DEDICATION
This issue of Head & Neck is dedicated to Dr. Christopher J. O’Brien, a world-class head and neck
surgeon, colleague, and friend. Following the In Memoriam below, we highlight three of Chris’s numerous
contributions to the literature, all published in Head & Neck, that impacted patient care and the practice
of head and neck surgery. For each, the article’s citation is followed by a brief commentary on that article.
In this small way, we honor Chris and the extraordinary work that he performed.
Ehab Y. Hanna, MD
Editor
IN MEMORIAM
Insignia, Officer of the Order of
Australia*
Christopher John O’Brien, AO, AM, MS, MD, FRCS
(HON), FRCS
(January 3, 1952 - June 4, 2009)
On June 4, 2009, Christopher John O’Brien succumbed to a malignant brain tumor after a 3-year
valiant battle. On that day, Australia and our discipline lost a great leader, surgeon, and visionary.
Chris was born on January 3, 1952, in the
western suburbs of Sydney, New South Wales.
He attended secondary school at the Marist
Brothers Parramata, where in his last year he
*
Insignia, Officer of the Order of Australia. Photograph shows Insignia of the Order of Australia awarded posthumously to Dr. Christopher J. O’Brien
on June 8, 2009, and accepted by his wife, Gail O’Brien, from The Governor-General of the Commonwealth of Australia and Chancellor of the Order of
Australia, who represents Her Majesty Queen Elizabeth II in Australia. Mrs. O’Brien accepted the medals on Chris’s behalf on August 21, 2009, at a private ceremony at Admiralty House, Sydney, the residence of the Governor-General, in the presence of the Prime Minister.
C 2009 Wiley Periodicals, Inc.
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In Memoriam
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was elected school captain of the rugby team
and recognized as the most outstanding sportsman/student. He received his undergraduate
and medical education at the University of Sydney, graduating in 1975. After he completed
medical school, Chris sought training in general
surgery at the Royal Prince Alfred Hospital
(RPAH). During this time, he became interested
in head and neck surgical oncology. Always
seeking new experiences and challenges, he
traveled to both England and the United States
to pursue fellowship training in head and neck
surgical oncology and microvascular reconstruction. Chris was instrumental in expanding the
role of free flap reconstructive surgery in head
and neck in Australia.
Chris returned to Australia in 1987 to join
the RPAH as a consultant head and neck surgeon. That same year, he received his Master
of Surgery for his work on flap monitoring
with ultrasonography. During the formative
years of his practice, he envisioned creating a
multidisciplinary head and neck surgery program at RPAH with the fundamental components of clinical care, education, and research.
A decade later, he was appointed as head of
the Department of Head and Neck Surgery at
the RPAH. During his tenure, Chris established one of the largest head and neck cancer
databases in the world, comprising over 8000
patients and outcome data on 5500 surgeries
he had personally performed or supervised
during his 20-year career in that institution.
The richness of this database allowed Chris
to publish several outstanding manuscripts
related to management of both melanoma and
non-melanoma skin cancer of the head and
neck. In 2004, his internationally recognized
work in this area culminated in his receiving a
Doctorate in Medicine.
Chris was dedicated to providing outstanding care to his patients with head and neck
cancer; but he recognized the limitations of our
current therapeutic approaches and the need to
train future generations of head and neck surgeons who embraced his life-long philosophy of
research-driven patient care. Toward that end,
he established a basic laboratory research program that complimented his robust clinical
research effort and an international fellowship
in head and neck surgical oncology and microvascular reconstruction at the RPAH. He
recruited full-time basic scientists to conduct
research into the molecular basis of head and
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In Memoriam
neck cancer, established a tumor bank and
focused investigations into the molecular genetics of salivary gland cancer and viral oncology.
The latter is at the forefront of head and neck
cancer research given the increasing incidence
of oropharyngeal cancer and its association
with the human papillomavirus that is an
emerging public health threat. The international fellowship flourished under Chris’s leadership, with 23 fellows from 9 countries
spending 1 year in the department. His graduates have gone on to lend their newly acquired
expertise to head and neck units around the
world.
In 1998, Chris envisioned the role for a truly
multidisciplinary society that would transcend
specialties and serve as a forum for fellowship
and cross-fertilization of ideas among practitioners from all of the disciplines involved in
head and neck cancer care and research. Along
with leaders from Australia and New Zealand,
Chris founded The Australian and New Zealand
Head and Neck Society, which held its first
meeting in 1999. The society is thriving and
meets biannually. Chris served as president in
2004.
