Qualification: 
MS, MCh
deepakb21151@aims.amrita.edu

Dr. Deepak Balasubramanian currently serves as Associate Professor at the Department of Head & Neck Surgery, School of Medicine, Kochi.

Publications

Publication Type: Journal Article

Year of Publication Title

2019

N. Subramaniam, Deepak Balasubramanian, Reddy, R., Thankappan, K., and Dr. Subramania Iyer K., “Organ Preservation Protocols in T4 Laryngeal Cancer: A Review of the Literature”, Indian J Surg Oncol, vol. 10, no. 1, pp. 149-155, 2019.[Abstract]


Population-based studies indicate that chemoradiation has become the most popular treatment for advanced laryngeal cancers; however, by extrapolating trial results to the general population, several issues have emerged, such as reduced overall survival, non-functional laryngeal preservation, and poor response to treatment. Although included in these trials, T4 laryngeal and hypopharyngeal cancers with cartilage invasion formed a small percentage of these patients and questions over whether they were appropriately staged remain unanswered. Literature on the use of chemoradiation in this set of patients, including the challenges, treatment considerations, and factors predicting response to treatment and outcomes, was reviewed. Current evidence indicates that all patients of T4 laryngeal and hypopharyngeal cancer are not suitable candidates for organ preservation; this modality should be offered only to select patients with good performance status and access to rehabilitative care and regular follow-up in order to achieve good results.

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2019

S. Vidhyadharan, Thankappan, K., Subramaniam, N., Ramu, J., Ajith, A., Deepak Balasubramanian, and Dr. Subramania Iyer K., “Robot-Assisted Surgery Avoids Mandibulotomy in a Case of Adenoid Cystic Carcinoma of Base of the Tongue.”, Craniomaxillofac Trauma Reconstr, vol. 12, no. 2, pp. 163-166, 2019.[Abstract]


Surgical management is increasingly preferred in human papilloma-related oropharyngeal squamous cell carcinoma. Robotic surgery has a different role to play in oropharyngeal salivary origin tumors, where surgery is the primary essential modality. This modality may be used for better access to the oropharynx, avoiding a lip split approach with mandibulotomy. The organ preservation approach such as in oropharyngeal squamous cell carcinoma, with nonsurgical modalities like chemoradiotherapy, is not preferred in such cancers, as in the present case. In this context, robot-assisted surgery helps in reducing the morbidity by avoiding the mandibulotomy

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2019

S. P. Murthy, Paderno, A., and Deepak Balasubramanian, “Management of the Marginal Mandibular Nerve During and After Neck Dissection”, Curr Opin Otolaryngol Head Neck Surg, vol. 27, no. 2, pp. 104-109, 2019.[Abstract]


PURPOSE OF REVIEW: Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options.

RECENT FINDINGS: A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer.

SUMMARY: When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered.

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2019

S. Murthy, Low, T. - H. Hubert, Subramaniam, N., Deepak Balasubramanian, Sivakumaran, V., Anand, A., Vijayan, S. Nalumackal, Nambiar, A., Thankappan, K., and Dr. Subramania Iyer K., “Validation of the Eighth Edition AJCC Staging System in Early T1 to T2 Oral Squamous Cell Carcinoma”, J Surg Oncol, vol. 119, no. 4, pp. 449-454, 2019.[Abstract]


BACKGROUND: To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control.

METHODS: Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease-specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems.

RESULTS: The 5-year OS was 78% and 61% for T1 and T2 tumours, respetively (P < 0.001) (AJCC 7) vs 87% and 67% (P < 0.001) (AJCC 8). The 5-year DSS was 78% and 61% for T1 and T2, respectively (P < 0.001) (AJCC 7) vs 89% and 71% (P < 0.001) (AJCC 8). For stages I and II tumours the 5-year OS was 81% and 76%, respectively (P < 0.302) (AJCC 7) vs 87% and 73% (P < 0.017) (AJCC 8). The 5-year DSS was 83% and 82% (P < 0.222) vs 89% and 77% (P < 0.016). With the AJCC eighth edition the 5-year local, regional, and distant control rates for T1 vs T2 tumours were 85% vs 74% (P = 0.003), 95% vs 77% (P = 0.001), and 95% vs 80% (P = 0.014), respectively.

CONCLUSION: The AJCC 8th staging system provided for more accurate prediction of OS, DSS, and disease control in early oral cavity cancers.

