Rochester, MN. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2017.10.002DOI Listing
December 2017

Deep lobe parotidectomy-why, when, and how?

Eur Arch Otorhinolaryngol 2017 Dec 12;274(12):4073-4078. Epub 2017 Oct 12.

International Head and Neck Scientific Group, Padua, Italy.

This editorial explores the controversies concerning the surgical management of the deep portion of the parotid gland. Specifically, when should the parotid deep lobe be removed if there is metastatic cancer to a superficial parotid node or when a primary aggressive cancer is found in the superficial lobe? The background, indications, rationale, and results of removing the deep lobe nodes are reviewed. Removal of the deep lobe is done to optimize the oncologic outcome for the patient. Deep lobe parotidectomy plays an important role in the treatment of many parotid gland malignancies.
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http://dx.doi.org/10.1007/s00405-017-4767-5DOI Listing
December 2017

Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery.

Otolaryngol Head Neck Surg 2017 07 4;157(1):69-76. Epub 2017 Apr 4.

1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.

Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery-based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days-6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery-based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.
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http://dx.doi.org/10.1177/0194599817696304DOI Listing
July 2017

Risk of Delayed Lymph Node Metastasis in Clinically N0 Esthesioneuroblastoma.

J Neurol Surg B Skull Base 2017 Feb 6;78(1):68-74. Epub 2016 Jul 6.

Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States.

 To determine both the rate of delayed cervical lymph node metastasis in patients with esthesioneuroblastoma (ENB) and a clinically N0 untreated neck and the effectiveness of salvage treatment.  Retrospective review.  Tertiary academic medical center.  All patients from January 1, 1965, to December 31, 2010, who received definitive treatment for ENB.  The study involved 52 patients: 27 (52%) patients underwent surgery and adjuvant radiotherapy (SART) to the primary site only and 25 (48%) underwent surgery alone (SA) as treatment of the primary site, without elective neck dissection.  Median follow-up for the SART group was 10 years versus 15.7 years for the SA group. The 10-year delayed cervical lymph node metastasis estimate is 41%. With median follow-up of 47 months after salvage treatment, the 4-year cervical lymph node recurrence-free survival estimate is 70%; the 5-year overall survival estimate is 39%.  Delayed cervical lymph node metastases are common, indolent, and salvaged effectively in most patients. We propose that patients with ENB and clinically N0 cervical lymph nodes may choose to forego elective neck dissection or elective neck radiotherapy in favor of neck observation within their initial treatment.
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http://dx.doi.org/10.1055/s-0036-1584904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288109PMC
February 2017

The History of Otorhinolaryngology at Mayo Clinic.

Mayo Clin Proc 2017 Feb;92(2):e25-e45

Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2016.11.010DOI Listing
February 2017

Scapular flap for maxillectomy defect reconstruction and preliminary results using three-dimensional modeling.

Laryngoscope 2017 01 12;127(1):E8-E14. Epub 2016 Oct 12.

Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.

Objectives/hypothesis: Discuss current techniques utilizing the scapular tip and subscapular system for free tissue reconstruction of maxillary defects and highlight the impact of medical modeling on these techniques with a case series.

Study Design: Case review series at an academic hospital of patients undergoing maxillectomy + thoracodorsal scapula composite free flap (TSCF) reconstruction. Three-dimensional (3D) models were used in the last five cases.

Methods: 3D modeling, surgical, functional, and aesthetic outcomes were reviewed.

Results: Nine patients underwent TSCF reconstruction for maxillectomy defects (median age = 43 years; range, 19-66 years). Five patients (55%) had a total maxillectomy (TM) ± orbital exenteration, whereas four patients (44%) underwent subtotal palatal maxillectomy. For TM, the contralateral scapula tip was positioned with its natural concavity recreating facial contour. The laterally based vascular pedicle was ideally positioned for facial vessel anastomosis. For subtotal-palatal defect, an ipsilateral flap was harvested, but inset with the convex surface facing superiorly. Once 3D models were available from our anatomic modeling lab, they were used for intraoperative planning of the last five patients. Use of the model intraoperatively improved efficiency and allowed for better contouring/plating of the TSCF. At last follow-up, all patients had good functional outcomes. Aesthetic outcomes were more successful in patients where 3D-modeling was used (100% vs. 50%). There were no flap failures. Median follow-up >1 month was 5.2 months (range, 1-32.7 months).

