Transcription

1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11 Friday November 19, :30-08:00 08:00-08:05 08:05-08:35 08:35-09:05 09:05-09:15 09:15-10:15 09:15-09:25 09:25-09:35 09:35-09:45 09:45-09:55 09:55-10:05 10:05-10:15 Registration Exhibition open to visitors Session III Moderators: Prof. R. Feinmesser, Dr. R. Pfeffer Honoring speech in light of Prof. G. Marshak retirement Integration of Biological treatments in treatment of locally advanced head and neck cancer - Prof. L. Licitra, Italy The role of neo-adjuvant chemotherapy in locally advanced head and neck cancer - Prof E. Vokes, USA Discussion Session IV - Free papers Moderators: Dr. I. Doweck, Dr. S. Billan Early Tongue Carcinoma - Analysis of Failure Dr. M. Preis, Dr. R. Feinmesser and colleagues Significance of Nodal Yield in Neck Dissections Dr. N. Melamud, Dr. O. Ronen, Dr. I. Doweck Squamous Cell Carcinoma of the lateral pharyngeal wall Surgery, Radiotherapy or both Review of the literature Dr. J. Benzion Voice Quality After Total Laryngectomy Manual VS Stapler Suturing Dr. A. Primov-Fever Endoscopic Partial Laryngectomy for Early Stage Glottic Cancer Dr. H. Shoffel-Havakuk, Dr. Y. Lahav, Dr. D. Halperin Additional surgical margins following transoral CO2 laser resection of early glottic cancer: does it improve local control rate? Dr. T. Marshak, Dr. N. Uri, Dr. O. Ronen, Dr. I. Doweck

12 12 Friday November 19, :15-10:45 Coffee Break with Exhibition 10:45-11:15 11:15-11:40 11:40-11:50 Session V Moderators: Prof. T. Shpitzer, Dr. G. Bachar The role of Surgery in the era of chemo-radiation based on clinical and genetic marker - Prof M. van den Brekel, The Netherlands The use of new technologies in the operating room - Prof. J. Irish, Canada Discussion 11:50-12:30 12:30-13:00 13:00-13:15 13:15 Session VI Moderator: Dr. A. Popovtzer Panel Discussion on Pharynx & Oropharynx - Dr. A. Popovtzer Standardization of neck dissection - Dr. I. Doweck, Dr. O. Ronen Closing Remarks & Award to the best submitted paper - Dr. A. Hefetz, Dr. M. Yehuda Lunch 19:00 21:00 Dinner at the hotel Entertainment show presented by Dr. T. Ben Tsion at the hotel

13 13 Node picking in recurrent neck metastases of papillary cancer are we being picky? Talmi YP, Bedrin L, Horowitz Z, Wolf M Introduction: Node or "berry" picking is suggested as a viable option for treatment of neck metastases in well differentiated thyroid cancer. This method, often favored by general surgeons is acceptable due to the relatively benign nature of the disease and effective radioiodine treatment. Yet, this approach is problematic in many aspects and selective neck dissection should be the standard of care. Even after formal neck dissection, recurrent disease may be incurred and preferably should be surgically treated prior to radioiodine re-treatment. Often in these cases, recurrence is localized to one or few adjacent nodes that can be localized by imaging and removed without opening of the full neck incision. Patients and method: in the years , 10 patients after selective neck dissection were diagnosed with recurrent localized neck disease. The patients were three males and 7 female with age ranging from 21 to 70. The patients were five months to 15 years following the neck procedure and all were diagnosed during routine follow up by US and/or elevated thyroglobulin levels. In all cases, the localization of the metastases was defined by US. Results: One patient had transient vocal cord paralysis and two had temporary hypocalcemia. Thyroglobulin levels were reduced in all cases and were zeroed in three. Conclusion: Node picking in recurrent neck disease in well differentiated thyroid cancer is a viable option in selected cases with localized disease.