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2018

A. Anand, Deepak Balasubramanian, Subramanian, N., Murthy, S., Limbachiya, S., Iyer, S., Thankappan, K., and Sharma, M., “Secondary Lymphedema After Head and Neck Cancer Therapy: A Review”, Lymphology, vol. 51, no. 3, pp. 109-118, 2018.[Abstract]


Secondary head and neck lymphedema (SHNL) is a chronic condition affecting patients who have undergone treatment for head and neck cancers. It results from the disruption of normal lymphatic flow by surgery and/or radiation. The incidence of secondary head and neck lymphedema varies anywhere between 12 and 54% of all patients treated for head and neck cancer, but it is still commonly under-diagnosed in routine clinical practice. In spite of awareness of this condition, treatment has been difficult as definitive staging, diagnostic, and assessment tools are still under development. This review article is aimed at looking at the evidence, standards of management, and deficiencies in current literature related to SHNL to optimize management of these patients and improve their quality of life.

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2018

Deepak Balasubramanian, Subramaniam, N., Rathod, P., Murthy, S., Sharma, M., Jimmy Mathew, Thankappan, K., and Dr. Subramania Iyer K., “Outcomes Following Pharyngeal Reconstruction in Total Laryngectomy - Institutional Experience and Review of Literature”, Indian J Plast Surg, vol. 51, no. 2, pp. 190-195, 2018.[Abstract]


Background: Pharyngeal reconstruction is a challenging aspect of reconstruction after resections for head-and-neck cancer. The goals of reconstruction are to restore the continuity of the pharyngeal passage to enable oral alimentation and rehabilitation of speech wherever possible. This study was performed to determine the outcomes following pharyngeal reconstruction in total laryngectomy (TL) using different reconstructive options and to determine the predictors of pharyngocutaneous fistula (PCF) and swallowing dysfunction.

Materials and Methods: Retrospective analysis of patient data between 2003 and 2010 of patients undergoing TL with partial or total pharyngectomy. Demographic and treatment details were collected and analysed. Univariate analysis was performed to determine predictors of PCF and swallowing dysfunction.

Results: Fifty-seven patients underwent pharyngeal reconstruction following TL, 31 of whom had received prior treatment. Following tumour resection, 31 patients had circumferential defects and 26 patients had partial pharyngeal defects. The flaps used include pectoralis major myocutaneous flap ( = 29), anterolateral thigh flap ( = 8), gastric pull-up ( = 13) and free jejunal flap ( = 7). PCF was seen in 20 patients, of which 15 (75%) were managed conservatively and 5 required another surgery. At last follow-up, 99 patients (68%) were on full oral alimentation. Tracheo-oesophageal puncture and prosthesis insertion was done in 20 patients, of whom 17 (85%) developed satisfactory speech. Partial pharyngeal defects were associated with a higher risk of PCF on univariate analysis ( = 0.006) but were not significant on multivariate analysis. Post-operative swallowing dysfunction was significantly higher with hypopharyngeal involvement by tumour ( = 0.003).

Conclusion: Pharyngeal reconstruction in TL is feasible with good results. Majority of the patients swallow and regain acceptable swallowing function within 3 months.

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2018

N. Subramaniam, Deepak Balasubramanian, Low, T. - H., Murthy, S., Clark, J. R., Thankappan, K., and Dr. Subramania Iyer K., “Factors Affecting Survival in Surgically Salvaged Locoregional Recurrences of Squamous Cell Carcinoma of the Tongue”, Journal of Oral and Maxillofacial Surgery, 2018.[Abstract]


Purpose: To determine the factors affecting outcomes in surgically salvaged, locoregionally recurrent squamous cell carcinoma of the tongue (SCCT). Materials and Methods: In a retrospective cohort of patients who underwent successful salvage of locoregionally recurrent SCCT, we performed this observational analytical study to determine survival and its determinants. Details extracted from our database were patient characteristics (age, gender, tobacco use), treatment characteristics, and characteristics of recurrent disease (stage and adverse pathologic features [APFs] such as grade, perineural invasion, and lymphovascular invasion). Overall survival (OS) curves were plotted using the Kaplan-Meier method. A Cox proportional hazards model was used to determine the impact of patient, disease, and treatment characteristics on OS. Results: Of 52 patients with locoregional recurrences of surgically treated SCCT, 25 (48.1%) underwent surgical salvage with curative intent. The median overall OS for this cohort was 26 months. Factors predictive of worse OS were previous adjuvant therapy (P = .016) and increasing APFs in recurrent tumor histology (P = .008). Lymphovascular invasion in recurrent tumor histology and patients with a disease-free interval of less than 6 months showed worse survival (P = .008 and P = .058, respectively). Conclusions: Among patients with locoregional recurrence, the number who are eligible for curative-intent surgical salvage is small. Those who received previous adjuvant therapy and those with increasing APFs in recurrent tumors had poor outcomes despite attempts at surgical salvage, particularly patients with early recurrence. © 2018 American Association of Oral and Maxillofacial Surgeons.

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