Conclusions: Reconstruction of maxillectomy defects is complex. Successful aesthetic and functional outcomes are critical to patient satisfaction. The TSCF is a versatile flap. Based on defect type, choosing laterality is crucial for proper vessel orientation and outcomes. The use of internally produced 3D models has helped refine intraoperative contouring and flap inset, leading to more successful outcomes.

Level Of Evidence: 4. Laryngoscope, 127:E8-E14, 2017.
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http://dx.doi.org/10.1002/lary.26351DOI Listing
January 2017

Pediatric malignant salivary gland tumors: 60 year follow up.

Int J Pediatr Otorhinolaryngol 2016 Sep 4;88:1-6. Epub 2016 Jun 4.

Mayo Clinic Department of Otorhinolaryngology, Head and Neck Surgery, 200 First St SW, Rochester, MN, 55905, USA. Electronic address:

Objective: To evaluate the presentation, treatments and outcomes in pediatric patients with salivary gland malignancies.

Study Design: Retrospective chart review (1950-2012), Prospective phone interview.

Methods: Patients ≤18 years old with a salivary gland malignancy treated at our institution were identified. Patients were also contacted by phone for a follow up survey.

Results: Fifty-six patients were identified. Tumor origin was 88% parotid (n = 49), 5% (n = 3) submandibular and 7% (n = 4) minor salivary glands. Time from onset of symptoms to diagnosis was over one year (mean = 14.4 years). Fifteen out of 52 patients with major gland malignancy had a locoregional recurrence and local recurrences were almost all after initial enucleation. Two of these patients died of disease (overall disease specific survival = 96%). Three out of 4 patients with minor gland malignancy had a local recurrence and two patients with high grade pathology developed metastases and died of their disease (overall survival = 50%). On long term follow up survey in 13 patients (25%), 100% reported normal facial movement and 54% described symptoms of Frey's syndrome, which is higher than other reported series in children. Recurrence was noted up to 45 years after initial treatment.

Conclusions: The majority of malignant pediatric salivary gland tumors are low grade and have excellent survival, especially if found at an early stage. Minor salivary gland malignancies, particularly high grade, have a worse prognosis. Long term mild Frey's syndrome can be expected in approximately half of patients. We advocate a need for long term follow up and increased awareness among providers to diagnose these patients earlier.
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http://dx.doi.org/10.1016/j.ijporl.2016.05.021DOI Listing
September 2016

High Stress and Negative Health Behaviors: A Five-Year Wellness Center Member Cohort Study.

J Occup Environ Med 2016 09;58(9):868-73

Department of Psychiatry and Psychology (Drs Clark, Vickers Douglas); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (Ms Jenkins); Division of Preventive, Occupational, and Aerospace Medicine, Department of Internal Medicine (Ms Hagen); Dan Abraham Healthy Living Center, Mayo Clinic, Rochester (Ms Riley, Ms Eriksen, Ms Heath, Ms Werneburg, Dr Olsen); StayWell, St. Paul (Ms Eriksen); Division of Cardiovascular Diseases (Dr Lopez-Jimenez); Division of General Internal Medicine (Dr Sood); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Benzo); and Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota (Dr Olsen).

Objective: The aim of this study was to examine the association between having a high stress level and health behaviors in employees of an academic medical center.

Methods: Beginning January 1, 2009, through December 31, 2013, an annual survey was completed by 676 worksite wellness members.

Results: Each year, about one-sixth of members had a high stress level, high stress individuals visited the wellness center less often, and most years there was a significant relationship (P < 0.05) between stress level and poor physical health behaviors (physical activity level and confidence, strength, climbing stairs), low mental health (quality of life, support, spiritual well-being and fatigue), poor nutritional habits (habits and confidence), and lower perceived overall health.

