About

D. Gregory Farwell, M.D., F.A.C.S., M.A.M.S.E, is the Gabriel Tucker Professor of Otorhinolaryngology and Chair of the Department of Otorhinolaryngology-Head and Neck Surgery at the University of Pennsylvania. He is based in Philadelphia, PA, and is affiliated with the University of Pennsylvania Health System. Dr. Farwell's clinical expertise includes head and neck cancer and thyroid cancer. His research focuses on non-invasive image-guided surgery, with significant contributions to the understanding and treatment of head and neck cancers, including the use of advanced imaging techniques for early detection and intraoperative guidance. He has authored numerous publications on these topics and is recognized for his leadership in the field of otorhinolaryngology.

Research topics

• Medicine
• Artificial Intelligence
• Computer Science
• Surgery
• Internal medicine
• Pathology
• Radiology
• Physical therapy
• Family medicine
• Physics
• Nursing
• Biology
• Demography
• Biomedical engineering

Selected publications

• Risk of Occult Contralateral Neck Metastasis in Early‐Stage <scp>HPV</scp> ‐Related Lateralized Cancer of the Base of the Tongue

  Head & Neck · 2025-12-10

  articleOpen access

  OBJECTIVES: (1) To determine the incidence of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated base-of-tongue (BOT) oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery; and (2) to compare survival and recurrence in patients who did and did not undergo contralateral neck treatment. BACKGROUND: Contralateral neck management in patients with early-stage HPV+ OPSCC of the BOT treated surgically remains controversial. Despite lacking data, most patients receive surgery and/or radiation to the contralateral neck based on historical incidence of occult lymph node metastasis in OPSCC. METHODS: A retrospective chart review of patients with AJCC 7th edition pT1-2, pN0-1 HPV+ BOT OPSCC undergoing transoral robotic BOT resection and ipsilateral neck dissection with adjuvant treatment was conducted. The incidence of occult contralateral nodal metastasis was assessed. Overall and disease-free survival were compared between patients who did and did not undergo contralateral neck treatment. RESULTS: Of 106 patients meeting inclusion criteria, 46 (43.3%) did not undergo treatment of the contralateral neck with radiation or lymphadenectomy, whereas 29 (27.4%) received radiation alone to the contralateral neck, and 31 (29.2%) underwent elective contralateral neck dissection without identification of occult metastasis in any case. Overall survival (HR: 0.95, 95% CI: 0.23-4.00) and disease-free survival (HR: 1.43, CI: 0.55-3.71) did not significantly differ between patients who did and did not receive treatment to the contralateral neck. CONCLUSION: Risk of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated BOT OPSCC treated with primary surgery was low, prompting consideration of forgoing contralateral neck treatment in these patients.

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• Outcomes of <scp>HPV</scp> + Oropharyngeal Carcinoma of Unknown Primary Following Transoral Robotic Surgery

  The Laryngoscope · 2025-08-13 · 2 citations

  articleOpen access

  OBJECTIVES: Treatment of patients with head and neck squamous cell carcinoma of unknown primary (CUP) is challenging. Given the relative rarity of this condition and the recent use of primary transoral robotic surgery (TORS) in modern diagnostic and treatment algorithms, long-term oncologic outcomes are unclear. The objectives were to evaluate oncologic outcomes of patients treated with TORS for management of CUP. METHODS: This retrospective case series was conducted at a tertiary care academic medical center from 2010 to 2021. All patients with HPV-mediated CUP who underwent TORS-assisted endoscopy were included. CUP was defined as biopsy-proven squamous cell carcinoma in a cervical lymph node with uncertain primary location following standard-of-care clinical and radiologic assessment. Primary outcomes were recurrence-free survival and overall survival. Secondary outcomes included usage of radiation and chemotherapy. RESULTS: In total, 157 patients were included in the study. Median follow-up time was 62 months. Primary tumor was identified in 88% of patients. Surgery alone was performed in 21%, although adjuvant therapy was recommended but declined in 13%. Adjuvant radiation was completed in 46% and adjuvant chemoradiation in 33%. Two-thirds of patients avoided chemoradiation. Overall survival was 94% and recurrence-free survival was 92% at 5 years. CONCLUSION: In the largest reported experience to date of TORS-assisted management of CUP, we demonstrate that this approach facilitates a high rate of identification of occult mucosal malignancies and can eliminate the need for chemotherapy and potentially radiation therapy in select patients without compromising excellent oncologic and functional outcomes.

