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Lukianova-Hleb EY, Lapotko DO. Rapid detection and destruction of squamous cell carcinoma of the head and neck by nano-quadrapeutics. Head Neck 2015; 37:1547-55. [DOI: 10.1002/hed.24018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/12/2014] [Accepted: 02/06/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
| | - Dmitri O. Lapotko
- Department of BioSciences at Rice; Rice University; Houston Texas
- Department of Physics and Astronomy; Rice University; Houston Texas
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Hartl DM, Laoufi S, Brasnu DF. Voice Outcomes of Transoral Laser Microsurgery of the Larynx. Otolaryngol Clin North Am 2015; 48:627-37. [PMID: 26096137 DOI: 10.1016/j.otc.2015.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Transoral laser microsurgery (TLM) is the mainstay in the treatment of early (TisT1T2) glottic cancer. Current knowledge concerning voice quality and voice-related quality of life in patients treated using TLM is based on small cohort studies using various instruments to evaluate these functional results. The bulk of the literature indicates that subjective and objective measurements of voice quality can return to normal or almost normal values after TLM, generally after 6 to 12 months and particularly after cordectomy types I, II, and III.
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Affiliation(s)
- Dana M Hartl
- Service Rhône, Department of Head and Neck Oncology, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif 94805, France.
| | - Samia Laoufi
- Department of Head and Neck Oncology, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Daniel F Brasnu
- Otolaryngology-Head and Neck Surgery, University Hospital Cancer Specialities Pole, University Paris Descartes and Sorbonne Nouvelle, Hôpital Européen Georges Pompidou, 20, rue Leblanc, Paris 75908 Cedex 15, France
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Succo G, Crosetti E, Bertolin A, Lucioni M, Caracciolo A, Panetta V, Sprio AE, Berta GN, Rizzotto G. Benefits and drawbacks of open partial horizontal laryngectomies, Part A: Early- to intermediate-stage glottic carcinoma. Head Neck 2015; 38 Suppl 1:E333-40. [PMID: 25581514 DOI: 10.1002/hed.23997] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Laryngeal squamous cell carcinoma (SCC) accounts for 1.9% of cancers worldwide. Most of these are diagnosed in the early stages (T1-T2, and N0). For these, a larynx preserving/conserving option is preferable. Beyond transoral laser microsurgery (TLM), open partial horizontal laryngectomy is a function-sparing surgical technique used to treat laryngeal SCC. METHODS We retrospectively analyzed the clinical outcomes of 216 patients who underwent open partial horizontal laryngectomy for glottic cT2 laryngeal cancer. RESULTS Five-year overall survival (OS), disease-specific survival (DFS), locoregional control, local control, laryngeal function preservation, and laryngectomy-free survival rates were 93.1%, 98.0%, 97.1%, 97.5%, 97.8%, and 98.5%, respectively. Disease controls were significantly affected by previous treatment and type of surgery used. CONCLUSION Although TLM for cT2 laryngeal cancer with unimpaired vocal cord mobility still represents a sound option, open partial horizontal laryngectomy offers higher local control and laryngeal preservation rates for selected patients with impaired mobility of vocal cords combined with involvement of the paraglottic space. © 2015 Wiley Periodicals, Inc. Head Neck 38: E333-E340, 2016.
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Affiliation(s)
- Giovanni Succo
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Erika Crosetti
- Otorhinolaryngology Service, Martini Hospital, Turin, Italy
| | - Andy Bertolin
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Marco Lucioni
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Alessandra Caracciolo
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy and Training, Biostatistics Office, Rome, Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Giuseppe Rizzotto
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
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Shaw RJ, Holsinger FC, Paleri V, Evans M, Tudur-Smith C, Ferris RL. Surgical trials in head and neck oncology: Renaissance and revolution? Head Neck 2015; 37:927-30. [DOI: 10.1002/hed.23846] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Richard J. Shaw
- Department of Molecular and Clinical Cancer Medicine; The University of Liverpool Cancer Research Centre; Liverpool United Kingdom
| | - F. Christopher Holsinger
- Department of Otolaryngology / Head and Neck Surgery; Stanford University School of Medicine; Stanford California
| | - Vinidh Paleri
- Department of Head and Neck and Thyroid Surgery; Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne United Kingdom
| | - Mererid Evans
- Department of Clinical Oncology; Velindre Cancer Centre; Whitchurch Cardiff United Kingdom
| | - Catrin Tudur-Smith
- Department of Biostatistics; Institute of Translational Medicine; University of Liverpool; Liverpool United Kingdom
| | - Robert L. Ferris
- Department of Clinical Operations Chief; Division of Head and Neck Surgery Departments of Otolaryngology; Radiation Oncology; and Immunology; Cancer Immunology Program University of Pittsburgh Cancer Institute, Eye and Ear Institute; Pittsburgh Pennsylvania
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56
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Böttcher A, Kucher S, Knecht R, Jowett N, Krötz P, Reimer R, Schumacher U, Anders S, Münscher A, Dalchow CV, Miller RJD. Reduction of thermocoagulative injury via use of a picosecond infrared laser (PIRL) in laryngeal tissues. Eur Arch Otorhinolaryngol 2015; 272:941-948. [PMID: 25575843 DOI: 10.1007/s00405-015-3501-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/03/2015] [Indexed: 11/24/2022]
Abstract
The carbon dioxide (CO2) laser is routinely used in glottic microsurgery for the treatment of benign and malignant disease, despite significant collateral thermal damage secondary to photothermal vaporization without thermal confinement. Subsequent tissue response to thermal injury involves excess collagen deposition resulting in scarring and functional impairment. To minimize collateral thermal injury, short-pulse laser systems such as the microsecond pulsed erbium:yttrium-aluminium-garnet (Er:YAG) laser and picosecond infrared laser (PIRL) have been developed. This study compares incisions made in ex vivo human laryngeal tissues by CO2 and Er:YAG lasers versus PIRL using light microscopy, environmental scanning electron microscopy (ESEM), and infrared thermography (IRT). In comparison to the CO2 and Er:YAG lasers, PIRL incisions showed significantly decreased mean epithelial (59.70 µm) and subepithelial (22.15 µm) damage zones (p < 0.05). Cutting gaps were significantly narrower for PIRL (133.70 µm) compared to Er:YAG and CO2 lasers (p < 0.05), which were more than 5 times larger. ESEM revealed intact collagen fibers along PIRL cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 and Er:YAG laser incisions. IRT demonstrated median temperature rise of 4.1 K in PIRL vocal fold incisions, significantly less than for Er:YAG laser cuts (171.85 K; p < 0.001). This study has shown increased cutting precision and reduced lateral thermal damage zones for PIRL ablation in comparison to conventional CO2 and Er:YAG lasers in human glottis and supraglottic tissues.