14 14 Postoperative parathyroid hormone measurement and early discharge after total Thyroidectomy. D Krakovsky, E Eviater, L Muallem kalmovich Department of Otolaryngology head and neck surgery Asaf Harofeh Medical Center, Zeriffin,Israel Postoperative hypocalcemia is the most common complication of total Thyroidectomy. In the recent years there has been much interest in the published work about the use of intact Parathyroid hormone (PTH) levels in predicting hypocalcemia, but nevertheless, its use is not widespread. Aims: To evaluate the applicability of IPTH assay to identify clinically significant hypocalcemia compared with postoperative serum calcium monitoring, and to promote early hospital discharge of normocalcemic patients. Methods: a prospective study in which PTH levels were tested in 28 consecutive patients who underwent total Thyroidectomy. Levels of PTH and corrected calcium were measured in the recovery room, and then at 6 and 12 hours postoperatively. Results: postoperative PTH levels were a sensitive predictor of normal and low calcium levels post total Thyroidectomy. Conclusions: Low PTH levels are a feasible predictor of postoperative hypocalcemia, and normal levels accurately predict normal calcium levels after total Thyroidectomy, thus promoting early hospital discharge.

15 15 Quest for a parathyroid adenoma and coming across a metastatic papillary microcarcinoma of the thyroid. A small case series and some questions. Udi Cinamon, M.D. Abstract: Background: Many patients with primary hyperparathyroidism (PHPT) have thyroid pathologies, including carcinomas. In general, data suggest an association between PHPT and cancer. In that context, should thyroid findings, including small nodules necessarily require a thorough work-up considering PHPT a risk group regarding thyroid cancer? The objectives: To present patients with PHPT having a small, unsuspicious thyroid lesion, with no risk factors relating to thyroid cancer that were operated, and found to have, in addition to a parathyroid adenoma, a metastatic papillary micro-carcinoma of the thyroid. As well of presenting and addressing some questions that rose during this quest. Patients and methods: A time limited, small case series study of PHPT patients having a sonographical and cytological benign appearing small (5-10mm) thyroid nodule and baring no apparent cancer risk factors. Patients were operated. Thyroid, parathyroid and neck surgical pathology was reviewed Results: Four patients were included (3 females, 1 male). All had a parathyroid adenoma, all had papillary thyroid cancer (5-17mm), 3 had multicentre lesions, and 3 had lymph node metastasis. Conclusions: PHPT patients with thyroid nodules may be regarded as a "risk group" to have thyroid cancer: 1 All patients with PHPT require a sonographic study of the thyroid. Finding a thyroid nodule require a comprehensive work-up that if negative an intra-operative tissue sampling should be advised. 2 In this group of patients, even a small thyroid lesion (less than 10mm), having an innocent ultrasonic and cytological findings should be addressed with extra suspicion.

16 16 Diagnostic Accuracy of Fine-Needle Aspiration Cytology in Parotid Tumors: Correlation with Tumor Size and Ultrasound Guidance. Noam Yehudai, Alexander Brodsky and Michal Luntz Department of Otolaryngology - Head and Neck Surgery, Bnai Zion Medical Center, Technion Israel Institute of Technology, Haifa, Israel Introduction: Fine-needle aspiration cytology (FNAC) has gained widespread acceptance and popularity among head and neck surgeons in the assessment of neck masses. Its use in parotid masses is still controversial, and reports regarding its sensitivity and specificity vary between % and % respectively. Objectives: To assess the sensitivity and specificity of FNAC in the diagnosis of parotid tumors compared with final pathologic evaluation in relation to tumor size on pre-operative computerized tomography and ultrasound guidance. Methods: FNAC and final pathology data were retrospectively reviewed and compared for patients who underwent Parotidectomy for parotid tumors ( ). Literature review was based on trials comparing FNAC with final histological evaluation of parotid tumors identified through an extensive Medline search of the English literature. Outcome measures analyzed included percentage of non-diagnostic samples, sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of FNAC. Results: Final pathologic results revealed that there were overall 11 (18%) malignant tumors and 50 (82%) benign tumors. FNAC results were true positive for malignancy in 6 tumors and false negative in 5 tumors (54.5% sensitivity); true negative in 39 tumors without any false positive cases (100% specificity). FNAC was non-diagnostic in 3 benign cases (5%). Positive predictive value was 100% and the negative predictive value was 90.6%. Total accuracy of FNAC for parotid tumors was 88.5%. FNAC accurately classified 42 of the benign lesions (84%) and 3 of the malignant lesions (27%). Conclusions: FNAC is a verified adjunct in the pre-operative assessment of parotid tumors. The histological classification of benign tumors with FNAC is highly accurate, yet classification of malignant tumors is very poor. Relatively small lesions with non-diagnostic aspirate should be re-sampled, preferably under ultrasound guidance, in order to maximize diagnostic yield.