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• What are the functional outcomes of total laryngeal transplantation? A systematic review of preclinical and clinical studies

  Frontiers in Immunology · 2025-07-03 · 4 citations

  reviewOpen access

  Purpose: This systematic review aims to evaluate the functional outcomes of total laryngeal transplantation by synthesizing findings from both preclinical and clinical studies. It focuses on assessing postoperative functional recovery, including swallowing, airway patency, phonation, and speech, while also considering the associated morbidities and immunosuppressive strategies. Methods: A systematic review was conducted for functional outcomes of total laryngeal transplantation through PubMed/MEDLINE, Embase, Scopus, and Web of Science databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Case reports, case series, letters to the editor, reviews, and preclinical studies related to laryngeal transplantation were eligible for inclusion. Methodological quality and risk of bias were assessed via the CAMARADES checklist for preclinical studies and the JBI checklists for clinical studies. Results: Out of n=188 identified studies, n=16 (8.5%) met the inclusion criteria. There were n=13 (81%) clinical and n=3 (19%) preclinical studies. In preclinical models, canine and minipig studies showed partial recovery: electrical stimulation restored vocal fold mobility in n=8 (40%) of canine allografts; some minipigs recovered swallowing, vocalization, and short-term survival post-transplant without immunosuppression, though all canines remained tracheostomy-dependent. Among n=18 (100%) human recipients, speech or phonation was restored fully or partially in n=12 (67%), as well as full or partial oral intake. Here, n=3 patients (17%) died within two years post-VCA, while n=4 (36%) resumed full oral intake. Voice quality was considered as satisfactory or better than pre-VCA in n=6 (55%) patients, whereas airway patency was deemed good or excellent. Nonetheless, no patient regained full vocal fold mobility. However, n=1 (5.6%) patient was able to breathe without a tracheostomy, and n=1 (5.6%) could intermittently cap their tracheostomy tube. Immunosuppressive regimens included tacrolimus (n=18, 100%), mycophenolate mofetil (n=15, 83%), corticosteroids (n=15, 83%), and anti-thymocyte globulin (n=6, 33%), with adjunctive use of leflunomide and stem cells in select cases. Conclusion: Laryngeal transplantation shows promising results in restoring swallowing and phonation, but challenges remain for breathing without tracheostomy. The procedure remains an experimental surgery, still associated with significant morbidity and mortality, and requires lifelong immunosuppression. Future research, including long-term follow-up, larger-scale trials and interdisciplinary collaboration, is essential to further refine this procedure and evaluate its outcomes comprehensively.

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• Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration

