Hintze, Justin

ABSTRACT Objective To estimate the pooled prevalence of lymphedema among adults with mucosal head and neck cancer treated with radiation therapy. Data Sources PubMed, Embase, Scopus, and Cochrane Library. Review Methods A comprehensive literature search of PubMed, Embase, Scopus, and Cochrane Library (2000–2025) identified cohort, case series, cross‐sectional, and clinical trial studies reporting lymphedema after radiotherapy for head and neck cancer. Logit‐transformed lymphedema prevalence was pooled using a DerSimonian‐Laird random‐effects model with Hartung‐Knapp‐Sidik‐Jonkman variance correction; statistical heterogeneity was evaluated using I 2 . This review was not prospectively registered. Results A total of 26 studies ( n = 3133 patients) met inclusion criteria. The pooled prevalence of lymphedema was 49% (95% CI, 36%–62%), with considerable heterogeneity (I 2 = 94%). Subgroup analyses yielded a pooled prevalence of 37% (12%–71%) for external and 45% (31%–60%) for internal lymphedema. Among studies reporting severity‐graded data, the pooled prevalence of clinically significant (grade ≥ 2) lymphedema was 32% (14%–59%). Lymphedema definitions and assessment methods varied across the included studies, most commonly employing clinical grading. Methodological quality was mixed, reflecting the predominantly retrospective, single‐arm nature of the available evidence. Overall certainty of evidence was very low. Funnel plot inspection and Egger's test suggested small‐study effects ( p = 0.06). Conclusion Lymphedema affects nearly half of patients following radiation for head and neck cancer. These findings may support routine surveillance, early identification, and timely referral for lymphedema management within survivorship care pathways. Future prospective studies should adopt standardized definitions and outcome measures to refine risk estimates and guide prevention strategies. Level of Evidence N/A.

ABSTRACT Background Predictors of complications and length of stay (LOS) in patients requiring brief inpatient stays after total thyroidectomy remain poorly understood. We identify preoperative risk factors for complications, differentiate predictors of overnight versus two‐day stays and estimate associated hospital costs. Methods The National Inpatient Sample for 2016–2021 was used to analyse adult patients undergoing total thyroidectomy with LOS = 1 or 2 days. Multivariate regressions identified predictors of complications and LOS. Costs were transformed logarithmically. Results Of 26 560 patients, 70% had an overnight stay. Two‐day stays were associated with higher complication rates, comorbidity index, neck dissection and increased cost. Hispanic and Asian or Pacific Islander race, comorbidity and surgery in a rural hospital increased the risk of any thyroidectomy‐specific complication. Two‐day stays had a 29% higher cost than overnight stays. Conclusions Preoperative characteristics can help predict complications and LOS following total thyroidectomy. Risk stratification supports cost‐effective, patient‐centred care planning.

ABSTRACT Objectives Laryngeal chondrosarcoma (LC) is a rare tumor accounting for less than 1% of all laryngeal cancers. While surgery is the primary treatment, national trends in management and outcomes remain poorly defined. This study aimed to analyze incidence, survival, and treatment strategies for LC using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with LC diagnosed between 2000 and 2021 were identified from SEER. Demographic, treatment, and survival data were analyzed. Kaplan–Meier analysis and multivariate Cox regression were used to analyze survival outcomes. Results In total, 351 patients with LC were identified, representing 0.3% of all laryngeal malignancies. Among patients with treatment data, 53.3% underwent local excision or partial laryngectomy, 27.5% underwent total laryngectomy (TL), and 19.2% received no surgery. Ten‐year disease‐specific survival was 84.8%. Patients undergoing partial resection demonstrated significantly improved survival compared with TL ( p < 0.05), although this finding is likely confounded by tumor size and stage. On multivariate analysis, advanced stage (HR 2.59, 95% CI 1.68–3.97), older age (HR 1.66, 95% CI 1.36–1.99), and TL (HR 2.95, 95% CI 1.88–4.62) were associated with worse survival. Conclusion LC remains rare but carries favorable long‐term survival. National trends demonstrate a shift toward organ‐preserving surgery, with partial resections increasingly favored over TL. Prognosis is most strongly influenced by age and stage, while radiation therapy appears to play a little role. These findings support organ preservation in appropriately selected patients and highlight the need for prospective studies integrating oncologic and functional outcomes. Level of Evidence 4