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Affiliation(s)
- Arne Böttcher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Stanislav Kucher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainald Knecht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nathan Jowett
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Peter Krötz
- Atomically Resolved Dynamics Division, Max Planck Institute for the Structure and Dynamics of Matter, Hamburg, Germany
| | - Rudolph Reimer
- Leibniz Institute for Experimental Virology, Heinrich Pette Institute, University of Hamburg, Hamburg, Germany
| | - Udo Schumacher
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Anders
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Münscher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten V Dalchow
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R J Dwayne Miller
- Atomically Resolved Dynamics Division, Max Planck Institute for the Structure and Dynamics of Matter, Hamburg, Germany
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Abstract
The sinonasal cavities represent an anatomical region affected by a variety of tumours with clinical, aetiological, pathological, and genetic features distinct from tumours at the main head and neck cancer localizations. Together, squamous-cell carcinoma and adenocarcinoma account for 80% of all sinonasal tumours, and are aetiologically associated with professional exposure to wood and leather dust particles and other industrial compounds, and therefore, are officially recognized as an occupational disease. Owing to their distinctive characteristics, sinonasal tumours should be considered as separate entities, not to be included in the miscellany of head and neck cancers. Sinonasal tumours are rare, with an annual incidence of approximately 1 case per 100,000 inhabitants worldwide, a fact that has hampered molecular-genetic studies of the tumorigenic pathways and the testing of alternative treatment strategies. Nevertheless, the clinical management of sinonasal cancer has improved owing to advances in imaging techniques, endoscopic surgical approaches, and radiotherapy. Genetic profiling and the development of in vitro cell lines and animal models currently form the basis for future targeted anticancer therapies. We review these advances in our understanding and treatment of sinonasal tumours.
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58
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Gioacchini FM, Alicandri-Ciufelli M, Magliulo G, Rubini C, Presutti L, Re M. The clinical relevance of Ki-67 expression in laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2014; 272:1569-76. [PMID: 24890978 DOI: 10.1007/s00405-014-3117-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/20/2014] [Indexed: 12/31/2022]
Abstract
The aim of this study was to determine the prognostic value of Ki-67 immunostaining in patients affected by laryngeal squamous cell carcinoma. A systematic review was carried out in a tertiary university referral center. An appropriate string was run on PubMed to retrieve articles dealing with Ki-67 immunohistochemical staining and laryngeal squamous cell carcinoma. A double cross-check was performed on citations and full-text articles by two investigators independently to review all manuscripts and perform a comprehensive quality assessment. Of 85 abstracts identified, 18 articles were included. These studies reported on 1,342 patients with histological confirmed diagnosis of laryngeal squamous cell carcinoma. Most studies showed a statistical association between Ki-67 immunohistochemical expression and at least one of the clinical and histopathological parameters considered by the authors. Overall the studies analyzed suggested that the tumoral proliferative index was statistically connected respectively with T stage (2/18), N stage (4/18), grading (6/18), disease-free survival (10/18) and overall survival (4/18). Our review strongly suggests that immunohistochemical staining of Ki-67 correlates with tumoral aggressiveness and worse prognosis in patients affected by laryngeal squamous cell carcinoma. Further high-quality prospective studies should be carried out to confirm our finding and determine the eventual differences between cancers of specific laryngeal subsites.
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Lukianova-Hleb EY, Ren X, Sawant RR, Wu X, Torchilin VP, Lapotko DO. On-demand intracellular amplification of chemoradiation with cancer-specific plasmonic nanobubbles. Nat Med 2014; 20:778-784. [PMID: 24880615 DOI: 10.1038/nm.3484] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 10/24/2013] [Indexed: 02/08/2023]
Abstract
Chemoradiation-resistant cancers limit treatment efficacy and safety. We show here the cancer cell-specific, on-demand intracellular amplification of chemotherapy and chemoradiation therapy via gold nanoparticle- and laser pulse-induced mechanical intracellular impact. Cancer aggressiveness promotes the clustering of drug nanocarriers and gold nanoparticles in cancer cells. This cluster, upon exposure to a laser pulse, generates a plasmonic nanobubble, the mechanical explosion that destroys the host cancer cell or ejects the drug into its cytoplasm by disrupting the liposome and endosome. The same cluster locally amplifies external X-rays. Intracellular synergy of the mechanical impact of plasmonic nanobubble, ejected drug and amplified X-rays improves the efficacy of standard chemoradiation in resistant and aggressive head and neck cancer by 100-fold in vitro and 17-fold in vivo, reduces the effective entry doses of drugs and X-rays to 2-6% of their clinical doses and efficiently spares normal cells. The developed quadrapeutics technology combines four clinically validated components and transforms a standard macrotherapy into an intracellular on-demand theranostic microtreatment with radically amplified therapeutic efficacy and specificity.
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Affiliation(s)
| | - Xiaoyang Ren
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rupa R Sawant
- Center for Pharmaceutical Biotechnology and Nanomedicine, Northeastern University, Boston, Massachusetts, USA
| | - Xiangwei Wu
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vladimir P Torchilin
- Center for Pharmaceutical Biotechnology and Nanomedicine, Northeastern University, Boston, Massachusetts, USA
| | - Dmitri O Lapotko
- Department of Biochemistry and Cell Biology, Rice University, Houston, Texas, USA.,Department of Physics and Astronomy, Rice University, Houston, Texas, USA
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60
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Hamzany Y, Brasnu D, Shpitzer T, Shvero J. Assessment of margins in transoral laser and robotic surgery. Rambam Maimonides Med J 2014; 5:e0016. [PMID: 24808954 PMCID: PMC4011481 DOI: 10.5041/rmmj.10150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Free margin status is being approached differently in vocal cord cancer (1-2 mm) compared with other sites in the upper aerodigestive tract (2-5 mm). Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon's judgment with regard to the completeness of tumor resection.