17 17 Pediatric Head and neck Teratoma, presentation of 3cases and review of the literature. Efrat Reindorp Kfir, Dan Fliss, Gad Fishman, Ari DeRowe Department of Otolaryngology Head and neck surgery-pediatric otolaryngology unit, Tel Aviv Sourasky Medical Center. Congenital teratomas of the head and neck are extremely rare and account for approximately 1.5%-5.5% of all pediatric teratomas. The incidence is reported to be between 1: and 1: live births. Teratomas are composed of tissue originating from all 3 embryonic layers and histologically are classified as mature (benign in 95% of cases), immature and malignant. We report 3 cases of congenital head and neck teratomas diagnosed after birth. Airway interventions are discussed. Treatment strategies including surgical approach were tailored for each patient. All patients were cured with minimal morbidity. The prognosis is determined by the severity of the associated airway obstruction. Complete surgical excision should be the goal for all of these tumors combined if needed with immediate reconstruction.

18 18 Percutaneous Dilatational Tracheostomy in non-icu hospital wards: A new model Moshe Hain, MD Department of Otolaryngology-Head and Neck surgery and Intensive Care Unit, Kaplan Medical Center, affiliated with the Hebrew University- Hadassah Medical School, Jerusalem, Israel. Introduction: Percutaneous dilatational tracheostomy (PDT) is a widely applied procedure used mainly as a bedside procedure in intensive care settings. The clinical and financial feasibility as compared to the traditional surgical open tracheostomy performed in the operating room, have been extensively studied and have been proven advantages on several accounts without compromising safety. We propose a working model for performing bedside PDT in non- ICU wards. Objectives: To retrospectively assess the feasibility of performance of bedside PDT in non-intensive care wards using a novel joint otolaryngology- intensive care unit, team model. A control group comprised of patients that underwent PDT in the ICU was used to assess the relative complication rate and outcome. Methods: A working protocol was constructed where the ICU received the request for tracheostomy from the wards and preparation of the patient for the procedure including current lab tests, chest XR, informed consent and examination by an otolaryngologist were preformed. The procedure was carried out by a combined team of an otolaryngolgist, intensivist, and an ICU nurse under sterile conditions, using the "Blue Rhino PDT set. Vital signs and ETCO2 were monitored. All early and late complications were recorded. Other parameters analyzed were patient epidemiology, pre-procedure morbidity, staff learning curve, duration of procedure, anesthetics used, interval to weening from ventilation and interval to decanulation. Endpoints were hospital discharge, decanulation and death. Results: From September 2009 until July 2010, 48 PDT s were preformed in the hospital wards, and 45 PDT s were preformed in the ICU. Preliminary results show no life threatening complications in the non-icu group and no significant difference between the two groups with regard to complications. As compared with performing tracheostomy in the OR, there was a significant reduction in waiting time, staff and overall cost. Conclusion: Percutaneous tracheostomy is an available, safe, low cost procedure which may be safely performed bedside in the hospital ward by a qualified dedicated team. This novel approach once accepted, may greatly simplify the entire process of tracheostomy performance eliminating much of the excess time, hassle and cost, without compromising on safety and success rate.

19 19 Advanced oral tongue cancer in pregnancy: case report and literature review Limor Muallem Kalmovich, Ephraim Eviatar Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Recent reports have noted an increase in the incidence of oral squamous cell carcinoma in patients less than 40 years of age, and a rise in the female population. Oral squamous cell carcinoma during pregnancy is very rare and accounts for less than 2% of all cancers. We report a case of a young woman, 30 weeks pregnant, who presented with stage IVC carcinoma of the oral tongue. A multidisciplinary team including a head and neck surgeon, a radiation oncologist and a high risk maternal-fetal medicine specialist was assembled. The patient underwent a partial glossectomy and a bilateral modified neck dissection followed by a cesarean section, and received postoperative concomitant chemoradiotherapy. We review the literature with regard to the incidence and treatment of oral tongue cancer in pregnancy and present the ethical dilemmas, as there is almost always a conflict between the optimal maternal therapy and fetal wellbeing.

20 20 Non-melanoma skin cancer involving the facial skeleton Carmel E, Bedrin L, Horowitz Z, Wolf M, Talmi YP Aggressive nonmelanoma skin cancer of the head and neck occurs mostly in elderly Caucasian patients, often necessitating repeated resections. Locally advanced cases may require resection of bony structures, e.g. maxillectomy, rhinectomy, orbital rim resection with or without orbital exenteration, etc. In this retrospective analysis we present thirty five cases with nonmelanoma skin tumors requiring bony structure resection in the past 16 years. Records were evaluated for risk factors, histopathology, number of surgical procedures, surgical technique, reconstructive methods, postoperative radiation therapy and outcome. Results including outcome data will be presented. The importance of prevention and early recognition with initial aggressive treatment will be emphasized.

