The prognostic impact of extensive lymph node spread after resection for PDA plateaus above a specific threshold (LNC ≥ 4 or LNR ≥ 0.4), supporting the new 8th edition AJCC criteria for N2 disease. Clinically, lymph node spread above this threshold seems to correlate with occult systemic disease (elevated postoperative CA 19-9 and systemic pattern of failure).

Background There is a paucity of literature characterizing outcomes in older adult patients with head and neck cancer (HNC). This study aims to describe patients from this group, their adherence to National Comprehensive Cancer Network (NCCN) adjuvant treatment guidelines, and the impact of guideline adherence on overall survival (OS). Methods In this retrospective cohort study, we reviewed all patients ≥80 years old with HNC who underwent surgery with curative intent from 2008 to 2016. Adherence to NCCN guidelines was determined in blinded fashion, and quality metrics and OS were compared. Results One hundred fifty‐nine patients met inclusion criteria. The majority of patients (n = 94, 59%) underwent treatment in accordance with NCCN recommendations while 65 (41%) deviated from NCCN guidelines. The two cohorts did not demonstrate a difference in 2‐year OS (62% vs 66%, P = .50). Conclusion Older adult patient outcomes were not different when treatment deviated from NCCN guidelines.

ObjectivesHead and neck cancer (HNC) patients often require percutaneous gastrostomy (PEG) tube placement due to malnutrition and dysphagia. While beneficial, PEG tube placement can cause a rare but reportable complication of metastasis of the original tumor to the gastrostomy exit site. The objectives of this case series were to present HNC patients at a single institution that developed PEG tube metastases, their subsequent treatment, and review of the literature for similar cases.MethodsWe describe three HNC patients who underwent PEG tube placement and developed metastasis at their tube site. We also describe their metastatic disease treatment and compare these cases with similar cases in the literatureResultsAll three cases' initial staging were node positive and all three cases had their PEG tubes placed by the “pull” method. Two patients presented with masses at their PEG site while one patient had a site mass on surveillance positron emission topography (PET) imaging. Biopsy showed the original HNC metastasized to the gastrostomy site. Two patients were treated with surgical resection while one patient was treated with palliative chemotherapy. The “pull” method has been most associated with cases of metastasis in the literature. In the literature, risk factors for metastasis include initial tumor clinical and pathological staging.ConclusionPEG site metastasis should be suspected in patients with skin changes at the PEG site. “Pull” procedures may cause metastasis through physical contact with the primary tumor causing tumor seeding at the PEG site. Surgical resection of metastasis has been shown to be an effective treatment strategy for PEG site metastasis. In patients with higher stage cancers, tube insertion methods that avoid contact with the primary tumor should be considered.Level of EvidenceNA

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Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition diagnosed by the presence of flowing vertebral ossifications along the anterior longitudinal ligament. Limited literature on cervical spine DISH, or cervical hyperostosis (CH), demonstrates that this sub-type of DISH may present with severe oropharyngeal symptoms. Two common manifestations of CH are dysphagia and dyspnea. The purpose of this case series was to provide more insight into detection and management of CH to potentially reduce the risk of impending airway compromise.