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Affiliation(s)
- Yaniv Hamzany
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and
- To whom correspondence should be addressed. E-mail:
| | - Daniel Brasnu
- Department of Otorhinolaryngology—Head Neck Surgery, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Thomas Shpitzer
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and
| | - Jacob Shvero
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and
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61
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Sarris EG, Harrington KJ, Saif MW, Syrigos KN. Multimodal treatment strategies for elderly patients with head and neck cancer. Cancer Treat Rev 2014; 40:465-75. [DOI: 10.1016/j.ctrv.2013.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 10/06/2013] [Accepted: 10/18/2013] [Indexed: 12/15/2022]
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Abstract
Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these.
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63
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Wilkie MD, Lightbody KA, Lythgoe D, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery for early and moderately advanced laryngeal cancers: outcomes from a single centralised United Kingdom centre. Eur Arch Otorhinolaryngol 2014; 272:695-704. [PMID: 24682610 DOI: 10.1007/s00405-014-3011-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Transoral laser microsurgery (TLM) represents an important treatment for selected laryngeal cancers. Utilisation of TLM, however, is highly variable between United Kingdom (UK) centres, and published data relating to its use in the UK is scarce. We report outcomes from our tertiary referral centre, and highlight lessons learned. Patients undergoing primary TLM for laryngeal cancer with curative intent (2007-2011) were studied retrospectively. Survival analyses were evaluated using the Kaplan-Meier method and log-rank statistics used to examine the influence of several variables. Overall, 170 cases were included-153 glottic and 17 supraglottic. Median follow-up was 39 months (range 14-79 months). Respective 3-year local control (LC), overall survival (OS), disease-specific survival (DSS), and disease-free survival were 92, 92, 98, and 86 % for glottic carcinomas. Three-year LC and OS were both 88 % for supraglottic carcinomas. For glottic cases, a significant impact of pT stage on DSS was observed, and of age on OS. Median hospital stay was one and 19 days for glottic and supraglottic cases respectively, with respective 3-year laryngeal preservation rates of 97 and 94 %, and tracheostomy rates of 0 and 29 %. One patient in the glottic group and four in the supraglottic group failed to regain swallowing function post-operatively, remaining either PEG dependent or undergoing functional total laryngectomy. Our series confirms the oncological and functional efficacy of TLM, offering a unique large-scale UK perspective. Our experience indicates, however, that treatment of larger supraglottic tumours should be considered carefully, as functional outcomes may be compromised.
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Affiliation(s)
- Mark D Wilkie
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK,
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64
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Analysis of failure following transoral laser surgery for early glottic cancer. Eur Arch Otorhinolaryngol 2014; 271:2247-51. [DOI: 10.1007/s00405-014-2964-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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65
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Makki FM, Rigby MH, Bullock M, Brown T, Hart RD, Trites J, Hinni ML, Taylor SM. CO(2) laser versus cold steel margin analysis following endoscopic excision of glottic cancer. J Otolaryngol Head Neck Surg 2014; 43:6. [PMID: 24502856 PMCID: PMC3927765 DOI: 10.1186/1916-0216-43-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 01/27/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery. Methods Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. Results 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24). Conclusion Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.
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Affiliation(s)
| | | | | | | | | | | | | | - S Mark Taylor
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Grant DG, Repanos C, Malpas G, Salassa JR, Hinni ML. Transoral laser microsurgery for early laryngeal cancer. Expert Rev Anticancer Ther 2014; 10:331-8. [DOI: 10.1586/era.10.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harréus U. Surgical errors and risks - the head and neck cancer patient. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc04. [PMID: 24403972 PMCID: PMC3884539 DOI: 10.3205/cto000096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.
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Affiliation(s)
- Ulrich Harréus
- Department of Otolaryngology/Head and Neck Surgery, University Hospital Munich, Campus Grosshadern, Munich, Germany
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68
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Ansarin M, Zorzi S, Massaro MA, Tagliabue M, Proh M, Giugliano G, Calabrese L, Chiesa F. Transoral robotic surgery vs transoral laser microsurgery for resection of supraglottic cancer: a pilot surgery. Int J Med Robot 2013; 10:107-12. [PMID: 24288345 DOI: 10.1002/rcs.1546] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 09/13/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transoral laser microsurgery (TLM) is a mature approach to supraglottic cancer, while transoral robotic surgery (TORS) is emerging. The present study compared these approaches. METHODS The first 10 patients (2002-2005) given TLM were compared with the first 10 (2007-2011) given TORS for cT1-3 cN0-cN2c supraglottic cancer. RESULTS A feeding tube was used in four TLM and seven TORS patients. Margins were more often positive, but operating times shorter, in TORS. All 10 TORS patients are without evidence of disease, but only six TLM patients remain disease-free after much longer follow-up. TORS was considerably less uncomfortable and fatiguing for the surgeon. CONCLUSIONS TORS seems as safe and effective as TLM. Shorter TORS operating times are probably attributable to prior experience with TLM. For laryngeal exposure, length of tube placement and margin evaluability, TLM was superior; however, this may change as TORS develops and transoral robotic instruments are optimized.
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Affiliation(s)
- Mohssen Ansarin
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
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Goyal N, Yoo F, Setabutr D, Goldenberg D. Surgical anatomy of the supraglottic larynx using the da Vinci robot. Head Neck 2013; 36:1126-31. [DOI: 10.1002/hed.23418] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/15/2013] [Accepted: 06/10/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Neerav Goyal
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Frederick Yoo
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Dhave Setabutr
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - David Goldenberg
- Department of Surgery; Division of Otolaryngology - Head and Neck Surgery; The Pennsylvania State University - Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
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Balcerowiak A, Kruk-Zagajewska A, Iwanik K. [Anterior commissure status in patients with larynx cancer]. Otolaryngol Pol 2013; 67:295-301. [PMID: 24238114 DOI: 10.1016/j.otpol.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022]
Abstract
AIM OF THE WORK Assessment of directions and ways of cancer spreading in the anterior commissure of the larynx, depending on the tumor location, age, sex of patients in a clinical trial and in microscopic serial section study. MATERIALS AND METHODS The study included 50 larynx preparations obtained from open partial and total laryngectomies (F-7; M-43). For the assessment of larynx anterior commissure microscopic status 28 larynx preparations with macroscopic free anterior commissure were used. For study of the directions and ways of tumor spreading in the anterior commissure served 22 larynx with macroscopic infiltration of anterior commissure. Anterior Commissure (AC) and TNM classifications was used to determine the location and tumor stage. Larynx anterior commissure was extracted and divided into 3 subregions: supraglottic, glottic and subglottic. RESULTS The direction and the way of cancer propagation in larynx anterior commissure structures is dependent on morphological changes that occur with aging. Cancer spreads in the anterior commissure along the fibers anchoring voice muscle within the Broyles ligament and is seen in tumor cells microembolism. CONCLUSIONS In patients with cancer of the larynx without macroscopically visible neoplastic lesions in the anterior commissure, cannot be excluded its microinfilration. Changed with age anterior commissure' Broyles ligament by the process of neovascularization and ossification is not an effective protection against the spread of cancer. Directions and the ways of cancer spread in the anterior commissure is similar in men and women. AC classification can be important in qualifying patients for organ preservation surgery and should be supplemented by an additional AC4 degree, taking into account subglottic changes in the anterior commissure of the larynx.
