Nick Roland - Academia.edu (original) (raw)
Papers by Nick Roland
Stell and Maran's Textbook of Head and Neck Surgery and Oncology Fifth edition, 2012
European Archives of Oto-Rhino-Laryngology
Symptom Oriented Otolaryngology Head & Neck Surgery: Head & Neck and Laryngology (Volume 1), 2017
Symptom Oriented Otolaryngology Head & Neck Surgery: Head & Neck and Laryngology (Volume 1), 2017
BMJ (Clinical research ed.), Jan 23, 2014
Archives of Pathology & Laboratory Medicine, Apr 1, 2019
Current Opinion in Otolaryngology & Head and Neck Surgery, 2014
The public demands that &... more The public demands that 'all modes of treatment' should be offered to patients who present with head and neck cancer. Up to 40% of patients present with advanced stage disease, of whom some 10% have metastatic disease and are currently deemed incurable. This review summarizes the current role and philosophy of surgical interventions in the palliation of head and neck cancer. Patients who present with advanced or recurrent head and neck cancers over the past decade have been offered nonsurgical palliative treatments of radiotherapy with or without chemotherapy, with variable responses. The aims are to achieve tumour shrinkage and gain effective relief of symptoms, such as pain, breathing and swallowing. The use of surgery in the palliation of disease and its symptoms has declined significantly since the 1980s. Within the concept of multidisciplinary clinical working as the 'gold standard' for the provision of optimum care for the head and neck patient, the place for surgery should be discussed within the many options available currently. Patients who present with advanced, incurable or recurrent head and neck cancer should be made aware of their prognosis and the potential need and benefits of palliative care. The active involvement of patients and their carers, their desires and wishes should be the prime consideration for any interventions. Careful selection of suitable patients can achieve prolonged symptom relief safely and result in an improvement in their quality of living. The ultimate goal should incorporate not only quality of life but quality of dying.
The English Journal, 1972
An academic directory and search engine.
BMJ case reports, Jan 18, 2013
Trichilemmal carcinoma (TC) is a rare cutaneous neoplasm which is derived from adnexal keratinocy... more Trichilemmal carcinoma (TC) is a rare cutaneous neoplasm which is derived from adnexal keratinocytes, is histologically invasive, contains cytologically atypical clear cell neoplasm and is in continuity with the epidermis and/or follicular epithelium. However, the diagnostic criteria and even the existence of TC have been contentious. We report the case of a 92-year-old woman with TC of the head and neck region who presented with an unusually long history. She was treated successfully with wide local excision. Important aspects in presentation, differential diagnosis, including histopathological features and management are discussed.
BMJ (Clinical research ed.), Jan 11, 2014
Seminars in Surgical Oncology, 1992
Revised staging systems for cancers of the upper aerodigestive tract, the major salivary glands, ... more Revised staging systems for cancers of the upper aerodigestive tract, the major salivary glands, and the thyroid are presented. The staging has been accepted by both the American Joint Committee on Cancer and the International Union Against Cancer and is gaining worldwide acceptance.
Head & Neck, 2001
Background. There is no previously published information on clinicians' abilities to accurately d... more Background. There is no previously published information on clinicians' abilities to accurately differentiate between different stages of node positive disease in head and neck cancer.