  JAMA Otolaryngology–Head & Neck Surgery · 2024-03-07 · 9 citations

  articleOpen access

  Importance: Late effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive. Objective: To investigate the association of FL with changes in self-reported perceptions of voice, swallowing, oral intake, QoL, and mood in survivors of HNC experiencing profound dysphagia and intractable aspiration. Design, Settings, and Participants: This cohort study was conducted at a single academic institution and included survivors of HNC with profound swallowing dysfunction and intractable aspiration who underwent FL from July 2016 through March 2022. Of the initial 22 patients enrolled, 2 patients (15%) died of aspiration pneumonia before receiving FL. Data analyses were performed from July 2016 through March 2023. Main Outcomes and Measures: Self-reported measures of voice using the VHI (30-item Voice Handicap Index), swallowing using the EAT-10 (10-item Eating Assessment Tool), functional oral intake scale using the FOIS (Functional Oral Intake Scale), and quality of life using the FACT-H&N (Functional Assessment of Cancer Therapy-Head & Neck) were assessed before FL and at 1, 3, and 6 months after FL. Mood states were evaluated using the POMS (Profile of Mood States, second edition), before FL and at 6 months after FL. Results: The study analyses included 20 patients (mean [SD] age, 72.4 (7.0) years; 19 [95%] males and 1 [5%] female) who underwent FL and had complete data across all time points. Among these, 12 patients (60%) had received chemoradiation for oropharyngeal, 7 (35%) for laryngeal, or 1 (5%) for nasopharyngeal cancer. The mean (SD) time from completion of oncologic treatment to FL was 15.5 (5.5) years. Mean (SD) score on the EAT-10 improved from 33.2 (7.4) to 23.1 (10.8) at 1 month; 12.1 (9.1) at 3 months; and 8.3 (7.4) at 6 months, with a large effect size (η2 = 0.72; 95% CI, 0.54-0.80). Mean (SD) score on the FOIS improved from 2.0 (1.5) to 2.9 (1.7) at 1 month; 4.8 (2.5) at 3 months; and 5.2 (1.7) at 6 months, with a large effect size (η2 = 0.6; 95% CI, 0.38-0.71). Improvement in oral intake was achieved in 19 patients (95%), and feeding tubes were removed in 10 of 16 patients (63%) who were feeding tube-dependent; 6 patients (27%) continued to require supplemental tube feedings. Mean (SD) score on the VHI improved from 63.6 (34.0) to 86.9 (33.7) at 1 month; 71.3 (36.1) at 3 months; and 39.7 (26.9) at 6 months, with a large effect size (η2 = 0.42; 95% CI, 0.19-0.56). Seventeen patients (85%) were able to use a tracheoesophageal voice prosthesis for alaryngeal communication. Mean (SD) score on the FACT-H&N improved from 86.2 (17.8) to 93.6 (18.4) at 1 month; 109.0 (18.4) at 3 months; and 121.0 (16.8) at 6 months, with a large effect size (η2 = 0.64; 95% CI, 0.42-0.74). Mean (SD) score on the POMS improved from 58.9 (13.2) at baseline to 44.5 (9.9) at 6 months, with a large effect size (Cohen d = 1.04; 95% CI, 0.48-1.57). None of the patients experienced major complications of FL; 1 patient (5%) had a postoperative pharyngocutaneous fistula. Conclusions and Relevance: The findings of this cohort study indicate that FL was associated with marked improvements in self-perception of voice and swallowing, functional oral intake, QoL, and mood state among survivors of HNC. These findings can serve as a framework for FL counseling among HNC survivors experiencing profound dysphagia and intractable aspiration.

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• Early Detection of Lymph Node Metastasis Using Primary Head and Neck Cancer Computed Tomography and Fluorescence Lifetime Imaging

  Diagnostics · 2024-09-23 · 2 citations

  articleOpen access

  Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the potential of combining pre-operative CT and intra-operative fluorescence lifetime imaging (FLIm) to enhance LNM prediction in HNC using primary tumor signatures. Methods: CT and FLIm data were collected from 46 HNC patients. A total of 42 FLIm features and 924 CT radiomic features were extracted from the primary tumor site and fused. A support vector machine (SVM) model with a radial basis function kernel was trained to predict LNM. Hyperparameter tuning was conducted using 10-fold nested cross-validation. Prediction performance was evaluated using balanced accuracy (bACC) and the area under the ROC curve (AUC). Results: The model, leveraging combined CT and FLIm features, demonstrated improved testing accuracy (bACC: 0.71, AUC: 0.79) over the CT-only (bACC: 0.58, AUC: 0.67) and FLIm-only (bACC: 0.61, AUC: 0.72) models. Feature selection identified that a subset of 10 FLIm and 10 CT features provided optimal predictive capability. Feature contribution analysis identified high-pass and low-pass wavelet-filtered CT images as well as Laguerre coefficients from FLIm as key predictors. Conclusions: Combining CT and FLIm of the primary tumor improves the prediction of HNC LNM compared to either modality alone. Significance: This study underscores the potential of combining pre-operative radiomics with intra-operative FLIm for more accurate LNM prediction in HNC, offering promise to enhance patient outcomes.

  PublisherOA PDFDOI

• The Global Experience of Laryngeal Transplantation: Series of Eleven Patients in Three Continents