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Affiliation(s)
- Andrzej Balcerowiak
- Klinika Otolaryngologii i Onkologii Laryngologicznej Uniwersytetu Medycznego im. Karola Marcinkowskiego, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Poland.
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71
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Böttcher A, Jowett N, Kucher S, Reimer R, Schumacher U, Knecht R, Wöllmer W, Münscher A, Dalchow CV. Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral thermal injury in comparison to superpulsed CO2 laser. Eur Arch Otorhinolaryngol 2013; 271:1121-8. [DOI: 10.1007/s00405-013-2761-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
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72
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Löhler J, Gerstner AOH, Bootz F, Walther LE. Incidence and localization of abnormal mucosa findings in patients consulting ENT outpatient clinics and data analysis of a cancer registry. Eur Arch Otorhinolaryngol 2013; 271:1289-97. [PMID: 24114062 DOI: 10.1007/s00405-013-2738-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Abstract
For patients without symptoms and at risk, there is no established early detection program to discover carcinomas of the upper aerodigestive tract in the sense of secondary prevention. Such type of prevention seems even more desirable because the chances for a cure and the quality of life are strongly dependent on the stage of the tumor and the time of the initial diagnosis. Six hundred and eight patients without symptoms but at least one of the self-reported risk factors "smoking", "alcohol consumption" or "reflux" were examined with an endoscope or an optical microscope for pathological findings in the upper aerodigestive tract once a year. In addition, the incidence of malignancies of the upper aerodigestive tract between 2001 and 2010 was determined through the Cancer Registry of Schleswig-Holstein. Tissue samples were taken from 18 of the 608 patients. Eleven patients (1.8%) had a squamous cell carcinoma. Another patient suffered from non-Hodgkin's lymphoma and one from larynx tuberculosis. The ratio of detected malignancies in the oral cavity and the oropharynx on the one hand and the hypopharynx and larynx, which can only be examined by endoscopes, on the other hand were in our cohorts and in our survey according to the cancer registry was 5/6. The above-described methods allow examining risk patients easily and safely. According to current publications, the ratio of the found malignancies exceeds the expected ratio significantly, which presumably was caused by the examination targeting patients at risk. Due to the expanded examination area using optical instruments more than doubles the rate of discoverable malignancies compared to the limitations posed by the examination of directly visible areas of the oral cavity of the oropharynx.
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Affiliation(s)
- J Löhler
- Research Institute for Applied Otolaryngology (WIAHNO) of the German Professional Association of Otolaryngologists e. V., Maienbeeck 1, 24576, Bad Bramstedt, Germany,
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73
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Outcomes of transoral laser microsurgery for recurrent head and neck cancer. The Journal of Laryngology & Otology 2013; 127:982-6. [PMID: 24093129 DOI: 10.1017/s0022215113001953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To report our outcomes with salvage CO2 laser surgery following recurrence of laryngeal and oropharyngeal cancer after radiotherapy. METHOD This study entailed a prospective review of patients treated with transoral laser microsurgery for recurrent laryngeal and oropharyngeal cancer between 2002 and 2010 at the Queen Elizabeth II Health Science Centre in Canada. RESULTS Sixteen patients were identified, with a mean follow up of 30.6 months. Five patients died of recurrence. Complications were common in patients with oropharyngeal cancer. The overall survival and disease-free survival rates at an average of 29.8 months follow up were 50 per cent and 68.8 per cent respectively. CONCLUSION Salvage surgery using transoral laser microsurgery should be considered in the management of patients with recurrent laryngeal and oropharyngeal cancer. This technique offers acceptable salvage rates with less comorbidity than other treatments.
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74
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Mercante G, Grammatica A, Battaglia P, Cristalli G, Pellini R, Spriano G. Supracricoid partial laryngectomy in the management of t3 laryngeal cancer. Otolaryngol Head Neck Surg 2013; 149:714-20. [PMID: 23921496 DOI: 10.1177/0194599813500018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the oncologic results only in T3 glottic and supraglottic cancers regarding supracricoid partial laryngectomy (SCPL) not requiring total laryngectomy and to assess functional results by self-evaluation by the patient. Study Design Case series with medical record review. SETTING Single tertiary care center. SUBJECTS AND METHODS Thirty-two patients with laryngeal squamous cell carcinoma, previously untreated, who underwent SCPL with cricohyoidopexy or cricohyoidoepiglottopexy were reviewed. RESULTS At 1, 3, and 5 years, the disease-free survival rates were 96.9%, 89.4%, and 78.2%; overall survival rates were 96.9%, 93.2%, and 87.3%; local control and locoregional control rates were 100%, 96.2%, and 96.2%; and distant metastasis-free survival rates were 100%, 100%, and 88.2%, respectively. Aspiration pneumonia was the most common complication observed. The 3 laryngeal functions (speech, swallowing, and breathing) were spared in 83.9% of patients. CONCLUSION Supracricoid partial laryngectomy for selected glottic and supraglottic T3 tumors has excellent oncologic and functional results.
