No abstract

Background Outcomes following surgical intervention for laryngeal and hypopharyngeal tumors are dependent on several factors. In the present study, we sought to determine whether tumor subsite, salvage status, and extent of resection influenced postoperative outcomes. Methods Retrospective review of 107 patients at a single institution who underwent total laryngectomy or partial/total laryngopharyngectomy. Results Hypopharyngeal subsite and total laryngopharyngectomy subgroups had inferior speech and swallow outcomes compared to their respective cohorts (P < .05). Salvage patients had inferior 3‐year overall survival (P < .05) and swallow outcomes (P < .001). Previously radiated patients had increased fistula rates (29.9% vs 10%, P = .02), and the use of tissue coverage in salvage total laryngectomy had a protective effect on fistula formation (10% vs 37%, P = .04). Conclusions By stratifying patients across multiple subgroups, we provide a detailed narrative in surgical outcomes that can be incorporated into treatment planning. Further prospective studies are needed to compare surgical outcomes to those of organ preservation therapy.

A prospective randomized controlled pilot study was performed to determine if video self-assessment improves competency in mastoidectomy and to assess interrater agreement between expert and resident evaluations of recorded mastoidectomy. Sixteen otolaryngology residents were recorded while performing cadaveric mastoidectomy and randomized into video self-assessment and control groups. All residents performed a second recorded mastoidectomy. Performance was evaluated by blinded experts with a validated assessment scale. Video self-assessment did not lead to greater skill improvement between the first and second mastoidectomy. Interrater agreement was fair to substantial between the expert evaluators and between resident self-evaluations by recall and video review. Agreement between experts and residents was only slight to fair; residents consistently rated their performance higher than experts (P < .05). In conclusion, 1 session of video self-review did not lead to improved competence in mastoidectomy over standard practice. While experts agree on assessments, residents may overestimate their competency in performing cadaveric mastoidectomy.

Objective: Tyrosine kinase inhibitors (TKIs) are a class of systemic chemotherapy used in patients with radioactive iodine-refractory metastatic thyroid cancer. TKIs have been linked with impaired wound healing, but their association with upper aerodigestive tract complications is not well defined. The objective of this case series was to demonstrate that upper aerodigestive tract complications can occur in thyroid cancer patients receiving TKIs.Methods: A retrospective chart review was conducted on 3 cases involving patients with stage IV differentiated or medullary thyroid cancer treated between the years from 2000 to 2015. Each patient received surgical management, external beam radiation therapy, and subsequent TKI therapy and they also developed upper aerodigestive tract complications during their clinical course.Results: Patient 1 received TKIs for radioactive iodine-refractory pulmonary metastases and developed a tracheoesophageal fistula 1 year after initiation of chemotherapy. Patient 2 received TKIs for pulmonary metastases and developed a tracheoesophageal fistula several months after initiation of chemotherapy. Patient 3 was placed on TKIs for progressive metastatic disease 9 years after initial intervention and later developed laryngeal necrosis.Conclusion: Systemic TKIs can offer a clinical benefit in patients with metastatic thyroid cancer. However, clinicians should monitor patients for upper aerodigestive tract fistula formation and tissue necrosis during and after TKI therapy. Although a history of external beam radiation therapy may place patients at increased risk for fistula development, further investigation is needed to determine the relative risk associated with subsequent TKI exposure in these patients. (AACE Clinical Case Rep. 2018;4:e270-e274) Abbreviations: DTC = differentiated thyroid cancer; EBRT = external beam radiation therapy; MKI = multikinase inhibitor; MTC = medullary thyroid cancer; RAI = radioactive iodine; TEF = tracheoesophageal fistula; TKI = tyrosine kinase inhibitor; VEGFR = vascular endothelial growth factor receptor