Modifiable Surgical Outcomes in ENT Cancer Surgery That May Improve Survival Interview with:
David Schoppy, MD PhD
Resident, Division of Head and Neck Surgery
Department of Otolaryngology
Stanford University School of Medicine
Stanford, Palo Alto, California What is the background for this study? What are the main findings?

Response: There is a growing focus in healthcare on quality, and one component of this focus is the development of robust measures of quality. Currently, there are relatively few validated metrics of performance in oncologic surgery, and several of these indicators are relatively static metrics (such as hospital case volume and institution type).

This study examined the relationship between overall survival (one surrogate of quality cancer surgery) and two modifiable variables in Head and Neck surgery – achieving negative surgical margins around a primary tumor and 18 or more lymph nodes from a concurrent neck dissection. After controlling for multiple other patient variables, data collected from the National Cancer Database (NCDB) showed that treatment at hospitals where a high percentage of patients had a surgery with negative margins and 18 or more lymph nodes removed from their neck was associated with improved survival. Importantly, this survival benefit was independent of the individual, patient-level survival benefit conferred by having either of these surgical process measures reached.

This study therefore highlights two modifiable measures of institutional performance in Head and Neck surgery that may serve as targets for quality improvement programs. What should clinicians and patients take away from your report?

Response: There are modifiable surgical outcome metrics in Head and Neck surgery that may help identify institutions where patients experience improved survival. What recommendations do you have for future research as a result of this study?

Response: Future work could examine whether an increased focus on these measures would prospectively improve patient outcomes, such as recurrence rates and overall survival.



No disclosures Thank you for your contribution to the community.



Schoppy DW, Rhoads KF, Ma Y, Chen MM, Nussenbaum B, Orosco RK, Rosenthal EL, Divi V. Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level DataNegative Margin Rates and Neck Dissection Yield. JAMA Otolaryngol Head Neck Surg. Published online October 05, 2017. doi:10.1001/jamaoto.2017.1694


Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


[wysija_form id=”1″]






Last Updated on October 12, 2017 by Marie Benz MD FAAD