Background: Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, high-grade, and aggressive tumor of the sinonasal tract. Due to the rarity of this malignancy, current treatment guidelines are based on small and often/mainly single-center retrospective datasets. In the absence of a universally accepted standard of care for SNUC, treatment approaches vary across countries and institutions, reflecting real-world clinical practice. The primary aim of this study was to describe real-world treatment and outcomes for patients with confirmed SNUC. Methods: This was an international, multi-center, retrospective, observational cohort study that pooled patients into the largest SNUC dataset to date. Fifteen centers were enrolled to contribute data, including seven from Europe, four from the United States, three from the United Kingdom, and one from Canada. In the absence of a universally accepted standard of care for SNUC, treatment approaches varied across countries and institutions, reflecting real-world clinical practice. Patients included were those with histologically confirmed SNUC who were treated between 1997 and 2021. Results: This study yielded 485 patients treated for SNUC. The median age at diagnosis was 55.6 years (IQR: 44.5–67.6), and 63.7% were male. Most cases presented at advanced stages, with 70.8% as T4a or T4b. Overall survival (OS) outcomes were available for 412 patients, with a median follow-up of 26.0 months. The 5- and 10-year OS were 47.2% (95% CI: 40.8–53.3%) and 39.6% (95% CI: 32.5–46.6%), respectively. Advanced age, dichotomized T-stage (T4a/b vs. T1–3), M-stage, and orbital involvement were significant poor prognostic factors on univariable analysis (p’s < 0.01). On multivariable analysis, orbital involvement (HR: 2.73, 95% CI: 1.42–5.27, p = 0.003) and distance metastasis stage (HR: 3.00, 95% CI: 1.25–7.21, p = 0.014) were both independently associated with worse OS. Conclusions: This observational study presents the largest multi-center cohort analysis of SNUC to date, providing new insights into prognostic factors for a rare cancer treated at global centers of excellence. Orbital involvement and the presence of metastases are candidate independent risk factors associated with poorer OS.

Abstract Objective Lymphoepithelial carcinoma of the salivary gland (LECSG) is a rare malignancy. The purpose of this study is to evaluate the clinical features of LECSG with a focus on the role of Epstein‐Barr virus (EBV). Data Sources PubMed, Embase, Web of Science, institutional pathology Natural Language search tool. Review Methods Retrospective review of patients diagnosed with LECSG at a single institution and a systematic literature review. Full text articles in English were included. Results 285 cases of LECSG identified via literature review and an additional 10 within our institution. Most tumors were in the parotid gland (70.5%). Lymph node metastasis was observed in 28%. Most cases were in Asian or Inuit patients (70.5%). EBV association was positive in 52%, and 87.6% of these were in endemic populations. Treatment primarily involved surgical resection (65.8%), often combined with adjuvant therapy (50.2%). No significant differences in disease‐free survival (DFS) or disease‐specific survival (DSS) were observed by EBV status. Advanced tumor stage was associated with worse DFS ( P < .0001) and worse DSS ( P < .0001). Lymph node metastasis was also associated with reduced DSS ( P = .04). Independent predictors of poorer DFS and DSS included late tumor and endemic region of origin. Conclusion This comprehensive analysis of 295 salivary gland LEC cases provides valuable insights into the clinical behavior, pathological features, and treatment outcomes of this rare malignancy. The study highlights the potential role of EBV in tumor pathogenesis, particularly in endemic populations, and emphasizes the need for further research to establish optimal management strategies.

Abstract Objective Intraoperative parathyroid hormone (ioPTH) monitoring is crucial during parathyroid surgery to ensure chemical cure. However, delays in processing can prolong operative times. This study evaluates the effectiveness of a checklist to expedite ioPTH assay processes. Methods A multidisciplinary checklist was developed to standardize ioPTH collection and workflow. Thirty patients treated with use of the checklist were prospectively studied, while 30 patients treated without use of the checklist were retrospectively reviewed. Time intervals for post–15‐minute ioPTH assay results were compared. Results Thirty age‐ and sex‐matched patients were included in each group (n = 60) involving 5 surgeons. The intervention and control group had a mean baseline PTH of 140.9 and 130.3 pg/mL and a post–15‐minute ioPTH of 69.6 and 52.0 pg/mL, respectively. The mean time from sample collection to the post–15‐minute ioPTH assay result was significantly reduced in the intervention as compared to the control group (22.2 vs 33.3 minutes; P < .01). The proportional operative time spent awaiting ioPTH assay results was also reduced (24.4 vs 34.1%; P < .01). In subgroup analysis, a significant difference in the total operative time was found in adenomatous disease (68.0 vs 92.2 minutes, P < .05) but not four‐gland hyperplasia (119.3 vs 142.3 minutes). Discussion The implementation of a simple intraoperative checklist effectively reduces the overall ioPTH assay processing time, creating a more efficient surgical workflow. It is low‐cost and requires minimal additional resources. Implications for Practice This quality improvement intervention holds promise for broader adoption in parathyroid surgery to reduce delays and optimize patient care.

