news fromSwedish Head & Neck Surgery

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HEAD AND NECK SURGERY CLINIC Arnold Pavilion, 1221 Madison Street, Suite 1523, Seattle, WA 98104T 206-292-6464 www.swedish.org/headandnecksurgery

Swedish Head & Neck Surgery Clinic Team

Back row, left to right:Namou Kim, M.D., FACS J. Blake Golden, M.D., FACSForrest Simmons, PA-CJoseph C. Sniezek, M.D., FACS

Front row, left to right:Christine Tiu, PA-C, MPASDavid W. Moore, M.D., MBA, FACSJeffrey M. Robin, PA-C, MS

Joseph Sniezek, M.D.

The Swedish Cancer Institute (SCI) has proudly closed 2017 with another productive and gratifying year for the Head & Neck Surgery service line. Established in

October 2009, the Head & Neck Surgery service line has harnessed the SCI’s multidisciplinary clinical resources, collaborated with regional cancer centers across the Pacific Northwest and Alaska, and has matured into the premier center for head, neck and endocrine cancer treatment in the Northwest.

As a quaternary referral center, SCI has built an impressive caseload, clinical experience and technical expertise rarely seen in non-academic centers. This has translated into dedicated efforts to advance research within SCI through structured analytical projects that leverage clinical and pathological data amassed during past years of operation. The evolution in our technical expertise has allowed us to foray into true cutting-edge surgeries, such as completing the first successful Jaw-in-a-Day reconstruction in the Pacific Northwest.

In 2017, our family grew significantly. Our new state-of-the-art 6,800 square-foot clinic opened in July, and the newest members of the team joined us in the fall. This has increased

our capacity to further deliver excellent care to a wider network of patients in a timely manner.

The following represents major milestones for 2017:

• New providers

- J. Blake Golden, M.D.: Head and neck oncology, microvascular surgery, endocrine surgery, clinical research

- Forrest Simmons, PA-C

• New state-of-the-art 6,800 square-foot clinic, with 5 exam rooms, 2 procedure rooms and 1 cytology lab

• Index tumors presented at Head & Neck Tumor Boards: 360

• Microvascular free flaps cases: 71

• Thyroid and parathyroid surgical cases: 345 thyroids, 226 parathyroids

• Trans-Oral Robotic (TORS) cases: 21

In 2018 and beyond, we will continue to be grateful and humbled by the trust and cooperation that our colleagues and patients have granted us. We look forward to achieving our unequivocal goal of providing the best care in the most caring manner.

J. Blake Golden, M.D., FACS Head and Neck Surgery Swedish Medical Center

Namou Kim, M.D., FACS Head & Neck Reconstructive Surgery Swedish Medical Center

David Moore, M.D., MBA, FACSHead & Neck SurgerySwedish Medical Center

Joseph Sniezek, M.D., FACSHead & Neck Endocrine SurgerySwedish Medical Center

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Friday, June 9, 2017Swedish education and conference center

Swedish cherry Hill500 17th avenueSeattle, Wa

7th annual Pacific northwest Head and neck cancer Symposium:Updates on Parathyroid and Salivary Glands

UpdatesNew clinicSwedish Head & Neck Surgery moved into a new 6,800 square-foot clinic in July 2017. The new clinic is housed within the Swedish Cancer Institute’s main facility in the heart of Seattle’s First Hill. It includes:

• 5 examination rooms, each with state-of-the-art endoscopic equipment, including trans-nasal esophagoscopes

• 2 procedure rooms with dedicated new ultrasound units

• 1 cytology on-site laboratory for real-time FNA results

• 10 offices for clinical and mid-level providers

• 1 conference room with state-of-the-art A/V system, including teleconference capacity

EducationSCI is a non-university affiliated center, but we have maintained a significant role in education in the region. Prospectively, SCI’s mission includes improved clinic outcomes through clinical research.

• 7th Annual Pacific Northwest Head & Neck Symposium

- Held in collaboration with the University of Washington and SCCA, the 7th Annual Symposium was held in the education center of the Swedish Cherry Hill campus in June. Guest lecturers included leaders of the Head & Neck field, such as Dr. Brian Burkey (Cleveland Clinic) and Dr. Randy Weber (MD Anderson Cancer Center).

• Graduate medical education - Swedish is the primary head and neck training site for the

otolaryngology residency of the Madigan Army Medical Center. Each ENT resident spends a total of 5 months at Swedish to sharpen their clinical and surgical skills.

- Swedish general surgery residents also spend dedicated rotations on the head and neck service.

• Presentation, publication, IRB research project - On-site review by a clinician improves the diagnostic

accuracy of ultrasound-guided thyroid FNAs. World Thyroid Congress, Boston, MA, July 2017

- A rare case of water-clear cell double parathyroid adenoma. World Thyroid Congress, Boston, MA July 2017

- Humanitarian surgical missions. Vanderbilt-Sisson Otolaryngology Seminar. Vail, CO, Feb. 2017

- Sarcomas of the Head and Neck. UCSF Pacific Rim Otolaryngology Update. Honolulu, HI, Feb 2017

- Melanomas of the Head and Neck: An Update. UCSF Pacific Rim Otolaryngology Update. Honolulu, HI, Feb. 2017

- Neck Dissection Fundamentals. Stanford/UCSF Head & Neck Dissection and Reconstruction Course. Palo Alto, CA, Dec. 2017

- Dynamic facial reanimation using gracilis free flap. 7th Annual Pacific Northwest Head & Neck Symposium. Seattle, WA, June 2017

- Parathyoid Surgery. 7th Annual Pacific Northwest Head & Neck Symposium. Seattle, WA, June 2017

- Anisowicz SK, Tolisano AM, Golden JB. Visual Diagnosis: Newborn With a Large Oral Mass. Pediatric Rev. 2017 Mar;38(3):e10-e12. PMID: 28250081

- Extracapsular extension of neck lymphadenopathy in head and neck squamous cell carcinoma: Can preoperative imaging reliably predict it?