Conclusions: High stress is associated with negative health behavior, and future studies, therefore, should explore strategies to effectively engage high stress employees into comprehensive wellness programs.
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http://dx.doi.org/10.1097/JOM.0000000000000826DOI Listing
September 2016

Transoral robotic surgery in the seated position: Rethinking our operative approach.

Laryngoscope 2017 01 5;127(1):122-126. Epub 2016 Jul 5.

Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.

Objectives/hypothesis: Transoral surgery (TOS) is commonly performed in a supine patient with an oral retractor. Paradoxically, this strategy can create difficulty with visualizing and accessing pathology at the base of tongue, inferior pharynx, and larynx. We investigate the feasibility of TOS with the patient in the seated position.

Study Design: Pilot study.

Methods: TOS utilizing the da Vinci Robotic Surgical Xi and Si systems (Intuitive Surgical, Sunnyvale, CA) was performed on a fresh cadaver placed in both the traditional supine position and the seated position. Transoral robotic surgery (TORS) in the seated position was then performed on two patients for a supraglottic laryngectomy and a hypopharyngeal carcinoma resection.

Results: Visualization of the entire upper aerodigestive tract was possible in the cadaver and two patients in the seated position. The Si was superior for docking, instrumentation, and assistant access. The minimum operating table height is critical for successful access. Advantages of this position included increased posterior airway/operative space by approximately 2 cm, ability to manipulate the surgical field (nonrigid retraction), and improved visualization. Surgical procedures were completed in comparable times compared with standard TORS procedures. There were no complications related to seated TORS.

Conclusions: TORS in the seated position was both safe and effective in this pilot study. It allows the surgeon to optimally operate in the inferior pharynx and larynx without the limitation of line of site access and visualization. A paradigm shift in patient positioning during TOS may allow improved surgical access and even greater patient candidacy. Further clinical investigation into this technique is warranted.

Level Of Evidence: NA Laryngoscope, 127:122-126, 2017.
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http://dx.doi.org/10.1002/lary.26148DOI Listing
January 2017

Preoperative diagnosis of vagal and sympathetic cervical schwannomas based on radiographic findings.

J Neurosurg 2017 Mar 22;126(3):690-697. Epub 2016 Apr 22.

Departments of 1 Neurologic Surgery.

OBJECTIVE Vagus nerve and sympathetic chain cervical schwannomas (VNCSs and SCCSs) are benign nerve sheath tumors that arise in the head and neck. Despite similar presentations that make accurate preoperative diagnosis more difficult, the potential for morbidity following resection is significantly higher for patients with VNCS. Therefore, the authors analyzed a retrospective case series and performed a comparative analysis of the literature to establish diagnostic criteria to facilitate more accurate preoperative diagnoses. METHODS The authors conducted a blinded review of imaging studies from retrospectively collected, operatively confirmed cases of VNCS and SCCS. They also performed a systematic review of published series that reported patient-specific preoperative imaging findings in VNCS or SCCS. RESULTS Nine patients with VNCS and 11 with SCCS were identified. In the study cohort, splaying of the internal carotid artery (ICA) and internal jugular vein (IJV) did not significantly predict the nerve of origin (p = 0.06); however, medial and lateral ICA displacement were significantly associated with VNCS and SCCS, respectively (p = 0.01 and p = 0.003, respectively). Multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carried an 86% probability of VNCS (p = 0.001), while the absence of splaying with lateral ICA displacement carried a 91% probability of SCCS (p = 0.006). The presence of vocal cord symptoms or peripheral enhancement significantly augmented the predictive probability of VNCS, as did Horner's syndrome or homogeneous enhancement for SCCS. A review of the literature produced 25 publications that incorporated a total of 106 patients, including the present series. Splaying of the ICA and IJV was significantly, but not uniquely, associated with VNCS (p < 0.0001); multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carries a 75% probability of VNCS (p < 0.0001), while the absence of such splaying with lateral ICA displacement carries an 87% probability of SCCS (p = 0.0003). CONCLUSIONS ICA and IJV splaying frequently predicts VNCS; however, this finding is also commonly observed in SCCS and, among the 9 cases in the present study, was observed more often than previously reported. When congruent with splaying, medial or lateral ICA displacement significantly enhances the reliability of preoperative predictions, empowering more accurate prognostication.
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http://dx.doi.org/10.3171/2016.1.JNS151763DOI Listing
March 2017

High-grade transformation of acinic cell carcinoma: an inadequately treated entity?