Chris realized, in 2002, that the early successes of the head and neck cancer program at
RPAH would falter without a continuous funding source from both the government and philanthropy. Toward this goal, he prepared a
proposal to the Health Minister of New South
Wales to establish the Sydney Head and Neck
Cancer Institute whose missions were to provide comprehensive treatment, provide education for physicians and patients, coordinate
statewide data collection, and conduct clinical
and basic research. Recognized for his leadership in these efforts, he was appointed Clinical
Director for Cancer Services, Central Sydney
Area Health Service in 2003. The head and
neck program at RPAH continues to thrive as
part of his legacy and serves as a model for
many programs today.
Chris’s academic career was luminous. He
published more than 110 scientific papers and
17 book chapters. His published works on management of melanoma and non-melanoma skin
cancer have highlighted the role for lymphatic
mapping and sentinel lymph node biopsy for
melanoma of the head and neck. More importantly, he identified the complexities that the
surgeon will encounter when attempting sentinel lymph node mapping in the head and neck
HEAD & NECK—DOI 10.1002/hed
December 2009
that includes the finding of multiple sentinel
lymph nodes in multiple lymphatic basins and
lymphatic drainage patterns that are counterintuitive. In non-melanoma skin cancer, Chris
demonstrated the relationship between the volume of metastasis in the parotid and the
adverse impact on prognosis, leading to his proposed new nodal staging system for metastatic
nodes in the parotid region for this disease.
Chris, a gifted and sought after speaker, was
both entertaining and enlightening. He was
charismatic and could light up the room with
his banter and wit. He was honored by delivering the most prestigious named lectureships in
our discipline during his illustrious career: the
Wharton Lecture at the University of Toronto;
the Hayes Martin Lecture of the American
Head and Neck Society; the Eugene Myers
International Lecture of the American Academy
of Otolaryngology-Head and Neck Surgery; the
Lambie-Dew Orator, Faculty of Medicine, University of Sydney; the Jatin P. Shah lecture for
the International Federation of Head and Neck
Oncologic Societies; and the Helmuth Goepfert
Distinguished Lecture at The University of
Texas M. D. Anderson Cancer Center. In the
last months of his life, he delivered the Semon
Lecture at the Royal Society of Medicine sponsored by the University of London. As the first
Australian to do so, he was especially proud of
this honor, not only because of its prestige but
it brought him full circle to London where he
spent time as a fellow at The Royal Marsden in
the early days of his career. To honor Chris’s
commitment to educating future generations of
head and neck surgeons, the American Head
and Neck Society and the Australian–New Zealand Head and Neck Society have established
an endowment to support the Chris O’Brien
Lecture at the quadrennial International Head
and Neck Cancer Conference and a biannual
Traveling Fellowship supporting visits to Australia, New Zealand, and the United States for
emerging academicians. Carsten Palme from
Sydney is the first Chris O’Brien Traveling
Scholar, 2009.
In 2003, Chris became the Director of the
Sydney Cancer Center at RPAH and the University of Sydney while maintaining a busy clinical
practice and appearing frequently on the medi-
cal reality television program RPA. Through
this program, he became widely know to Australians. During his tenure as Director, he formulated a vision for transformation of the
RPAH cancer program into a comprehensive
cancer center organized similarly to the
National Comprehensive Cancer Centers in the
United States. His vision was to create a worldclass institution to serve the people of Australia
afflicted with cancer. Chris envisioned a dedicated building that would be known as Lifehouse at RPA, and he worked tirelessly to make
this a reality. In April 2009, Prime Minister
Kevin Rudd committed $150 million of public
funds to establish the comprehensive cancer
center.
In the waning months of his life, Chris published his autobiography Never Say Die, which
became a best-seller in Australia and was recognized as one of the best biographies of the year.
The book is suffused with Chris’s wit and personality but also a personal account of his career, life experiences, and wonderful family.
With all of his remaining strength, he dedicated
himself to seeing the establishment of Lifehouse
at RPA.
Chris’s great joy in life was his family. He
was married for 29 years to his lovely wife
Gail. Their great love and deep respect for one
another was always evident. Three children
who adored him, Adam, Juliette and James,
survive Chris. The O’Brien clan always shared
the triumphs and tragedies in life with dignity
and grace. As his life faded away, Chris was
surrounded by his loving family and Prime
Minister Rudd, with whom he had developed a
close personal relationship. On June 4, 2009, at
his bedside vigil, he was made an Officer in the
Order of Australia (AO) for his service to medicine and to his country. It is the highest honor
an Australian civilian can receive. Christopher
John O’Brien passed away peacefully that evening at the age of 57. His memory and contributions were honored with a state funeral
flying the flag of Australia at half-mast. Finally
the greatest legacy and tribute to his memory
will be the dedication of The Chris O’Brien
Lifehouse at RPA. May this great Australian
who gave so much to so many have eternal
peace.
In Memoriam
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Death Be Not Proud
By John Donne (1572–1631)
Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally,
And death shall be no more; death, thou shalt die.