21 21 Early Tongue Carcinoma - Analysis of Failure Michal Preis, MD1,3, Tuvia Hadar MD1,3, Ethan Soudry, MD1,3, Thomas Shpitzer MD1,3, Yulia Strenov, MD2,Ben I Nageris MD1,3 Raphael Feinmesser, MD1,3 Departments of 1Otorhinolaryngology Head and Neck Surgery and 2Pathology, Rabin Medical Center, Beilinson Campus, Petach Tikva, and 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ABSTRACT Background: Failure rate of surgery for early tongue carcinoma remains high. We sought to identify patterns of failure and recurrence risk factors. Methods: Data review of 50 patients treated for early tongue carcinoma (T1/2N0M0) of which 11 failed surgery. All underwent transoral resection of the tongue tumor and prophylactic neck dissection (supraomohyoid). Results: Tumor recurred within 3-18 months. Nine died of disease. Four failed in neck level 4, six failed in level 1, one failed simultaneously in level 1 and locally. Most tumors were moderately differentiated. Average depth was 6.64mm. Conclusions: We report 11 patients with early tongue carcinoma who failed local excision with neck dissection. Failures occurred in level 4 (4 patients) and level 1 (7 patients). This group may benefit from extended neck surgery. Gender, age, stage, and depth of tumor were not significantly different in the failing group. Tumors in the failing group were more poorly differentiated.

22 22 Significance of Nodal Yield in Neck Dissections. Nurit Melamud, Ohad Ronen and Ilana Doweck Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, Israel. Objectives: To characterize nodal yield in different types of neck dissections (ND), and to determine the effect of nodal yield on histologically positive nodes and patient outcome. Study design: Retrospective chart review. Materials and methods: The charts of all patients who underwent neck dissection due to head and neck cancer in the Department of Otolaryngology - Head and Neck Surgery at Carmel Medical Center between October 2001 and April 2009 were reviewed. Clinical and demographic parameters were correlated to pathologic parameters, including number of nodes removed, number of pathologic nodes revealed and to patients outcome. Results: The study included 124 patients who underwent 136 neck dissection with mean age of 59; M:F 69:55. Of these group, 40 ND were done for Squamous cell carcinoma (SCC) of the head and neck, 65 ND for thyroid malignancies (well differentiated thyroid carcinoma-54, medullary carcinoma- 10, parathyroid carcinoma- 1), 24 for skin cancer (SCC-13, melanoma-10, Merkel cell carcinoma- 1), and 7 for salivary gland malignancies. Mean nodal yield for all neck dissection was 29±14.6 nodes. However, nodal yield was different among the types of ND: Mean nodal yield for ND including central ND was 36 nodes, for modified radical ND as well as posterolateral ND - 29 nodes, supraomohyoid ND and lateral ND - 22 nodes. There was significant correlation between nodal yield and the number of pathological positive nodes found in neck dissection (p= ). Proportional hazards fit showed that both pathology (p<.0001) and nodal yield (p= ) were significant predictors of survival. Conclusions: Nodal yield is significantly correlated to pathological positive nodes, and is a possible predictor for patients outcome.

23 Squamous Cell Carcinoma of the lateral pharyngeal wall Surgery, Radiotherapy or both Review of the literature. 23 Benzion Joshua, MD. Background: Transoral robotic surgery (TORS) Radical tonsillectomy has shown promise in recent publications. It is important to know the pros and cons of conventional surgery and radiotherapy for squamous cell carcinoma of the tonsillar area in order to understand the advantages of this new technique. Methods: Review of the English literature from regarding treatment of SCC of the tonsillar area. Results: Over 50 publications were reviewed. Local control and survival did not differ between the two treatment modalities. Earlier publications showed a higher complication rate with surgery; however more recent series have not shown an increased complication rate. This may be due to better function preservation surgery as well as to improved reconstruction techniques. Conclusion: Surgery as primary treatment for SCC of the lateral pharyngeal wall may have a role especially in the current era where patients are younger than in the past and second primaries are a significant concern.