Cancer, 1993
Patients presenting with an enlarged cervical lymph node containing squamous cell carcinoma are a... more Patients presenting with an enlarged cervical lymph node containing squamous cell carcinoma are a difficult problem for head and neck surgeons. In most cases, the primary site lies in the head and neck region. The advent of fine-needle aspiration cytologic study means that this group of patients can be accurately identified in the clinic and investigated accordingly. The current report studies the records of 267 such patients presenting to the Head and Neck Unit at The University of Liverpool over a 29-year period. The 5-year survival rate for all patients presenting with a cervical lymph node metastasis was 27%. The 5-year survival rate for patients with a detected primary in the head and neck was 31% and the primary site was identified during the patient's life time in all but 36 patients (13%). In 53% of patients, the primary site was discovered during routine clinical examination, and in a further 16% it was discovered at panendoscopy. Most diagnostic tests proved relatively unhelpful but 10 patients in our series had the primary site discovered by radiograph and 9 of these had carcinoma of the lung. In the current study when the primary site was discovered it was in the head and neck region in 74% of patients. Primary sites other than head and neck occurred in 11% of the patients and no 5-year survivors existed. Multivariate analysis suggested that open biopsy of the lymph node metastasis appeared to have an adverse effect on survival as did advanced age and advanced N stage. The late diagnosis of the primary site, if it proved to be in the head and neck region, on the other hand, had a positive association with survival. Patients presenting with a lymph node metastasis in the head and neck region from an unknown primary have a prognosis identical to that of other patients with head and neck squamous carcinoma with neck node metastases. The prognosis for patients in whom the primary site is never discovered or in whom the primary site is not head and neck, however, is disastrous. If the primary tumor proves to be in the head and neck region, treatment is worthwhile since almost a third of patients are cured of their disease. When the primary carcinoma is not in the head and neck region, treatment must be considered palliative.
Auris Nasus Larynx, 2011
Objectives: To systematically review the literature to identify studies from which it is possible... more Objectives: To systematically review the literature to identify studies from which it is possible to perform a Number Needed to Treat (NNT) analysis to identify, in a more clinically intuitive manner, neck node levels for which treatment is essential in the N0 and N+ neck with respect to the primary site of tumour. Methods: Systematic literature review using a defined search strategy; data extraction from studies meeting the inclusion criteria; calculation of NNT for individual neck node levels with respect to primary site. Results: A total of 6169 articles were identified from searches of Embase, Medline, The Cochrane library of randomised control trials, conference proceedings and the bibliographies of retrieved papers. Titles and abstracts were screened; from these, 219 studies were retrieved for detailed review. One hundred and ninety six papers were excluded and 23 studies were included in the final analysis. Following review of the data from these studies, and accepting a NNT cutoff of 5 we confirmed that the following lymph node levels should be treated: N0 neck: oral cavity levels II; larynx levels VI; oropharynx levels IIA; hypopharynx levels VI. N+ neck: oral cavity insufficient data; larynx levels IIA À IV + VI; oropharynx levels IIA À III; hypopharynx levels IIA, IIB À IV + VI. Conclusions: NNT is a clinically intuitive parameter to guide appropriate lymph node level treatment in patients presenting with squamous cell carcinoma of the head and neck.
American Journal of Physical Anthropology, 1988
Objectives: To test the validity of the comparative audit tool of POSSUM (Physiological and Opera... more Objectives: To test the validity of the comparative audit tool of POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) against a cohort of 92 consecutive laryngectomies at a major tertiary referral centre for head and neck cancer. The major outcome measurements were 30-day mortality rates, formation of a pharyngo-cutaneous fistula, and length of hospital stay. Methods: By means of a prospective and retrospective case note analysis. Results: No significant difference between the mean POSSUM morbidity scores of those patients who did, or did not develop a fistula, was found (p = 0.535, 95% C.I. À4.36 to 8.33). No significant correlation was observed between POSSUM predicted morbidity and bed occupancy [r = 0.137 (95% C.I. À0.070 to 0.334)]. The Portsmouth POSSUM equation for mortality however did accurately predict the mortality rate (observed to expected ratio of 1.05). Conclusion: The authors propose that whilst there are many similar factors linked to mortality between cohorts of general surgical and head and neck patients, there are several highly specific risk factors in open surgery of the upper aero-digestive tract in the head and neck which are linked with wound breakdown and morbidity which are omitted from the POSSUM scoring system. The authors warn against the use of this comparative audit tool in its current state for such surgical procedures and recommend the creation of a specific POSSUM for head and neck cancer surgery.