- Thyroid cancer disparities: The American Pacific Islander experience. A SEER database analysis.

- Thyroid cancer disparities: The Filipino-American experience. A SEER database analysis.

New providersDr. J. Blake Golden has joined the Head & Neck Surgery team in the fall of 2017. Dr. Golden completed his Head & Neck Surgery fellowship at the University of Alabama. Prior to his arrival at Swedish, he was stationed at Tripler Army Medical Center in Hawaii. Dr. Golden has a unique mission of combining clinical excellence with clinical research. He will be expanding our footprint by facilitating patient access at SCI’s Edmonds facility, and will be a dedicated researcher to analyze our extensive clinical data.

Forrest Simmons, PA-C, is our newest addition, having finished a special physician assistant fellowship in microvascular surgery at Duke University. Mr. Simmons looks forward to integrating himself into the Head & Neck Surgery team.

Our experience in reconstructive surgery continues to evolve, as the needs of patients change and as the available technology continues to improve. The ultimate goal of mandible reconstruction has always been to achieve full function and form. This translates to a reconstructed neo-mandible that matches the contour of the native mandible, with full dental restoration with masticating capacity. This has always been a difficult ultimate goal to achieve in the majority of H&N patients, given the complexity of their treatment, logistical challenges and financial costs associated with full dental restoration. Furthermore, achieving this goal

in a single surgery has been considered the “holy grail” of mandibular reconstruction.

By harnessing the experience of our multidisciplinary team, we achieved the first successful “Jaw-In-A-Day” case for a patient with a mandible ameloblastoma. The patient had resection, reconstruction and dental restoration in a single day of surgery, and left the hospital with a fully functional dental prosthesis. This took many weeks of preparation and 3-D virtual surgical planning, and unified collaboration between microvascular surgery, oral surgery and prosthodentistry.

Clinical case “Jaw-in-a-day”

Figure 1. Pre-op virtual surgical planning of the surgery

Figure 2.Ameloblastoma in left lower mandible

Figure 3.Cutting guides for precise ostectomies

Figure 4. Resected tumor

Figure 5.Fibula free flap with osteointegrated implants and computer modeled cutting guide

Figure 6.Fibula free flap fixed to mandible with customized prefabricated reconstruction plate

Figure 7.Final full dental restoration with prothetics

© 2018 SWEDISH HEALTH SERVICES. ALL RIGHTS RESERVED. CAN-18-0009 2/18

We do not discriminate on the basis of race, color, national origin, sex, age, or disability in our health programs and activities.

Head & Neck Tumor Board (New Index Cases)

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2014 2015 2016 2017

Head & Neck Tumor Board Cases

Type of flap January 2017-December 2017

Fibula 15

Scapula 7

Radial forearm 35

Anterolateral thigh 12

Latissimus Dorsi 1

Gracilis 1

Total 71

Updates (continued from page 2)

Head & Neck tumor boardThe increase in case volume of our dedicated weekly multi-disciplinary Head & Neck tumor board reflects our quaternary referral status in the region. We have maintained our goal of providing bias-free objective recommendations based on the newest NCCN guidelines and emerging clinical protocols.

Free tissue transfer programWe continue to be at the forefront of reconstructive surgery, utilizing a wide variety of tissues to maximize function and form. We also continue to be the only center in the Pacific Northwest employing 3-D virtual surgical planning on nearly all of our mandible and maxillary reconstructions. In 2017, we completed a total of 71 flaps with 100% success rate. Since the start of the free flap program in 2010, we have completed a total of 436 free flaps.

Endocrine programOur H&N endocrine surgery program has evolved into a nationally-recognized service line with extremely strong clinical volume and surgical outcomes. As a referral center, we often treat the most complex and recalcitrant cases of

thyroid cancer and parathyroid abnormalities. Our patients benefit from the dedicated multidisciplinary Thyroid & Parathyroid tumor board and from our onsite, same-day ultrasound, FNA and cytologic examinations. Dr. Sniezek continues to teach at the American College of Surgeons H&N Ultrasound Course (AAO-HNS, Chicago, IL, Sept 2017) and is an active member of the American Head & Neck Society Endocrine Committee. With the addition of Dr. Golden, who is also an ACS ultrasound instructor, the H&N endocrine surgery product line will continue to grow with a focus on

advanced techniques and quality outcomes along with a commitment to compassionate care and patient satisfaction.

SCI updateThe last decade has seen exponential growth at the Swedish Cancer Institute in the prevention, diagnosis and treatment of cancer, as well as — and arguably most importantly — in survivorship. SCI has a long-standing tradition of forward projection when it comes to integrating new technologies, improving patient outcomes and translating research advances into evidence-based standards of care. This tradition has become the foundation upon which we have created a vital nexus of personalized medicine, population health and research to benefit patients and their families far into the future. It is through the optics of a decades-long history that the men and women of SCI approach each day, and how they have made SCI the nexus for highly personalized cancer care, evidence-based population health and research into innovative new therapies and technology.

At SCI, our commitment to personalized medicine goes beyond gene sequencing and targeted therapies. It drives our holistic approach to cancer care. Because of the progress we have made in the last three years, personalized medicine at SCI is positioned to influence cancer care for many more patients throughout Swedish and its partner health care organizations. We see personalized medicine as our portal to population health and to improving the well-being of individuals and communities throughout the Pacific Northwest and beyond.

2017 surgical cases Total

Thyroid 345

Parathyroid 226