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Affiliation(s)
- Giuseppe Mercante
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
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75
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Hazard of CO₂ laser-induced airway fire in laryngeal surgery: experimental data of contributing factors. Eur Arch Otorhinolaryngol 2013; 270:2701-7. [PMID: 23636479 DOI: 10.1007/s00405-013-2521-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
In carbon dioxide (CO2) laser surgery of the larynx, the potentially dangerous combination of laser-induced heat in an oxygen-enriched atmosphere typically occurs when jet ventilation is used or due to an insufficiently blocked endotracheal tube. Until now, no limitations for safe oxygen concentrations or laser intervals have been established. The aim of this study was to investigate and quantify the factors that may contribute to an airway fire in laryngeal laser surgery. Fat, muscle and cartilage were irradiated with a CO2 laser at 2, 4, 6 and 8 W in five different oxygen concentrations with and without smoke exhaustion. The time to ignition was recorded for each different experimental setup. Fat burnt fastest, followed by cartilage and muscle. The elevation of laser energy or oxygen concentration reduced the time to inflammation of any tissue. The elevation of oxygen by 10 % increases the risk of inflammation more than the elevation of laser power by 2 W. Under smoke exhaustion, inflammation and burning occurred delayed or were even inhibited at lower oxygen concentrations. Lasing in more than 50 % oxygen is comparatively dangerous and can cause airway fire in less than 5 s, especially when laser energies of more than 5 W are applied. In equal or lower than 50 % oxygen, an irradiation interval of 5 s can be considered a comparatively safe time limit to prevent inflammation in laryngeal laser surgery. Smoke exhaustion should always be applied.
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76
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Huang J, Yu Z, Fang J, Chen X, Chen X, Huang Z. Salvage transoral laser microsurgery for early recurrent glottic carcinoma after primary laser treatment. Acta Otolaryngol 2013; 133:531-7. [PMID: 23350599 DOI: 10.3109/00016489.2012.734929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Salvage transoral laser microsurgery (TLM) may be a curative organ-preserving treatment for early recurrent glottic carcinoma after primary laser resection. However, failure after TLM seems to be associated with decrease of survival and larynx preservation rates. OBJECTIVE To evaluate the oncological results of salvage TLM for early recurrent glottic carcinoma after primary laser treatment. METHODS Records of 50 patients with local recurrences of glottic carcinoma treated by salvage TLM between January 1994 and December 2008 were retrospectively analyzed. RESULTS Thirty-six rT1 and 14 rT2 lesions were treated with salvage TLM. Mean follow-up was 68.3 months. Thirty-one patients were cured by first salvage TLM and four by further laser procedures. The other 15 patients were finally salvaged by laryngectomy or radiotherapy. Five-year overall survival, disease-specific survival, local control, and loco-regional control rates were 89.9%, 97.9%, 62.3%, and 60.1%, respectively. Larynx preservation rate after long-term follow-up was 86%. In univariate analysis, second local recurrence showed a statistically significant impact on disease-specific survival rate ( p = 0.049) and larynx preservation rate ( p = 0.006). In multivariate analysis, it was associated with a statistically significant decrease in larynx preservation rate ( p = 0.016). There was no statistically significant difference in oncological results between patients with and without anterior commissure involvement.
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Affiliation(s)
- Junwei Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Capital Medical University, Beijing, China
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Vilaseca I, Bernal-Sprekelsen M. Transoral Laser Microsurgery for Locally Advanced Laryngeal Cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.otoeng.2013.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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78
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Vilaseca I, Bernal-Sprekelsen M. Tratamiento de los tumores laríngeos localmente avanzados mediante microcirugía transoral láser. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:140-9. [DOI: 10.1016/j.otorri.2012.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
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Lapotko DO. Nanophotonics and theranostics: will light do the magic? Theranostics 2013; 3:138-40. [PMID: 23472062 PMCID: PMC3590583 DOI: 10.7150/thno.6062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 12/31/2022] Open
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Abstract
Glottal gaps can be either physiological or pathological. The latter are multifactorial, predominantly organic in origin and occasionally functional. Organic causes include vocal fold paralysis or scarring, as well as a deficiency or excess of tissue. In addition to loss of the mucosal wave, the degree of hoarseness is primarily determined by the circumferential area of the glottal gap. It is thus important to quantify the extent of glottal insufficiency. Although a patient's symptoms form the basis for treatment decisions, these may be subjective and inadequately reflected by the results of auditory-perceptual evaluation, voice analysis and voice performance tests. The therapeutic approach should always combine phonosurgery with conventional voice therapy methods. Voice therapy utilises all the resources made available by the sphincter model of the aerodigestive tract and knowledge on the mechanism of voice production. The aim of phonosurgery is medialization, reconstruction or reinnervation by injection laryngoplasty or larynx framework surgery. These different methods can be combined and often applied directly after vocal fold surgery (primary reconstruction). In conclusion, the techniques described here can be effectively employed to compensate for glottal gaps.
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81
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Hong JC, Kim SW, Lee HS, Han YJ, Park HS, Lee KD. Salvage Transoral Laser Supraglottic Laryngectomy after Radiation Failure: A Report of Seven Cases. Ann Otol Rhinol Laryngol 2013; 122:85-90. [PMID: 23534122 DOI: 10.1177/000348941312200203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We evaluated the oncological and functional outcomes of salvage transoral laser supraglottic laryngectomy after radiation failure. In addition, we demonstrated the usefulness of laser surgery in patients with recurrent supraglottic cancer. Methods: Between December 1999 and May 2011, 7 patients (6 men and 1 woman) underwent transoral laser supraglottic laryngectomy after radiation failure. We conducted 4 different types of endoscopic supraglottic laryngectomy. In the cases with lymph node metastasis, we performed neck dissection at the time of laser surgery. Results: All patients had recurrent squamous cell carcinoma confirmed on the surgical specimen. Two patients were classified as having T1 disease, 2 as having T2 disease, and 3 as having T3 disease with preepiglottic space involvement. The 2- and 5-year overall survival rates were 85.7% and 68.6%, respectively. There was a recurrence at 8 months of follow-up after laser surgery in 1 patient; he underwent successful salvage total laryngectomy. The ultimate local control rate was 100%, and the laryngeal preservation rate was 85.7%. The hospitalization times ranged from 2 to 32 days (mean, 15.6 days). The mean decannulation time was 10.7 days (range, 5 to 30 days). All patients started oral feeding within 1 to 3 days after surgery. Conclusions: Salvage transoral laser supraglottic laryngectomy following radiation failure seems a feasible and oncologically safe procedure in recurrent supraglottic cancers ranging from T1 to selected T3 with minimal preepiglottic space involvement. It can be an option for minimally invasive organ preservation surgery with lesser morbidity for recurrent supraglottic cancer.
