Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P70

Head and Neck

P70		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
Methods: We enrolled 9 patients undergoing curative surgipositive margins at TORS with no adjuvant therapy had a high
cal resection at the University of Alabama at Birmingham and
risk of local recurrence.
Stanford University and used anti-EGFR antibodies conjugated to IRDye800CW to fluorescently localize tumor tissue.
Impact of Time to Surgery on Pathologic
Real-time imaging of the primary specimen and post-resecDisease Progression in Oral Cavity
tion wound bed was performed intraoperatively, and the
Squamous Cell Carcinoma
resected primary specimens and margins were imaged ex
Mia Jusufbegovic, MD (Presenter); Elizabeth Cash, PhD;
vivo. Tumor-to-background ratio (TBR) was calculated by
Shesh Rai; Xiaoyong Wu, PhD; Jeffrey M. Bumpous, MD;
dividing mean tumor relative fluorescence units (RFU) by
Paul A. Tennant, MD; Jeffrey B. Jorgensen, MD
respective background RFU.
Objectives: This study aimed to determine if patients with
Results: Intraoperative fluorescence imaging with the robot
oral cavity squamous cell carcinoma (OSCCa) with delays
showed cancer-specific tumor fluorescence in vivo with TBRs
from diagnosis to time to surgical intervention (TTI) were
> 2.0 in all cases except 1 (mean TBR 2.85 ± 0.87; P < 0.05).
more likely to have adverse pathologic features, be upstaged
Importantly, this technology was able to influence surgical
between clinical and pathologic staging, and have poorer
decision making; residual tumor was identified with fluoresoverall survival.
cence imaging in the post-resection wound bed in 2 patients,
Methods: Patients with nonmetastatic OSCCa who underwhich lead to the resection of pathology-confirmed cancer
went surgery with curative intent were identified in the
tissue.
National Cancer Database (2004-2016). TTI was defined as
Conclusions: The results show the potential for this technolthe time from diagnosis to definitive surgery and restricted to
ogy to guide real-time tumor resection, margin assessment,
7-30 days. Pathologic features evaluated included extracapsuand immediate post-resection pathological processing.
lar extension (ECE), lymphovascular invasion (LVI), and
positive surgical margins. Multivariable models tested hypothIs Frailty Associated With Time to Adjuvant
eses after adjusting for clinicopathologic factors.
Therapy or 6-Month Survival in Head and
Results: A total of 2165 patients were included. Multivariable
Neck Free Flap Patients?
analysis revealed that longer TTI was associated with
Jordan Sukys, MD (Presenter); Jonathan Hanna;
increased overall mortality (hazard ratio [HR] = 1.254; 95%
Phillip Brauer; Saral Mehra, MD, MBA
CI, 1.092-1.438; P = .001) and a greater likelihood for nodal
Objectives: Recently, frailty has been correlated with worse
upstaging (odds ratio [OR] = 1.350; 95% CI, 1.097-1.676; P =
clinical outcomes in head and neck cancer (HNC) surgery, but
.007). Positive surgical margins were associated with increasfew studies have focused specifically on free flap patients.
ing T stage (P = .035) but were not significantly more likely
This study examines the association of frailty with time to
with increased TTI (OR = 1.002; 95% CI, 0.744-1.349; P =
adjuvant therapy and 6-month survival in HNC patients who
.991). Neither ECE nor LVI were more frequent with proreceived free flap reconstruction.
longed TTI. Similar results were found when treatment times
Methods: A retrospective review was performed to identify
were extended to 180 and 365 days.
patients that underwent free flap reconstruction after HNC
Conclusions: For patients with surgically treated OSCCa, a
resection by a single surgeon at a tertiary care center from
longer TTI is associated with increased mortality though not
2015-2019. Frailty was assessed using the modified frailty
with adverse pathologic features. Notably, this cohort was
index (mFI) and the Johns Hopkins Adjusted Clinical Groups
staged according to the American Joint Committee on Cancer
(ACG) frailty-defining diagnosis indicator. Primary outcomes
(AJCC) 6th and 7th editions, in which DOI and ECE were not
were starting adjuvant therapy by 6 weeks, if indicated, and
used as criteria. Within the evaluated time period, pathologic
mortality at 6 months. Multivariate analysis was performed
disease progression is unlikely to be the most significant
controlling for age, sex, primary site, flap type, T stage, and
source of increased mortality seen with delayed initiation of
prior therapy.
treatment.
Results: A total of 227 cases were reviewed. Seventy
patients
(30.8%) demonstrated frailty via the ACG indicator.
Intraoperative Detection of Head and Neck
mFI
scores
ranged from 0 (33%) to 1 (32.6%), 2 (18.9%), or
Cancer Using the da Vinci Xi Robot and
3+
(15.4%).
Multivariate analysis demonstrated no significant
Fluorescently Labeled Anti-EGFR Antibodies
correlation between mFI score and adjuvant therapy start by 6
Lindsay Moore, MD (Presenter); Jason M. Warram;
weeks (P = .98) or 6-month mortality (P = .13). Similarly, no
Luke Bailey, MS; Hailey A. Houson, PhD; Melanie D. Hicks;
significant correlation for these outcomes was observed for
Harishanker Jeyarajan, MD; William R. Carroll, MD;
the ACG indicator (6-month mortality odds ratio [OR] = 3.89;
Eben L. Rosenthal, MD
95% CI, 0.93-16.36; P = .06; 6-week start adjuvant therapy
Objectives: This is the first report to explore the use of tarOR = 1.35; 95% CI, 0.41-4.41; P = .62).
geted fluorescent optical imaging agents to guide surgical
Conclusions: Although frailty may be a reliable indicator for
resection of head and neck cancer squamous cell carcinoma
clinical outcomes in HNC surgery, it may not be a reliable
(HNSCC) using a robotic surgical platform and integrated
predictor of time to adjuvant therapy or 6-month mortality in
near-infrared (NIR) fluorescence imaging technology.
free flap patients. Frail HNC patients may be considered for
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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