Papers by Daniele Marchioni
Acta Oncologica
Abstract Background Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) exper... more Abstract Background Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving primary surgery for HNSCC, one might ask: What is the probability of recurrence in one year considering that the cancer has not yet recurred to date? Materials and methods To answer this question, 979 patients surgically treated for HNSCC (i.e. cancer of the oral cavity, oropharynx, hypopharynx or larynx) between March 2004 and June 2018 were enrolled in a multicenter retrospective cohort study, followed up for death and recurrence over a 5 year period. The conditional probability of recurrence in 12 months – i.e. the probability of recurrence in the next 12 months given that, to date, the patient has not recurred – was derived from the cumulative incidence function (Aalen-Johansen method). Results Overall, the probability of recurrence was the highest during the first (17.3%) and the second years (9.6%) after surgery, declining thereafter to less than 5.0% a year thereafter. The probability of recurrence was significantly higher for stage III–IV HNSCCs than for stage I–II HNSCCs in the first year after surgery (20.4% versus 10.0%; p < 0.01), but not thereafter. This difference was most pronounced for oral cavity cancers. No significant differences were observed across different tumor sites. Conclusion This dynamic evaluation of recurrence risk in patients surgically treated for HNSCC provides helpful and clinically meaningful information, which can be useful to patients in planning their future life, and to clinicians in tailoring post-treatment surveillance according to a more personalized risk stratification.
Exoscope-Assisted Surgery in Otorhinolaryngology
International Journal of Pediatric Otorhinolaryngology
Supportive Care in Cancer
Purpose The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung ... more Purpose The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment. Methods The present multi-centre, retrospective study was performed in a consecutive cohort of patients who underwent upfront surgery with or without adjuvant (chemo)-radiotherapy for head and neck squamous cell carcinoma (HNSCC). Patients were stratified by ALI, and survival outcomes were compared between groups. In addition, the prognostic value of ALI was compared with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM). Results Two hundred twenty-three patients met the inclusion criteria (151 male and 72 female). Overall and progression-free survival were significantly predicted by ALI 2.5 (HR = 2.51, 95% CI: 1.23–5.10 for PFS and HR = 2.60, 95% CI: 1.19–5.67 for OS) were found to be significant predictors. Among the three indices, ALI
Head & Neck
Background: Studies concerning programmed death-ligand 1 (PD-L1) expression in precancerous lesio... more Background: Studies concerning programmed death-ligand 1 (PD-L1) expression in precancerous lesions of head and neck (HN) region have shown variable results. Methods: We systematically reviewed the published evidence on PD-L1 expression in HN precancerous lesions. Results: Of 1058 original articles, 14 were included in systematic review and 9 in meta-analysis. The pooled estimate of PD-L1 expression was 48.25% (confidence interval [CI] 21.07-75.98, I 2 98%, tau2 0.18). PD-L1 expression appeared to be more frequent in precancerous lesions than in normal mucosa (risk ratio [RR] 1.65, CI 0.65-4.03, I 2 91%, tau2 0.82) and less frequent than in invasive squamous cell carcinoma (RR 0.68, CI 0.43-1.08, I 2 91%, tau2 0.22). Conclusions: PD-L1 expression could reflect a point of balance between host immune response and cancer escape ability. High heterogeneity and moderate quality suggest that further studies with larger sample size and more rigorous case selection will allow more precise assessment of PD-L1 expression in HN precancerous lesions.
Otology & Neurotology
OBJECTIVES The stapedius muscle, tendon, and pyramidal eminence are structures within the retroty... more OBJECTIVES The stapedius muscle, tendon, and pyramidal eminence are structures within the retrotympanum. In cholesteatoma surgery, the retrotympanum is a common site of residual disease. The removal of the pyramidal eminence during surgery is sometimes necessary to obtain better visualization of the superior retrotympanum during surgery. Understanding the relational anatomy of structures in the region to the facial nerve allows the surgeon to safely access regional disease. This study aims to better understand the anatomical relationship between the mastoid portion of the facial nerve, the pyramidal eminence, and the stapedius muscle. A secondary aim is to demonstrate that removal of the stapedius muscle in the cadaver model, can increase exposure to the retrotympanic space. STUDY DESIGN Anatomical cadaveric observation study. METHODS Endoscopic dissection of cadaveric heads was undertaken. Classification of the superior and inferior retrotympanic area was performed. The anatomy of the stapedius muscle was described including relationships, depth, course, and angle with respect to the facial nerve. The pyramidal eminence and stapedius muscle were removed in all specimens and the exposure of the retrotympanum re-evaluated to determine if exposure of the region was increased. RESULTS In all cases (11 ears), the stapedius muscle was located medial and anterior to the mastoid portion of the facial nerve, with the second genu superior. The mean antero-posterior distance from the apex of the pyramidal eminence, which the stapedius tendon enters, to the stapes itself was 4.10 mm (range, 2.92-5.73 mm; standard deviation [SD] 0.90 mm). In all cases, irrespective of sinus tympani conformation, removal of the pyramidal eminence and stapedial bony crest in proximity to the facial nerve allowed exposure of the whole retrotympanic region, using a 0-degree endoscope. CONCLUSIONS The pyramidal eminence and stapedius muscle have a relatively constant relationship to the facial nerve. Removal of the stapedius muscle in the human cadaver model increases the exposure of the sinus tympani and subpyramidal space. Increased visualization in this region, may reduce risk of residual cholesteatoma in patients.