Stell and Maran's Textbook of Head and Neck Surgery and Oncology Fifth edition, 2012
European Archives of Oto-Rhino-Laryngology
Symptom Oriented Otolaryngology Head & Neck Surgery: Head & Neck and Laryngology (Volume 1), 2017
Symptom Oriented Otolaryngology Head & Neck Surgery: Head & Neck and Laryngology (Volume 1), 2017
BMJ (Clinical research ed.), Jan 23, 2014
Archives of Pathology & Laboratory Medicine, Apr 1, 2019
Current Opinion in Otolaryngology & Head and Neck Surgery, 2014
The public demands that &... more The public demands that 'all modes of treatment' should be offered to patients who present with head and neck cancer. Up to 40% of patients present with advanced stage disease, of whom some 10% have metastatic disease and are currently deemed incurable. This review summarizes the current role and philosophy of surgical interventions in the palliation of head and neck cancer. Patients who present with advanced or recurrent head and neck cancers over the past decade have been offered nonsurgical palliative treatments of radiotherapy with or without chemotherapy, with variable responses. The aims are to achieve tumour shrinkage and gain effective relief of symptoms, such as pain, breathing and swallowing. The use of surgery in the palliation of disease and its symptoms has declined significantly since the 1980s. Within the concept of multidisciplinary clinical working as the 'gold standard' for the provision of optimum care for the head and neck patient, the place for surgery should be discussed within the many options available currently. Patients who present with advanced, incurable or recurrent head and neck cancer should be made aware of their prognosis and the potential need and benefits of palliative care. The active involvement of patients and their carers, their desires and wishes should be the prime consideration for any interventions. Careful selection of suitable patients can achieve prolonged symptom relief safely and result in an improvement in their quality of living. The ultimate goal should incorporate not only quality of life but quality of dying.
The English Journal, 1972
An academic directory and search engine.
BMJ case reports, Jan 18, 2013
Trichilemmal carcinoma (TC) is a rare cutaneous neoplasm which is derived from adnexal keratinocy... more Trichilemmal carcinoma (TC) is a rare cutaneous neoplasm which is derived from adnexal keratinocytes, is histologically invasive, contains cytologically atypical clear cell neoplasm and is in continuity with the epidermis and/or follicular epithelium. However, the diagnostic criteria and even the existence of TC have been contentious. We report the case of a 92-year-old woman with TC of the head and neck region who presented with an unusually long history. She was treated successfully with wide local excision. Important aspects in presentation, differential diagnosis, including histopathological features and management are discussed.
BMJ (Clinical research ed.), Jan 11, 2014
Seminars in Surgical Oncology, 1992
Revised staging systems for cancers of the upper aerodigestive tract, the major salivary glands, ... more Revised staging systems for cancers of the upper aerodigestive tract, the major salivary glands, and the thyroid are presented. The staging has been accepted by both the American Joint Committee on Cancer and the International Union Against Cancer and is gaining worldwide acceptance.
Head & Neck, 2001
Background. There is no previously published information on clinicians' abilities to accurately d... more Background. There is no previously published information on clinicians' abilities to accurately differentiate between different stages of node positive disease in head and neck cancer.