  The Laryngoscope · 2024-07-06 · 11 citations

  articleOpen access

  BACKGROUND: The loss of laryngeal function affects breathing, swallowing, and voice, thus severely compromises quality of life. Laryngeal transplantation has long been suggested as a solution for selected highly affected patients with complete laryngeal function loss. OBJECTIVE: To obtain insights regarding the advantages, weaknesses, and limitations of this procedure and facilitate future advances, we collected uniform data from all known laryngeal transplants reported internationally. METHODOLOGY: A case series. Patients were enrolled retrospectively by each institutional hospital or clinic. Eleven patients with complete loss of laryngeal function undergoing total laryngeal transplantation between 1998 and 2018 were recruited. RESULTS: After a minimum of 24 months follow-up, three patients had died (27%), and there were two graft explants in survivors, one total and one partial, due to chronic rejection. In the remaining cases, voice was functional in 62.5% and 50% achieved decannulation. Swallowing was initially restricted, but only one patient was gastrostomy-dependent by 6 months and all had normal or near-normal swallowing by the end of year two after transplantation. Median follow-up was 73 months. Functional (voice, swallowing, airway) recovery peaked between 12 and 24 months. CONCLUSIONS: Laryngeal transplantation is a complex procedure with significant morbidity. Significant improvements in quality of life are possible for highly selected individuals with end-stage laryngeal disorders, including laryngeal neoplasia, but further technical and pharmacological developments are required if the technique is to be more widely applicable. An international registry should be created to provide better quality pooled data for analysis of outcomes of any future laryngeal transplants. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:4313-4320, 2024.

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• Laryngotracheal Transplant

  2023-01-01

  book-chapterSenior author
  PublisherDOI

• Anatomy-Specific Classification Model Using Label-Free FLIm to Aid Intraoperative Surgical Guidance of Head and Neck Cancer

  IEEE Transactions on Biomedical Engineering · 2023 · 17 citations

  • Artificial Intelligence
  • Computer Science
  • Medicine

  Intraoperative identification of head and neck cancer tissue is essential to achieve complete tumor resection and mitigate tumor recurrence. Mesoscopic fluorescence lifetime imaging (FLIm) of intrinsic tissue fluorophores emission has demonstrated the potential to demarcate the extent of the tumor in patients undergoing surgical procedures of the oral cavity and the oropharynx. Here, we report FLIm-based classification methods using standard machine learning models that account for the diverse anatomical and biochemical composition across the head and neck anatomy to improve tumor region identification. Three anatomy-specific binary classification models were developed (i.e., "base of tongue," "palatine tonsil," and "oral tongue"). FLIm data from patients (N = 85) undergoing upper aerodigestive oncologic surgery were used to train and validate the classification models using a leave-one-patient-out cross-validation method. These models were evaluated for two classification tasks: (1) to discriminate between healthy and cancer tissue, and (2) to apply the binary classification model trained on healthy and cancer to discriminate dysplasia through transfer learning. This approach achieved superior classification performance compared to models that are anatomy-agnostic; specifically, a ROC-AUC of 0.94 was for the first task and 0.92 for the second. Furthermore, the model demonstrated detection of dysplasia, highlighting the generalization of the FLIm-based classifier. Current findings demonstrate that a classifier that accounts for tumor location can improve the ability to accurately identify surgical margins and underscore FLIm's potential as a tool for surgical guidance in head and neck cancer patients, including those subjects of robotic surgery.

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• Using the Patient Health Questionnaire-2 to improve depression screening in head and neck cancer patients

  American Journal of Otolaryngology · 2022-12-01 · 7 citations

  article
  PublisherDOI

• Bereavement Practices Among Head and Neck Cancer Surgeons

  The Laryngoscope · 2022-01-29

  articleOpen access

  OBJECTIVES: Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons. METHODS: A 20-item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow-up. RESULTS: There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤ .001) was associated with more frequent surgeon bereavement follow-up with the family of deceased patients. CONCLUSION: There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow-up. Having higher empathy was predictive of higher engagement. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1971-1975, 2022.

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Recent grants

• Fluorescence Lifetime Imaging/Spectroscopy System For Robotic Cancer Surgery Guidance

  NIH · $4.6M · 2014–2027

Frequent coauthors

• Bevan Yueh

  University of Minnesota

  55 shared

• Eduardo Méndez

  55 shared

• Allen M. Chen

  University of California, Irvine

  54 shared

• Quang Luu

  43 shared

• Arnaud F. Bewley

  42 shared

• Neal D. Futran

  University of Washington

  40 shared

• Megan E. Daly

  University of California, Davis

  39 shared

• Laura Marcu

  University of California, Davis

  34 shared

Labs

• D. Gregory Farwell LaboratoryPI

Education

• MD

  Washington University Medical Center

Awards & honors

• Gabriel Tucker Professor of Otorhinolaryngology
• F.A.C.S.
• M.A.M.S.E