Tag Archives: surgical oncology

Otolaryngology, Print Release

PUBLISHED: Subtotal Parotidectomy and Unilateral Lateral Neck Dissection (Levels II, III, and IV) for Right Parotid Mucoepidermoid Carcinoma Involving the Deep and Superficial Lobes and Extending into Parapharyngeal Space

Subtotal Parotidectomy and Unilateral Lateral Neck Dissection (Levels II, III, and IV) for Right Parotid Mucoepidermoid Carcinoma Involving the Deep and Superficial Lobes and Extending into Parapharyngeal Space
Veenadhari Kollipara, BA1,2; Kunal A. Koka, BS1,2; Quentin C. Durfee, BS1; Emily K. Funk, MD1,2; Neerav Goyal, MD, MPH, FACS1,2; Guy Slonimsky, MD1,2
1Penn State College of Medicine
2Penn State Health Milton S. Hershey Medical Center

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands, predominantly affecting the parotid gland. It commonly presents as a painless neck mass. Diagnostic workup includes physical examination, imaging, and fine needle aspiration biopsy. Superficial, subtotal, or total parotidectomy, with or without neck dissection and possible adjuvant radiation therapy, is recommended in most cases according to tumor stage, grade, and adverse pathological features. In the case presented here, subtotal parotidectomy with facial nerve preservation and neck dissection followed by adjuvant radiation therapy was elected. Post-treatment imaging at three-month intervals showed no evidence of persistent disease. The attached video demonstrates subtotal right parotidectomy via combined anterograde and retrograde nerve dissection and right selective neck dissection of levels IIa, IIb, III, and IV.

General Surgery, Print Release

PUBLISHED: Robotic Whipple Procedure for an Ampullary Intramucosal Carcinoma

Robotic Whipple Procedure for an Ampullary Intramucosal Carcinoma
Charles C. Vining, MD, FACS, FSSO; Rushin D. Brahmbhatt, MD, FACS; Lawrence M. Knab, MD, FACS, FSSO
Penn State Health Milton S. Hershey Medical Center

A 76-year-old man presented to the emergency department with fatigue and chest pain. Initial laboratory evaluation revealed significant anemia with a hemoglobin level of 7.4 g/dL. He was transfused one unit of packed red blood cells and discharged with plans for outpatient gastroenterology follow-up. Upper endoscopy performed shortly thereafter demonstrated a tubulovillous adenoma without high-grade dysplasia at the level of the ampulla. Subsequent cross-sectional imaging with CT of the abdomen and pelvis identified an area of mass-like thickening in the descending duodenum as well as two suspicious peripancreatic lymph nodes. Endoscopic ultrasound with biopsy confirmed the presence of a uT3N1 duodenal mass. Histopathologic analysis revealed at least intramucosal adenocarcinoma arising within an adenoma.

The case was reviewed at a multidisciplinary tumor board, where consensus recommendation was for surgical resection. The patient subsequently underwent diagnostic laparoscopy, laparoscopic liver biopsy, robotic pancreaticoduodenectomy (Whipple procedure), and falciform ligament flap. Pathologic examination of the resected specimen revealed an 8.2-cm, grade 2, moderately differentiated invasive adenocarcinoma of intestinal type, arising from a duodenal adenoma. The tumor demonstrated direct invasion into the pancreas, peripancreatic soft tissues, and periduodenal tissue. All surgical resection margins were negative for carcinoma. A total of 22 lymph nodes were examined, of which 6 were positive for metastatic adenocarcinoma, consistent with a final pathologic stage of pT3b pN2 duodenal adenocarcinoma.

This case highlights the diagnostic and therapeutic challenges associated with duodenal adenocarcinoma, a rare and often late-presenting malignancy. It further demonstrates the role of a multidisciplinary approach in guiding management, as well as the feasibility of a minimally invasive robotic pancreaticoduodenectomy in selected patients.

Announcement, Content, General Surgery, Preprint Release

PREPRINT RELEASE: Lumpectomy with Sentinel Node Biopsy

Lumpectomy with Sentinel Node Biopsy
Massachusetts General Hospital

Barbara Smith, MD, PhD
Professor of Surgery
Harvard Medical School

Dr. Barbara Smith at MGH performs a lumpectomy and sentinel lymph node biopsy on a female patient who had palpable breast cancer. This case was part of a study featuring Lumicell technology, which looks for residual tumor following the lumpectomy with the goal of reducing rates of recurrence.

Announcement, Content, General Surgery, Preprint Release

PREPRINT RELEASE: Bilateral Modified Radical Neck Dissection

Bilateral Modified Radical Neck Dissection
Smilow Cancer Hospital at Yale New Haven

Tobias Carling, MD, PhD, FACS
Associate Professor of Surgery
Yale School of Medicine

In 2014, a now 61-year-old male had a total thyroidectomy and central neck dissection for bilateral papillary thyroid cancer with extrathyroidal extension. Now, after presenting with recurrent metastatic papillary thyroid cancer, Dr. Tobias Carling performs a bilateral modified radical neck dissection.