Precise laser incisions, corrected for patient respiration with an intelligent aiming system

Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management, and outcome

Although transoral laser surgery (TLS) for the treatment of early stage glottic carcinoma is now widely used, the patterns of local recurrences, related re-treatment methods, and results have not been documented comprehensively. Two hundred fifty-two patients with glottic carcinoma stage I or II were treated for cure with TLS alone and followed up for 24 to 139 months (mean, 62 months). Their charts were retrospectively reviewed to identify local recurrence patterns. Thirty-five patients (13.9%) presented with local recurrences or second laryngeal primaries 4 to 84 months (mean, 23 months) after initial treatment. Of the 161 patients classified T1N0M0, 21 (13.0%) suffered local recurrences, and in the 91 classified T2N0M0, 14 (15.4%) tumors recurred. If tumors recurring more than 60 months after initial treatment are considered second primary tumors rather than recurrences, then only 18 (11.2%) of 161 patients classified T1N0M0 would have had a recurrence. However, the difference in local control between patients with stage I versus stage II disease would still not be significant (p = .41). Of the 35 patients with local recurrences, 16 (45%) were managed with total laryngectomy, 10 (28.6%) with further TLS, 4 (11.4%) with partial laryngectomy, and 2 (5.7%) with radiotherapy, and 3 (8.6%) had no curative treatment. Accordingly, 16 patients (45.7%) with local treatment failure could be treated with further organ-sparing treatment methods. The actuarial overall survival, disease-specific survival, and organ preservation rates 5 years after the diagnosis of recurrent disease were 43.6%, 74.6%, and 33.7%. Transoral laser surgery leads to local control rates that are comparable to those found after radiotherapy for lesions classified T1 and leads to slightly better control rates for lesions classified T2, but the results are inferior to those achieved with conventional partial laryngectomy. However, if local recurrence occurs, then more re-treatment options are available after TLS as compared to initial radiotherapy or open surgery.

Potential role of transoral laser surgery for larynx carcinoma

BACKGROUND AND OBJECTIVE

The treatment of larynx carcinoma is not settled to date. This prospective study evaluates the potential role of transoral laser surgery (TLS) for larynx carcinoma in a large series of unselected patients from a single institution.

MATERIALS AND METHODS

A total of 504 consecutive patients with previously untreated carcinoma of the larynx were seen from 1986-1994. Their treatment modalities and results were prospectively evaluated.

RESULTS

TLS was used in 290 patients (58%), total laryngectomy in 130 (26%), conventional partial laryngectomies in 31 (6%), and radiotherapy in 34 (7%). Nineteen (4%) had no curative treatment. Uncorrected actuarial survival for all patients with glottic carcinoma stages I and II treated with laser surgery (n = 202) was 80.2%, cause specific survival 96.7%, and local control 85.8%. Uncorrected actuarial survival for all patients with supraglottic carcinoma stages I and II treated with laser surgery (n = 40) was 49.0%, cause specific survival 78.6%, and local control 87.3%.

CONCLUSION

TLS was the most important single treatment modality in this large series of unselected patients. It is a safe and time- and cost-effective alternative to radiotherapy for early stage larynx carcinoma.

Effect of pulse duration on wound healing using a CO2 laser

The authors investigated wound healing of incisions in the buccal mucosa of a canine model created using a CO2 laser with a short pulse structure (60 micros, 100 micros, and 120 micros) rather than a conventional continuous wave structure in a shuttered mode. The tissue from 10 animals was evaluated histologically and with tensiometry acutely and at postoperative days 3, 7, and 14. A Bonferroni-Dunn corrected ANOVA analysis at a 95% significance level was used to compare the effect of pulse duration on histologic morphology and wound tensile strength. The data indicate that shorter laser pulse durations create less lateral thermal injury (P < .009) and wounds with greater tensile strength (P < .005), resulting in earlier wound healing. The results also show that heat, sufficient to damage tissue, was conducted to adjacent tissue during laser pulses of 100 micros and longer. These results demonstrate that surgical CO2 lasers with a short pulse structure of approximately 60 micros or less could offer more prompt wound healing while maintaining the advantages of a 10.6-microm wavelength laser.