Otolaryngology–Head and Neck Surgery
Objective The aim of this study is to describe the endoscopic anatomy of the subtympanic sinus (S... more Objective The aim of this study is to describe the endoscopic anatomy of the subtympanic sinus (STS), establish a classification according to its extension regarding the level of the facial nerve (FN), and assess the feasibility of the transcanal endoscopic approach to the STS. Study Design Experimental anatomic research. Setting Temporal bone laboratory. Methods We performed endoscopic dissection of 34 human whole head and ear block specimens. Of those, 29 underwent high-resolution computed tomography. The STS was classified according to its extension regarding the level of the FN: type A, no extension medial to the FN; type B, extension to the medial limit of the FN; type C, extension of the sinus medially and posteriorly from the FN into the mastoid cavity. Results The majority of cases (n = 21, 72%) showed a shallow type A STS. We observed a deep type B configuration in 6 cases (21%) and a type C in 2 cases (7%). The STS was completely exposable with a 0° endoscope in 44% of the...
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018
The aim of this study was to examine the premise that endoscopic ear surgery (EES) is associated ... more The aim of this study was to examine the premise that endoscopic ear surgery (EES) is associated with a low rate of complications (intraoperative and postoperative). Retrospective review at two institutions. Tertiary referral center. The study included 825 patients who underwent exclusive EES between 2008 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Modena University Hospital, and between 2014 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Verona University Hospital. Exclusive endoscopic ear surgery between 2008 and 2016 (tympanoplasties, second look or revision tympanoplasties, myringoplasties, stapedoplasties, canalplasties, ossiculoplasties, and exploratory tympanotomies). All surgical procedures were performed by two experienced surgeons. For each procedure, intraoperative, and early and delayed postoperative complications were evaluated. The most common ear pathologies for which patients were sent for EES were cholesteatoma (3...
Interventional Neuroradiology
The technique of direct intratumoral injection of permanent liquid agents has evolved significant... more The technique of direct intratumoral injection of permanent liquid agents has evolved significantly over the past few decades. The percutaneous direct puncture technique is being utilised more and more for embolisation of head and neck hypervascular lesions. We describe a case treated via the direct percutaneous transnasal (TN) puncture technique for embolisation of a sinonasal hypervascular tumour, performed in a 21-year-old male patient. Due to extensive vascularisation of the tumour, preoperative embolisation was requested by our otolaryngologist team in order to minimise intraoperative bleeding and reduce surgical morbidity. A primary attempt at trans-arterial embolisation through selective ophthalmic artery catheterisation was unsuccessful due to unfavourable anatomy. An extensive devascularisation of the nasal fossa lesion was obtained using a single injection of low-density polymeric embolic agent (SQUID®). Post-operative eradication was uneventful. Final histopathology exam ...
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018
We aim to investigate the factors associated with recurrent disease following surgery for primary... more We aim to investigate the factors associated with recurrent disease following surgery for primary acquired attic cholesteatoma. We hypothesize that minimal invasive, mucosal sparing operation techniques have beneficial effects on the outcome in terms of recurrence. Retrospective study. Tertiary referral center. A total of 110 patients presenting with primary acquired attic cholesteatoma were enrolled in the study. Patients undergoing revision surgery or a canal wall down procedure, as well as patients with residual disease were excluded from the study. During follow-up recurrence was assessed and classified into normal, self-cleaning retraction pockets, or recurrent cholesteatoma requiring revision surgery. We observed during follow-up statistically significant decrease (p = 0.036) in the occurrence of retraction pockets and recurrence in patients operated by the transcanal endoscopic approach (n = 55, 11% re-retraction, 9% recurrence) compared with those who underwent a canal wall ...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2018
Objective Vestibular schwannoma (VS) is a benign tumor of the lateral skull base. Different micro... more Objective Vestibular schwannoma (VS) is a benign tumor of the lateral skull base. Different microscopic surgical techniques are described in literature: the retrosigmoid and translabyrinthine approaches are used to treat big tumors located in the cerebellopontine angle, and the middle cranial fossa approach is utilized for small tumors with good hearing preservation. The expanded transcanal transpromontorial (ExpTT) approach is a combined microscopic-endoscopic technique previously indicated for Koos stage I and II VS and now proposed for larger VS, up to 3 cm in diameter, with linear progression into the cerebellopontine angle and touching the brainstem. Study Design The study was a retrospective case series of patients who underwent ExpTT surgery for VS in our ear, nose, and throat department. Setting We reviewed the surgical videos and electrophysiologic data recorded during the surgical operations. Subjects and Methods From January 2015 to January 2017, 20 patients affected by K...