Randal S. Weber, MD
The University of Texas
M. D. Anderson Cancer Center
Houston, Texas
E-mail: [email protected]
Patrick J. Gullane, MB, FRCSC
Toronto General Hospital
University of Toronto
Toronto, Canada
Jatin P. Shah, MD, MS
Memorial Sloan-Kettering Cancer Center
New York, New York
COMMENTARIES
SIGNIFICANCE OF CLINICAL STAGE, EXTENT OF SURGERY, AND PATHOLOGIC FINDINGS IN
METASTATIC CUTANEOUS SQUAMOUS CARCINOMA OF THE PAROTID GLAND
Christopher J. O’Brien, MS, FRACS, Edward B. McNeil, BSc, Jeremy D. McMahon, FRACS, Irvin Pathak,
FRACSC, Christopher S. Lauer, FRACP, Michael A. Jackson, FRACR. Head Neck 2002;24(5):417–422.
Chris O’Brien and co-authors in this publication
provide data substantiating the prognostic
impact of parotid metastasis from cutaneous
squamous carcinoma. As an extension of his prior
work, this prospective study of Chris’ personal
surgical cases supports his advocacy for a more
precise staging system in patients with metastatic disease to the parotid from cutaneous
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Commentaries
squamous carcinoma. Further it demonstrates
the influence of the extent of parotid surgery on
outcome. Patients with P2 tumors (metastatic
parotid tumor larger than 3 cm and up to 6 cm)
and P3 tumors (metastatic parotid tumors >6 cm
or disease involving VII nerve or skull base),
more often required radical parotidectomy with
facial nerve sacrifice and more frequently had
HEAD & NECK—DOI 10.1002/hed
December 2009
pathologically involved margins. A critical finding in this study was the 36% incidence of occult
nodal disease among patients who were Pþ and
had an elective lymph node dissection. Patients
with parotid metastasis who are clinically N0 are
at high risk for harboring occult cervical metastasis and benefit from elective nodal dissection or
radiation to the parotid bed and neck. Chris and
colleagues demonstrated the prognostic importance of positive margins in the parotid bed,
presence of pN2 disease, and the importance of
postoperative radiation for positive patients.
Patients with metastatic cutaneous squamous
carcinoma of the skin to the parotid require
aggressive surgery combined with radiation to
improve local-regional control and survival.
Randal S. Weber, MD
The University of Texas
M. D. Anderson Cancer Center
Houston, Texas
PATTERNS OF LYMPH NODE SPREAD OF CUTANEOUS SQUAMOUS CELL CARCINOMA OF THE
HEAD AND NECK
Tom J. Vauterin, MD, Michael J. Veness, MMed (Clin Epi), FRANZCR, Garry J. Morgan, FRACDS, FRACS,
Michael G. Poulsen, FRANZCR, Christopher J. O’Brien, AM, MS, MD, FRACS. Head Neck 2006;28(9):785–791.
O’Brien and colleagues reported the patterns of
neck metastases from cutaneous squamous cell
carcinomas of the head and neck. In this
important contribution to the literature, the
authors identified the importance of metastatic
disease to the parotid gland and charted out
the extent of neck dissection based on the loca-
tion of the primary tumor. This important contribution to the literature provides excellent
guidelines in surgical treatment planning for
cutaneous primary squamous cell carcinomas
of the scalp and facial skin in the clinically
negative neck at risk of having micrometastasis.
Jatin P. Shah, MD, MS
Memorial Sloan-Kettering Cancer Center
New York, New York
OUTCOMES FOLLOWING PAROTIDECTOMY FOR METASTATIC SQUAMOUS CELL CARCINOMA WITH
MICROSCOPIC RESIDUAL DISEASE: IMPLICATIONS FOR FACIAL NERVE PRESERVATION
N. Gopalakrishna Iyer, MBBS (Hons), PhD (Cantab), FRCSEd (Gen), Jonathan R. Clark, MBBS (Hons), FRACS,
Rajmohan Murali, MBBS, FRCPA, Kan Gao, BSc, Christopher J. O’Brien, AM, MS, MD, FRACS. Head Neck
2009;31(1):21–27.
In this article, O’Brien and colleagues clearly
demonstrate that patients with metastatic cutaneous squamous cell carcinoma to the parotid
gland with close or microscopically positive margins identified as involving the facial nerve and
with normal preoperative function can be successfully treated with a nerve-sparing operation
combined with timely postoperative radiation
therapy. This study showed no statistical difference in survival between those with clear, close,
or microscopically involved margins. In my opinion, this report helped to preserve facial nerve
function that, prior to this publication, had frequently been sacrificed.
Patrick J. Gullane, MB, FRCSC
Toronto General Hospital
University of Toronto
Toronto, Canada
Commentaries
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