ABSTRACT Background Medial sural artery perforator (MSAP) flaps are favored in head and neck reconstruction for skin paddle pliability, pedicle length, and low donor site morbidity. We sought to characterize MSA vascular branching patterns based on the Dusseldorp et al. classification system using pre‐operative lower extremity computed tomography angiogram (CTA). Methods We conducted a retrospective review of 153 scans from 78 patients who underwent CTA prior to head and neck reconstruction at our institution. Primary data points included MSA branching pattern, branch dominance, and vessel depth. Results The type IIa branching type was most prevalent and the MSA lateral branch most frequently dominant, and they were significantly related to one another. There was no significant difference in depth between branching patterns. Conclusions Lower extremity CTA provides valuable insight to vascular anatomy for MSAP flap harvest. The type IIa and IIb types may be associated with lateral and medial MSA dominance, respectively.

ABSTRACT Objective Reconstruction of complex midface defects is challenging. Vascularized composite flaps are often needed to replace missing premaxilla and palatal bone, oral and sinonasal lining, as well as external facial skin in these defects. The submental flap has the potential to provide all these various tissues with the added advantage of matching facial skin color and hair‐bearing qualities and is available within the surgical field. Methods A retrospective cohort study was carried out at Mayo Clinic Arizona. Patients who had an osteocutaneous submental flap reconstruction for a midface defect between January 2002 and November 2017 were identified using a prospectively collected database. Patient demographics, surgical characteristics, short‐term and long‐term complications were collected. Results The osteocutaneous submental island flap was utilized for reconstruction of midfacial defects in 15 patients. The mean age of the cohort was 60.45 ± 16.57 years, with a male predominance (73.3%). Squamous cell carcinoma was the most common pathology ( n = 12, 80%). The mean soft tissue component of the flap utilized for reconstruction was 50cm 2 , with the mean bone length harvested being 4.4 cm. Short‐term complications occurred in three (20%) patients requiring re‐exploration in the operating room. One patient ultimately experienced flap failure. Conclusion The pedicled osteocutaneous submental flap is a highly versatile flap that offers excellent bony and soft tissue reconstruction for complex midfacial defects. It provides a rapid, reliable option with minimal donor morbidity and a unique color match to the facial defect. Level of Evidence 3.

ABSTRACT Objective Total laryngectomy (TL) represents a major operation often performed on medically complex patients. The impact of blood transfusion in TL patients is not well defined. Here, we utilize a national database to characterize these patients and further investigate a potential dose‐dependent relationship between transfusion and postoperative outcomes. Methods The National Surgical Quality Program (NSQIP) was queried for patients who underwent TL with/without neck dissection (CPT 31360, 31365) between 2014 and 2022. Total units of transfused blood were only available for patients between 2020 and 2023. Statistical analysis involved hypothesis testing, multivariate logistic regression, and receiver operating characteristic (ROC) analysis. Results Among 2311 patients, 413 (17.9%) received transfusions. Non‐White race, ASA Class ≥ 3, hypertension, cancer with distant metastases, bleeding disorders, and elevated BUN, WBC, and INR were associated with transfusion ( p < 0.05). Multivariate analysis identified hypertension (OR 1.81), bleeding disorders (OR 2.64), ASA ≥ 3 (OR 2.40), concurrent free flap (OR 3.75) and lower hematocrit (OR 0.85) as predictors. Transfused patients had longer hospital stays (12 vs. 9 days), increased complications (e.g., stroke, DVT), higher reoperation (23.2% vs. 13.9%) and mortality (2.7% vs. 0.8%) ( p < 0.05). ROC analysis suggested transfusion > 2.5 units was associated with adverse outcomes. Conclusion TL remains a major surgical endeavor that can be associated with lengthy and complicated hospital courses. We show that perioperative transfusion may be associated with increased hospital stay, reoperation, and mortality in TL patients, with a potential dose‐dependent effect. Our study reinforces the risks associated with blood transfusion and further supports the thoughtful utilization of blood products in TL patients. Level of Evidence 3.