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Affiliation(s)
- Jong Chul Hong
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
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82
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Goessler UR. Traditional transcutaneous approaches in head and neck surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc06. [PMID: 23320058 PMCID: PMC3544212 DOI: 10.3205/cto000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing.In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool.In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.
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Arens C. Transoral treatment strategies for head and neck tumors. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc05. [PMID: 23320057 PMCID: PMC3544208 DOI: 10.3205/cto000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.
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Affiliation(s)
- Christoph Arens
- Clinic for Ear, Nose and Throat Medicine, University Hospital Magdeburg, Germany
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Abstract
The main issue in the management of glottic squamous cell carcinoma, as for all cancers, is adequate disease control while optimizing functional outcomes and minimizing morbidity. This is true for early-stage disease as for advanced tumors. This article evaluates the current evidence for the diagnostic and pretherapeutic workup for glottic squamous cell carcinoma and the evidence concerning different treatment options for glottic carcinoma, from early-stage to advanced-stage disease.
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Affiliation(s)
- Dana M Hartl
- Department of Head and Neck Oncology, Institut Gustave Roussy, Villejuif, France.
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85
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Han YJ, Lee HS, Kim SW, Hong JC, Kim ST, Park HS, Lee KD. Transoral laser microsurgery of recurrent early glottic cancer after radiation therapy: clinical feasibility and limitations. Ann Otol Rhinol Laryngol 2012; 121:375-82. [PMID: 22737959 DOI: 10.1177/000348941212100603] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) is an accepted alternative to open partial laryngectomy for selected glottic cancers, but its role in salvage of radiation failure is debated. METHODS The records of 18 patients treated by TLM for rT1 and rT2 glottic cancer after curative radiation therapy from 2002 to 2007 were retrospectively analyzed. RESULTS Of the 18 patients, 10 (56%) remained free of disease after the first TLM. The 5-year local control and laryngeal preservation rates showed better outcomes in rpT1 tumors than in rpT2 tumors (87.5% versus 16.6%, p = 0.02; and 87.5% versus 33.3%, p = 0.03, respectively). However, the 5-year overall survival and disease-specific survival rates showed no significant difference between rpT1 and rpT2 tumors. CONCLUSIONS TLM can be a relatively safe and effective salvage option for rT1 glottic cancer. However, because of its high local recurrence rate, TLM may not be generally recommended for rT2 glottic cancer.
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Affiliation(s)
- Young Jin Han
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Ambrosch P, Fazel A. Functional organ preservation in laryngeal and hypopharyngeal cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc02. [PMID: 22558052 PMCID: PMC3341579 DOI: 10.3205/cto000075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology - Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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Shenoy AM, Prashanth V, Shivakumar T, Chavan P, Akshay S, Kumar RV, Devi S. The utility of second look microlaryngoscopy after trans oral laser resection of laryngeal cancer. Indian J Otolaryngol Head Neck Surg 2012; 64:137-41. [PMID: 23730573 DOI: 10.1007/s12070-012-0496-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/19/2012] [Indexed: 11/24/2022] Open
Abstract
In the past few decades more and more number of tumors of the glottis and supraglottis are been treated with single stage transoral laser microsurgery (TOLS). TOLS for the treatment of glottic and supraglottic carcinoma with anterior commissure (A-com) and/paraglottic space involvement is associated with a high rate of recurrence. We prospectively evaluated the outcomes of laser microsurgery and the impact of second look operation in these patients. Twenty-three patients with glottic and supraglottic carcinoma underwent transoral laser micro resection of the lesions. Subsequently five patients underwent second look microlaryngeal evaluation 6-8 months later for non-satisfactory healing, poor voice, and or suspicion of recurrent disease. Patients with A-com involvement and or paraglottic space involvement were followed up longitudinally for the effectiveness and timing of second look microsurgery. After initial transoral laser micro resection, all patients achieved microscopically clear resection margins. At second look microlaryngeal evaluation, local recurrence was found in four of 23 patients. Of these, two patients were salvaged by second look surgery and are disease free, whereas in two others, the larynx had to be subjected to open surgical intervention. One of two had extensive local recurrent tumor and underwent total laryngectomy with neck dissection followed by post-operative radiotherapy. Tracheohyoidopexy was done with successful functional and oncologic outcome for another patient who had local recurrence for the third time. Only the patient who underwent total laryngectomy with neck dissection was subjected to adjuvant post-operative radiotherapy. Finally, larynx was saved in 21 out of 23 patients.
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Affiliation(s)
- Ashok M Shenoy
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures. Eur Arch Otorhinolaryngol 2012; 269:1635-46. [DOI: 10.1007/s00405-012-1928-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 01/10/2012] [Indexed: 11/27/2022]
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McClelland L, Carr E, Kamani T, Cade J, Young K, Mortimore S. Transoral laser microsurgery for early glottic cancer. ISRN OTOLARYNGOLOGY 2011; 2011:750676. [PMID: 23724259 PMCID: PMC3658501 DOI: 10.5402/2011/750676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/13/2011] [Indexed: 11/23/2022]
Abstract
Objectives. To assess the outcome of transoral laser-assisted microsurgery (TLM) with regards to local and distant tumour control, quality of voice and swallowing. Design. Retrospective review of patients with five-year follow-up period. Setting. Royal Derby Hospital Head and Neck Department. Participants. All patients undergoing TLM with a diagnosis of Tis, T1, or T2 glottic tumour following endoscopic biopsy. Main Outcome Measures. Speech, swallowing, cancer-free survival, laryngectomy-free survival, and mortality rate. Results. 22 patients were treated for early glottic carcinoma with TLM. The 5-year local control rate for T1 tumours is 89% and 56% for T2 tumours. The laryngectomy rate was 4.5%. The mortality rate from local and distant disease was 4.5% with an overall mortality rate of 22% from all causes. 40% of patients had normal voices and a further 45% had only mild or moderate voice change. At their last followup, no patients assessed had any difficulty swallowing relating to their treatment for glottic cancer. Conclusion. Transoral Endoscopic CO2 laser microsurgery is a valid technique for treating early glottic tumours.
