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Head and Neck Surgery

Tumor Seeding Complicating Instrumentation in Otolaryngology: A Systematic Review

Tuesday, October 3, 2023
8:54 AM - 9:00 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Diya Ramanathan, BA

    Medical student
    Case Western Reserve University School of Medicine
    Cleveland, OH, United States

    • Co-Author(s)

  • Diya Ramanathan, BA

    Medical student
    Case Western Reserve University School of Medicine
    Cleveland, OH, United States

  • Pavel A. Kipnis, BS

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, MD, United States

    • Author(s)

  • Ashok R. Jethwa, MD

    Resident Physician
    University of Minnesota, Department of Otolaryngology-Head and Neck Surgery
    Minneapolis, Minnesota, United States

  • Jason E. Thuener, MD

    Attending
    University Hospitals Cleveland Medical Center
    Cleveland, OH, United States

  • DK

    Daniel Karakla, MD

    Professor
    Eastern Virginia Medical School
    Norfolk, Virginia, United States

  • SK

    Sobia Khaja, MD

    University of Minnesota School of Medicine, USA

    • Senior Author(s)

  • BC

    Bryan Carroll, MD, PhD

    University Hospitals Cleveland Medical Center, USA

Disclosure(s):
Diya Ramanathan, BA: No relevant relationships to disclose.
Pavel A. Kipnis, BS: No relevant relationships to disclose.
Ashok R. Jethwa, MD: No relevant relationships to disclose.
Daniel Karakla, MD: No relevant relationships to disclose.
Sobia Khaja, MD: No relevant relationships to disclose.
Introduction: Tumor seeding is a well-documented complication of primary tumor manipulation and source of post-procedure morbidity and mortality. Our aim was to identify instrumentation associated with seeding across specialties and specifically in otolaryngology (ENT).

Methods: A systematic review of tumor seeding was conducted using PubMed and Web of Science, according to PRISMA guidelines with antecedent PROSPERO registration. Studies with five or more reports of seeding were included, and seeding was defined as transplantation of tumor cells or secondary tumor growth at a site distinct from the primary tumor, with confirmed shared origins (i.e. histology).

Results: 7893 papers were screened with 146 papers included after full-text review. There were 311,004 patients with 8800 reports of seeding overall, 436 of which were in ENT. By specialty, 13.5% were in thoracic surgery, 53.5% gastroenterology or general surgery and its subspecialties, 11.2% ENT, 20.0% urology or gynecology, and 0.6% each in orthopedic surgery, dermatology, and neurosurgery. 97.9% of all papers and 100% of ENT papers supported the biological existence of seeding. 47.2% of all papers and 57.1% of ENT papers supported the clinical significance of seeding.

Across specialties, 43.1% of seeded tumors occurred with fine needle aspiration (FNA) or core needle biopsy (CNB), 22.5% ureteroscopy, 11.9% laparoscopy, 8.1% open surgery, 7.1% endoscopy, 4.7% percutaneous endoscopic gastrostomy (PEG) tube placement, 1.2% catheter placement, and 1.2% thoracoscopy. In ENT, tumor seeding was associated with PEG tube placement (n=339), FNA/CNB (n=26), and open and endoscopic skull base surgery (n=71).

Conclusions: This data reveals widespread reports of seeding across disciplines and anatomical sites. While the risks of pull-through PEG tube placement are recognized in head and neck oncologic surgery, this data suggests that FNA/CNB are most associated with tumor seeding across surgical disciplines and reported in ENT. Recognizing instrumentation associated with tumor seeding in ENT, namely endoscopy and FNA/CNB, can guide future clinical judgement.