Cancer, 1993
Patients presenting with an enlarged cervical lymph node containing squamous cell carcinoma are a... more Patients presenting with an enlarged cervical lymph node containing squamous cell carcinoma are a difficult problem for head and neck surgeons. In most cases, the primary site lies in the head and neck region. The advent of fine-needle aspiration cytologic study means that this group of patients can be accurately identified in the clinic and investigated accordingly. The current report studies the records of 267 such patients presenting to the Head and Neck Unit at The University of Liverpool over a 29-year period. The 5-year survival rate for all patients presenting with a cervical lymph node metastasis was 27%. The 5-year survival rate for patients with a detected primary in the head and neck was 31% and the primary site was identified during the patient's life time in all but 36 patients (13%). In 53% of patients, the primary site was discovered during routine clinical examination, and in a further 16% it was discovered at panendoscopy. Most diagnostic tests proved relatively unhelpful but 10 patients in our series had the primary site discovered by radiograph and 9 of these had carcinoma of the lung. In the current study when the primary site was discovered it was in the head and neck region in 74% of patients. Primary sites other than head and neck occurred in 11% of the patients and no 5-year survivors existed. Multivariate analysis suggested that open biopsy of the lymph node metastasis appeared to have an adverse effect on survival as did advanced age and advanced N stage. The late diagnosis of the primary site, if it proved to be in the head and neck region, on the other hand, had a positive association with survival. Patients presenting with a lymph node metastasis in the head and neck region from an unknown primary have a prognosis identical to that of other patients with head and neck squamous carcinoma with neck node metastases. The prognosis for patients in whom the primary site is never discovered or in whom the primary site is not head and neck, however, is disastrous. If the primary tumor proves to be in the head and neck region, treatment is worthwhile since almost a third of patients are cured of their disease. When the primary carcinoma is not in the head and neck region, treatment must be considered palliative.
Auris Nasus Larynx, 2011
Objectives: To systematically review the literature to identify studies from which it is possible... more Objectives: To systematically review the literature to identify studies from which it is possible to perform a Number Needed to Treat (NNT) analysis to identify, in a more clinically intuitive manner, neck node levels for which treatment is essential in the N0 and N+ neck with respect to the primary site of tumour. Methods: Systematic literature review using a defined search strategy; data extraction from studies meeting the inclusion criteria; calculation of NNT for individual neck node levels with respect to primary site. Results: A total of 6169 articles were identified from searches of Embase, Medline, The Cochrane library of randomised control trials, conference proceedings and the bibliographies of retrieved papers. Titles and abstracts were screened; from these, 219 studies were retrieved for detailed review. One hundred and ninety six papers were excluded and 23 studies were included in the final analysis. Following review of the data from these studies, and accepting a NNT cutoff of 5 we confirmed that the following lymph node levels should be treated: N0 neck: oral cavity levels II; larynx levels VI; oropharynx levels IIA; hypopharynx levels VI. N+ neck: oral cavity insufficient data; larynx levels IIA À IV + VI; oropharynx levels IIA À III; hypopharynx levels IIA, IIB À IV + VI. Conclusions: NNT is a clinically intuitive parameter to guide appropriate lymph node level treatment in patients presenting with squamous cell carcinoma of the head and neck.
American Journal of Physical Anthropology, 1988
Objectives: To test the validity of the comparative audit tool of POSSUM (Physiological and Opera... more Objectives: To test the validity of the comparative audit tool of POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) against a cohort of 92 consecutive laryngectomies at a major tertiary referral centre for head and neck cancer. The major outcome measurements were 30-day mortality rates, formation of a pharyngo-cutaneous fistula, and length of hospital stay. Methods: By means of a prospective and retrospective case note analysis. Results: No significant difference between the mean POSSUM morbidity scores of those patients who did, or did not develop a fistula, was found (p = 0.535, 95% C.I. À4.36 to 8.33). No significant correlation was observed between POSSUM predicted morbidity and bed occupancy [r = 0.137 (95% C.I. À0.070 to 0.334)]. The Portsmouth POSSUM equation for mortality however did accurately predict the mortality rate (observed to expected ratio of 1.05). Conclusion: The authors propose that whilst there are many similar factors linked to mortality between cohorts of general surgical and head and neck patients, there are several highly specific risk factors in open surgery of the upper aero-digestive tract in the head and neck which are linked with wound breakdown and morbidity which are omitted from the POSSUM scoring system. The authors warn against the use of this comparative audit tool in its current state for such surgical procedures and recommend the creation of a specific POSSUM for head and neck cancer surgery.