The Laryngoscope, Jan 7, 2018
To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classifi... more To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C...
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018
6. The cerebrospinal fluid leak rates (7.4%) in what the authors call conservative or minimally i... more 6. The cerebrospinal fluid leak rates (7.4%) in what the authors call conservative or minimally invasive surgery are about 10 times more than the incidence of the same (0.85%) in our published series of 1,865 patients of which over 41% of the tumors were large tumors (> 20 mm) in the cerebellopontine angle. 7. The authors compare their facial nerve (FN) results with our series of VS removed via translabyrinthine approach and conclude that their postoperative FN results of House-Brackmann I and II were 95.9% in comparison with ours which was 59.87%. This comparison is unscientific and rather imprudent as the authors fail to draw to the attention of the readers the fact that in our large series of 1,865 patients, 1,542 (88.5%) of the tumors were grade I (extrameatal) tumors, and 561 (32.2%) of them were grade III to V tumors (> 20 mm in the cerebellopontine angle) (6). A meaningful comparison would be when the postoperative FN outcomes 200 of our patients in whom the tumor was intrameatal (grade 0) were to be compared with the authors series of intrameatal tumors. Here, it turns out that that our FN results (House-Brackmann I & II) after translabyrinthine approach in 200 intrameatal tumors turn out to be 92.5% which is comparable to the authors’ results of 95.9% in 49 patients. 8. Finally, the duration of follow-up of the current series is 14 months (the authors have included a follow-up of even 2 mo) which is too short a period to determine definitive postoperative results.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Feb 1, 2018
Objectives The objectives of the study were to (1) study the anatomical variations of the tensor ... more Objectives The objectives of the study were to (1) study the anatomical variations of the tensor fold and its anatomic relation with transverse crest, supratubal recess, and anterior epitympanic space and (2) explore the most appropriate endoscopic surgical approach to each type of the tensor fold variants. Study Design Cadaver dissection study. Setting Temporal bone dissection laboratory. Subjects and Methods Twenty-eight human temporal bones (26 preserved and 2 fresh) were dissected through an endoscopic transcanal approach between September 2016 and June 2017. The anatomical variations of the tensor fold, transverse crest, supratubal recess, and anterior epitympanic space were studied before and after removing ossicles. Results Three different tensor fold orientations were observed: vertical (type A, 11/28, 39.3%) with attachment to the transverse crest, oblique (type B, 13/28, 46.4%) with attachment to the anterior tegmen tympani, and horizontal (type C, 4/28, 14.3%) with attach...
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 8, 2018
The clivus is a region characterized by complex anatomy, with vascular and neural structures that... more The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors' Skull Base Team. This was a retrospective chart review of patients who underwent an endoscopic exclusive transnasal approach (EEA) or a transoral one (TO) for clival lesions between June 2015 and November 2017 at our Skull Base Referral Center. Patient characteristics and symptoms, preoperative neuroradiological evaluation, surgical approach, complications, and postoperative results were evaluated. Nine patients (6 females and 3 males; age range 6-82 years, mean 50.8 years) underwent EEA or TO. From ...
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 20, 2018
To define a new surgical option, with lower morbidity, for the treatment of intralabyrinthine sch... more To define a new surgical option, with lower morbidity, for the treatment of intralabyrinthine schwannomas. Retrospective case review. Tertiary referral centers. Eight patients affected by an intralabyrinthine schwannoma, with or without extension to the internal auditory canal, that underwent surgery with a transcanal transpromontorial approach, were included in the study. The average age at presentation was 47 years. Patients' characteristics, symptoms, tumor features, and surgical results were analyzed. All patients were diagnosed and evaluated pre-operatively with high-resolution, gadolinium-enhanced MRI and CT scan of the temporal bone, and underwent surgery via either transcanal transpromontorial endoscopic approach (TTEA) or enlarged transcanal transpromontorial endoscopic approach (ETTA). Hearing function was evaluated with the Hearing Classification System according to the Committee on Hearing and Equilibrium Guidelines. Facial nerve function was evaluated using the Hous...
Audiology & neuro-otology, Jan 13, 2017
Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by rec... more Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Nucleus 6 sound processor features a data logging system capable of real-time recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1,366 CI patients, as recorded by SCAN. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed.
International Journal of Pediatric Otorhinolaryngology
To describe a multicenter study regarding surgical management of bilateral congenital cholesteato... more To describe a multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition. In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain. Retrospective chart and surgical video review of patients with BCC who underwent surgery at Otolaryngology Department of Modena and Verona University Hospitals and the Hospital for Sick Children, Toronto. From 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described. The median age at presentation was 4 years (range 2-7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months. When both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.
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Papers by Daniele Marchioni