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Löhler J, Gerstner AOH, Bootz F, Heinritz H, Fryen A, Fryen G, Holstein N, Lingg A, Kleeberg J, Langhoff W, Rösch G, Hanisch A, Schneeberg E, Heinrich D, Walther LE. [Prevalence of abnormal mucosal findings in patients in HNO practices]. HNO 2011; 60:240-8. [PMID: 22037968 DOI: 10.1007/s00106-011-2381-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To date, no secondary prevention program is in place for patients carrying an increased risk for developing head and neck cancer (HNSCC). In terms of successful, long-term curative therapy and increased quality of life, it would be useful to detect such diseases at an early stage. PATIENTS AND METHODS A total of 370 patients with at least one risk factor such as "smoking", "alcohol", or "reflux disease" and without any symptoms were examined during a 1-year period using standard HNO methods (e. g. endoscopy) for suspicious alterations of the mucosa of the upper aerodigestive tract. RESULTS In 13 (3.5%) of all 370 cases a biopsy was taken for further diagnosis. Squamous cell carcinoma was found in eight cases, while one further patient was suffering from non-Hodgkin lymphoma. CONCLUSIONS It is simple and safe to examine patients at risk of developing HNSCC by standard HNO methods. The rate of detected carcinomas is much higher than in former investigations, likely because our survey focused only on patients with specific risk factors.
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Affiliation(s)
- J Löhler
- Wissenschaftliches Institut für angewandte HNO-Heilkunde des Deutschen Berufsverbandes der HNO-Ärzte e. V., Maienbeeck 1, 24576, Bad Bramstedt, Deutschland.
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91
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Glottic laser surgery: outcomes according to 2007 ELS classification. Eur Arch Otorhinolaryngol 2011; 268:1771-8. [PMID: 21769448 DOI: 10.1007/s00405-011-1695-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 06/24/2011] [Indexed: 10/18/2022]
Abstract
The aim of the present investigation was to analyze the oncological results of a series of early stage glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery. We focused on prognosis factors with significant impact on local control and disease-free survival (DFS). This retrospective study was conducted on a series of 177 consecutive patients with pT1-T2 glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery in the period 2000-2007. All considered patients had at least a 24-month follow-up period (mean follow-up 49.1 ± 23.0 months). The overall survival and the disease-specific survival rates were respectively 90.8 and 98.8%. The rates of local control with primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 86.3, 94.3, and 97.7%, respectively. Arytenoids (p = 0.006) and limited subglottic involvements (p = 0.0002) have a significant impact on DFS. Endoscopic laser surgery is the gold standard in the treatment of early glottic carcinoma because of high local control rates with laser alone, day surgery modality, very low morbility, good post-operative voice quality in most of the cases, and low costs.
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92
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Csanády M, Czigner J, Vass G, Jóri J. Transoral CO2 laser management for selected supraglottic tumors and neck dissection. Eur Arch Otorhinolaryngol 2011; 268:1181-1186. [DOI: 10.1007/s00405-011-1603-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 04/06/2011] [Indexed: 11/24/2022]
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93
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Spielmann PM, Majumdar S, Morton RP. Quality of life and functional outcomes in the management of early glottic carcinoma: a systematic review of studies comparing radiotherapy and transoral laser microsurgery. Clin Otolaryngol 2011; 35:373-82. [PMID: 21108747 DOI: 10.1111/j.1749-4486.2010.02191.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early glottic carcinoma can be managed by radiotherapy and transoral laser microsurgery with similar control and survival rates. The functional and quality of life outcomes of these interventions are therefore important to guide management. OBJECTIVE OF REVIEW To compare the different treatment modalities for early glottic carcinoma with respect to quality of life, post-treatment voice character and swallowing outcomes. TYPE OF REVIEW A systematic review of the literature with defined search strategy. SEARCH STRATEGY Searches of EBM databases, and literature databases using key words: glotti*, laryn*, neoplasm, radiotherapy and laser surgery from 1970 to November 2009. Articles were screened for relevance using pre-determined inclusion and exclusion criteria. EVALUATION METHOD Articles reviewed by authors and data compiled in tables for analysis. RESULTS No randomised controlled trials were identified. There were 15 studies reporting vocal outcomes, and perception of voice disability was measured in eight studies; numbers were low in all the papers. Cumulatively, results for 880 patients were included, 448 had trans-oral laser microsurgery and 442 had radiotherapy. For vocal outcomes, 12 studies found no significant difference between radiotherapy and laser surgery, three reported superior outcomes for radiotherapy, whereas for the perception of voice disability, five reported no difference between treatment groups, while the remaining three reported conflicting results. Nine studies reported quality of life outcomes; seven of these reported no difference between the treatment groups in overall scores although some report differences in subsets of questions. CONCLUSIONS The evidence base to date demonstrates comparable vocal and quality of life outcomes for radiotherapy and transoral laser surgery for early glottic carcinoma. There is a need for consensus on which measures of vocal quality and life satisfaction to be used in research trials to allow comparison between studies.
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Affiliation(s)
- P M Spielmann
- University Department of Otolaryngology, Ninewells Hospital, Dundee, UK.
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94
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Alon EE, Kasperbauer JL, Olsen KD, Moore EJ. Feasibility of transoral robotic-assisted supraglottic laryngectomy. Head Neck 2011; 34:225-9. [DOI: 10.1002/hed.21719] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 10/14/2010] [Accepted: 12/13/2010] [Indexed: 11/05/2022] Open
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95
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Mantsopoulos K, Psychogios G, Koch M, Zenk J, Waldfahrer F, Iro H. Comparison of different surgical approaches in T2 glottic cancer. Head Neck 2011; 34:73-7. [PMID: 21374754 DOI: 10.1002/hed.21687] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate retrospectively the oncologic results of endoscopic and open surgical techniques in treating T2 glottic carcinomas. METHODS The medical chart of 354 patients with T2 glottic cancer managed with primary surgery were reviewed. Laser microsurgery and frontolateral partial laryngectomy were compared for disease-specific survival and local control rates, incidence of major complications, and related tracheostomies. Additionally, the influence of the anterior commissure invasion on these oncologic parameters was evaluated. RESULTS No statistically significant differences were found between the surgical procedures regarding our oncologic parameters. A lower incidence of tracheotomies and complications were comparatively found for laser surgery. Tumor invasion of the anterior commissure did not seem to influence the oncologic results. CONCLUSION Transoral surgery seems to be the treatment of choice for T2 glottic cancer. In our view, open partial laryngectomy should be reserved for those cases in which the lesion cannot be adequately exposed by direct microlaryngoscopy.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen - Nuremberg Medical School, Germany
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96
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Hartl DM, Ferlito A, Brasnu DF, Langendijk JA, Rinaldo A, Silver CE, Wolf GT. Evidence-based review of treatment options for patients with glottic cancer. Head Neck 2011; 33:1638-48. [PMID: 21990228 DOI: 10.1002/hed.21528] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 11/08/2022] Open
Affiliation(s)
- Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France.