24 24 Voice Quality After Total Laryngectomy Manual Vs Stapler Suturing Adi Primov-Fever1, Michael Wolf1, Anat Hamburger2, Yoav Talmi1, Ofer Amir2, Lev Bedrin1. 1 Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center. 2 School of communication disorders Tel-Aviv University. The Pharyngoesophageal segment (PES) is the source of voice production in patients after total Laryngectomy (TL). Operative closure Technique can alter the PES contour and function (manual Vs stapler suturing). Videolaryngostroboscopy unables the evaluation of the PES during phonation. 18 patients after TL (7 manual and 11 stapler suturing) were examined. Video recordings of the stroboscopic examinations were observed by 3 objective viewers (two ENT specialists and one speech language pathologist). Voice quality, structural and functional aspects of the PES were evaluated. Statistical analysis revealed no significant difference in voice quality, voice control, vibratory patterns and other structural characteristics of the PES between the two methods.

25 25 Endoscopic Partial Laryngectomy for Early Stage Glottic Cancer Hagit shoffel-havakuk, MD; Yonatan Lahav, MD; Doron Halperin, MD Department of Otolaryngology Head and Neck Surgery, Kaplan medical center, Rehovot, Israel Objectives: To assess clinical characteristics and short term outcome after Laser endoscopic partial laryngectomies for early stage glottic cancer. Study design: A retrospective study. Methods: Medical records of patients who underwent suspension micro-laryngoscopy for malignant disease, between January 2008 and July 2010, were reviewed. The data were comprised of demographics at presentation (age, sex and smoking habits), Clinical presentation (stage, geographic distribution of the tumor and histology), technical surgical details (cordectomy type by the European Laryngological Society, duration of surgery and number of procedures per patient), complications and immediate failures which resulted in referring patients to irradiation therapy. Results: 56 Laser endoscopic partial laryngectomies were performed in 34 patients diagnosed with glottic carcinoma, ranging from Carcinoma in Situ (Tis) to T2. 30 males and 4 females, 38 to 83 years old were included in the study, of whom 88% (30 patient) were smokers. 15% (5) had Tis, 47% (16) T1a, 29%(10) T1b and 9% (3) T2. 68% (23) of the patients underwent type I cordectomy, 32% (11) had type II or more. Average procedures per patients was 1.65, ranging between 1 to 4 procedures. Patients were discharged 1.1 days after the surgical procedure on average (median-1 day). Two complications were noticed one patient had intra-operative cardiac ischemia and one patient had post operative vocal cords adhesion. There were no other complications observed. 6 patients were referred to irradiation due to limited surgical exposure (2 patients), high risk for general anesthesia (2) or inability to control rapidly growing tumor (3). All patients were free of disease at the end of the follow up period. Conclusions: Endscopic partial laryngectomy for early stage glottic cancer allows for immediate recovery with minimal adverse effects. Appropriate patient selection, surgical plan and meticulous follow up will allow for early detection of recurrence, if occurs, and may spare the need for irradiation therapy for the majority of this group of patients.

26 26 Additional surgical margins following transoral CO2 laser resection of early glottic cancer: does it improve local control rate? Tal Marshak, Nechama Uri, Ohad Ronen and Ilana Doweck Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, Israel. Objectives: to assess the impact of additional surgical margins after removal of early- glottic squamous cell carcinomas (SCC) by transoral laser on patients outcome. Study design: Retrospective chart review. Materials and methods: retrospective analysis of patients with early-stage glottic cancer treated between 1/ /2009 at Carmel Medical Center. Clinical parameters were correlated to pathologic parameters including: additional surgical margins, repeated surgical procedures, local control rate, disease free-survival, overall survival, and organ preservation. Results: 64 patients included in the study, with a mean follow-up of 45 months. 24 patients had carcinoma in situ (CIS) whereas 33 patients had T1 (23 T1a,; 10 T1b) and 7 patients had T2. All patients underwent transoral CO2 laser resection. Additional surgical margins were taken following the resection in all patients. 28 patients had positive margins whereas 36 had negative margins. Nineteen patients with positive margins were treated with repeated laser resections (67.8%) whereas 9 patients had additional radiation therapy. Five year local control rate and overall survival were 86% and 75%, respectively. Nine patients had local recurrence, four of them had positive margins and 5 had negative margins. Organ preservation rate was 97%. Conclusions: Transoral CO2 laser resection is an effective treatment modality in early glottic cancer. Additional surgical margins following transoral CO2 laser resection does not improve local control rate.