Oral Surg Oral Med Oral Pathol Oral Radiol 2016 May 21;121(5):542-549.e1. Epub 2016 Jan 21.

Division of Anatomic Pathology, Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, Rochester, MN, USA.

Objective: Acinic cell carcinoma (AcCC) is an uncommon salivary gland malignancy. We aim to characterize the clinical and pathologic characteristics of AcCC with and without high-grade transformation (HGT). Importantly, cases of mammary analogue secretory carcinoma, a recently described histologic mimic of AcCC, have been excluded by using cytogenetics and molecular studies.

Study Design: Archival surgical pathology material was obtained for patients diagnosed with AcCC at Mayo Clinic Rochester between 1990 and 2010. Tumors harboring the ETV6-NTRK3 fusion transcript were excluded from analysis by using cytogenetics and molecular studies. Tumors with HGT were characterized by areas with an infiltrative growth pattern, nuclear anaplasia, prominent nucleoli, brisk mitotic activity, geographic necrosis, and stromal desmoplasia. Demographic and clinical data were extracted from the medical records.

Results: AcCC with HGT was seen in 8 of 48 cases (17%). Patients with AcCC with HGT were significantly older than patients without HGT (median 69 vs 54 years; P = .04). Angiolymphatic invasion was more common in AcCC with HGT (P = .02). Relapse-free survival and overall survival were significantly worse for cases of AcCC with HGT (hazard ratio 10.4 and 9.3, respectively; P < .0001 for both comparisons). Locoregional recurrence-free survival was not significantly different (P = .12), but distant metastases-free survival was significantly worse in patients with HGT compared with non-HGT patients (P < .0001).

Conclusions: Prognosis for overall survival and distant relapse for AcCC patients with HGT is significantly worse than that for patients without HGT.
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http://dx.doi.org/10.1016/j.oooo.2016.01.011DOI Listing
May 2016

Development and Impact of a Worksite Wellness Champions Program.

Am J Health Behav 2016 Mar;40(2):215-20

Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN, USA.

Objectives: Wellness champions have potential to be a high-reach, low-cost intervention for improving employee health, but research is needed to support this premise. Therefore, this project assessed the impact of a worksite wellness champions program at a large integrated healthcare organization.

Methods: A total of 2315 employees responded (56% response rate) to a survey.

Results: Program participants (N = 666) were more likely to agree that the organization provides a supportive environment to live a healthy lifestyle (82.7% vs 69.4%, p < .001), more likely to agree co-workers support one another in practicing a healthy lifestyle (76.8% vs 53.7%, p < .001), and to rate their overall health and wellness higher (p < .005) compared to those not familiar with the wellness champions program (N = 675).

Conclusions: Employees participating in wellness champion activities have increased their awareness of wellness opportunities, feel supported for having a healthy lifestyle, and rate their perceived health and wellness higher.
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http://dx.doi.org/10.5993/AJHB.40.2.6DOI Listing
March 2016

HPV vaccination to prevent oropharyngeal carcinoma: What can be learned from anogenital vaccination programs?

Oral Oncol 2015 Dec 29;51(12):1057-60. Epub 2015 Oct 29.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Human papillomavirus (HPV) infections are well known causes of anogenital cancers. Recent studies show that HPV also plays a role in oropharyngeal cancer (OPC). A review on the role of HPV vaccination in the prevention of head and neck squamous cell carcinoma (HNSCC) with special emphasis on OPC was conducted and available vaccines and vaccination strategies in HNSCC and OPC are discussed. Prophylactic vaccination is known to be effective for prevention of anogenital HPV infection and precursor lesions in the cervix and anus. While the value of vaccination for prevention of OPC and possibly as an adjuvant treatment is still an open question, evidence to date supports the possibility that HPV vaccination may prove to be effective in reducing the incidence of this malignancy.
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http://dx.doi.org/10.1016/j.oraloncology.2015.10.011DOI Listing
December 2015