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97
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Wang CJ, Knecht R. Current concepts of organ preservation in head and neck cancer. Eur Arch Otorhinolaryngol 2010; 268:481-7. [PMID: 21107854 DOI: 10.1007/s00405-010-1407-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 10/08/2010] [Indexed: 11/24/2022]
Abstract
The treatment of laryngeal and hypopharyngeal cancer nowadays is not limited by surgical resection. There are many interdisciplinary approaches which we can offer these patients in our clinics. These include radiotherapy, chemotherapy, biologicals and surgery. The combination of radiotherapy, chemotherapy, biologicals and surgery techniques more and more allows us to perform organ and function preservation in a former often mutilating and function destroying treatment. Since the early 1990s, evidence from large randomized trials has shown that organ preservation studies using sequential and concomitant radio-chemotherapy do not compromise survival when compared with surgery followed by radiotherapy. However, using these therapies side effects have to be taken into consideration and not organ preservation but function preservation is the treatment goal. The current most common treatment options are shown here in this review. For future treatment protocols there is an urgent need to refine the definition of a functional organ, to define quality of life endpoints and to refine the recommendations for evaluating treatment response.
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Affiliation(s)
- C-J Wang
- Department of Head and Neck Surgery and Otolaryngology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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98
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Karatzanis AD, Waldfahrer F, Psychogios G, Hornung J, Zenk J, Velegrakis GA, Iro H. Effect of repeated laser microsurgical operations on laryngeal cancer prognosis. Head Neck 2010; 32:921-8. [PMID: 19924806 DOI: 10.1002/hed.21272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate whether repeated sessions of transoral CO(2) laser microsurgery (TLM) aiming to achieve clear histologic margins carry a negative effect on the prognosis of laryngeal cancer. METHODS This was a retrospective evaluation of 763 cases that underwent primary TLM treatment for laryngeal cancer. Cases were compared for overall survival and local control rates with respect to status of surgical margins and number of procedures necessary to achieve these margins. RESULTS No significant differences were noted among cases with negative surgical margins regardless of the number of procedures necessary to achieve these margins. On the other hand, positive margins at the end of surgical treatment carried significant negative prognostic effect. CONCLUSION The prognostic effect of negative surgical margins in TLM for laryngeal cancer is significant regardless of the number of procedures required to obtain such margins.
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Affiliation(s)
- Alexander D Karatzanis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen - Nuremberg Medical School, Erlangen, Germany
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99
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Vilaseca I, Bernal-Sprekelsen M, Luis Blanch J. Transoral laser microsurgery for T3 laryngeal tumors: Prognostic factors. Head Neck 2010; 32:929-38. [PMID: 19953612 DOI: 10.1002/hed.21288] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the outcomes of transoral laser microsurgery (TLM) in T3 laryngeal carcinomas and to identify prognostic factors for survival and laryngeal preservation. METHODS This study aimed to provide a retrospective analysis of 147 consecutive patients, evaluating their overall survival, disease-specific survival, laryngectomy-free survival, and function preservation rate. RESULTS Five-year overall, disease-specific, and laryngectomy-free survivals were 53.1%, 70.2%, and 62.3%, respectively. Disease-specific survival differed between glottic and supraglottic tumors (86.3% vs 61.8%; p = .015). Function preservation was 65.5% in supraglottic and 49.1% in glottic tumors (p = .002). Disease-specific survival was not related to pre-epiglottic involvement, cord fixation, or focal cartilage infiltration (p > .05). Vocal cord fixation and cartilage infiltration were independent negative prognostic factors for organ preservation (odds ratio [OR] = 0.184; 95% confidence interval [CI] = 0.082-0.411; p = .000 and OR = 0.331; 95% CI = 0.139-0.789; p = .013, respectively). CONCLUSION Our conclusion is that TLM is a good alternative in a large number of T3 laryngeal tumors, with adequate survival and organ preservation rates above 60%.
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Affiliation(s)
- Isabel Vilaseca
- Department of Oto-Rhino-Laryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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100
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Blanch JL, Vilaseca I, Caballero M, Moragas M, Berenguer J, Bernal-Sprekelsen M. Outcome of transoral laser microsurgery for T2-T3 tumors growing in the laryngeal anterior commissure. Head Neck 2010; 33:1252-9. [PMID: 21837693 DOI: 10.1002/hed.21605] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To evaluate the outcomes of transoral laser microsurgery (TLM) in the treatment of T2 to T3 laryngeal carcinomas growing in the laryngeal anterior commissure. METHODS This study was a retrospective analysis of 107 patients. Overall survival, disease-specific survival, and laryngectomy-free survival were analyzed. Technical difficulties, postoperative complications, influence of the learning curve, and the number of surgeries were evaluated. RESULTS Five-year overall survival, disease-specific survival, and laryngectomy-free survival were 71%, 79.5%, and 71.4%, respectively. The probability of tumor relapse was related to the status of the margins (p = .01) and to surgical experience (p = .02), but not to tumor exposure (p = .78) or pT category (p = .36). Disease-specific survival differed significantly between the group of patients treated in the early period of surgical experience and those treated in the advanced period of surgical experience (71% vs 94%; p = .02) CONCLUSION TLM is a useful treatment for T2 to T3 laryngeal carcinomas growing in the laryngeal anterior commissure when it is performed under an advanced learning curve.
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Affiliation(s)
- José-Luis Blanch
- ENT Surgical Oncology Section, Hospital Clínic, Barcelona, Spain
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