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Bernard SE, van Lanschot CGF, Hardillo JA, Monserez DA, Meeuwis CA, Baatenburg de Jong RJ, Koljenović S, Sewnaik A. A New Proposal for Adequate Resection Margins in Larynx and Hypopharynx Tumor Surgery-Are the RCP Guidelines Feasible? Cancers (Basel) 2024; 16:2058. [PMID: 38893176 PMCID: PMC11171079 DOI: 10.3390/cancers16112058] [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: 04/22/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Resection margins are an important prognostic factor for patients with head and neck cancer. In general, for head and neck surgery, a margin >5 mm is advised by the Royal College of Pathologists. However, this cannot always be achieved during laryngeal and hypopharyngeal surgery. The aim of this study is to identify the resection surfaces and measure the maximum feasible margins per subsite. The clinical relevance of these maximum feasible resection margins were analyzed in this descriptive anatomical study. METHODS head and neck surgeons and a pathologist from the Erasmus MC performed a total laryngectomy and laryngopharyngectomy on a head and neck specimen specifically available for research. RESULTS For a total laryngectomy, resection margins >5 mm were not feasible for the ventral and dorsal resection surface. For a total laryngopharyngectomy, resection margins >5 mm were not feasible for the ventral, dorsal and lateral resection surface. CONCLUSION Clear resection margins, defined as a margin >5 mm, are not always feasible in laryngeal and hypopharyngeal surgery, due to the anatomy of the larynx and tumor location. However, striving for a maximum feasible margin is still the main goal. We propose a new guideline for maximum feasible but adequate resection margins in larynx and hypopharynx tumor surgery.
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Affiliation(s)
- Simone E. Bernard
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Cornelia G. F. van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jose A. Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Dominiek A. Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Cees A. Meeuwis
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Robert J. Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pathology, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Belgium
- Faculty of Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Bernard SE, van Lanschot CGF, Sewnaik A, de Ridder MAJ, Hardillo JA, Monserez DA, Baatenburg de Jong RJ, Koljenović S. Clinical Relevance of Resection Margins in Patients with Total Laryngectomy or Laryngopharyngectomy. Cancers (Basel) 2024; 16:2038. [PMID: 38893157 PMCID: PMC11171336 DOI: 10.3390/cancers16112038] [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: 04/22/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Laryngeal and hypopharyngeal cancer is complex and resection margins are therefore constrained. The aim of this study was to investigate the clinical relevance of resection margins in laryngeal and hypopharyngeal surgery. METHODS A retrospective cohort study was performed for patients treated with a total laryngectomy (TL) or laryngopharyngectomy (TLP) for laryngeal or hypopharyngeal squamous cell carcinoma (LSCC and HSCC, respectively). Within the groups primary LSCC, recurrent LSCC, primary HSCC, and recurrent HSCC the relationship between the status of the resection margin according to the Royal Collage of Pathology and the recurrence and survival rates were investigated. RESULTS Positive resection margins were found in 54% for primary LSCC, 29% for recurrent LSCC, 62% for primary HSCC, and 44% for recurrent HSCC. For primary and recurrent LSCC, there was a linear association between total recurrence and narrowing margins (p = 0.007 resp. p = 0.008). Multivariate survival analysis for primary and recurrent LSCC showed a significantly worse disease free and disease-specific survival in case of positive margins compared to clear margins. CONCLUSION Similar survival rates were recorded for close and clear margins for primary and recurrent LSCC. This may suggest that a margin > 5 mm is not clinically relevant in terms of survival. Therefore, a margin of 1-5 mm should be accepted in certain subsites. Margins < 1 mm are related to significantly worse outcomes and should be avoided.
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Affiliation(s)
- Simone E. Bernard
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Cornelia G. F. van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maria A. J. de Ridder
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jose A. Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Dominiek A. Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Robert J. Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pathology, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Belgium
- Faculty of Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium
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Free Flap microvascular pharyngeal closure results in improved dysphagia-specific quality of life following total laryngectomy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Total laryngectomy (TL) as either a primary or salvage treatment strategy remains an effective oncologic operation in the management of laryngeal cancer. Dysphagia is the most common complication following TL and this has a significant impact on patients’ quality of life (QOL). Following removal of the larynx, a number of pharyngeal closure techniques exist. We aimed to evaluate the effect pharyngeal closure techniques have on dysphagia-specific QOL postoperatively.
Methods
We retrospectively reviewed patients who had undergone TL at our institution (2014–2019). Patients alive at the time of study were invited to complete the MD Anderson Dysphagia Inventory (MDADI). Outcomes were compared among Primary Closure (PC), Pedicled Pectoralis Major Myocutaneous Flap (PMMF) and Free Flap (FF) closure groups.
Results
There were 27 patients identified for inclusion. Eight patients (30%) underwent PC, 10 patients (37%) had PMMF-assisted closure and 9 patients (33%) underwent FF-assisted closure. Patients within the FF group scored consistently higher MDADI scores across all subscales (emotional, functional, physical, global) as well as composite MDADI score in comparison to the PC and PMMF groups. FF closure was associated with a reduced inpatient length of stay (LOS). Additionally, no significant differences in postoperative morbidity including rates of pharyngo-cutaneous fistula (PCF) were observed between groups.
Conclusions
We now advocate FF closure for our patients following salvage TL due to the improved dysphagia-specific QOL, reduced inpatient LOS and lack of additional surgical morbidity.
Level of evidence, Level III, therapeutic/prognostic study.
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Miśkiewicz-Orczyk K, Ścierski W, Lisowska G, Zięba N, Misiołek M. Factors Associated with Outcomes Following Salvage Surgery for Recurrent Laryngeal Cancer: A Retrospective Study of 50 Cases from a Single Center in Poland. Med Sci Monit 2021; 27:e932004. [PMID: 34535622 PMCID: PMC8456775 DOI: 10.12659/msm.932004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This retrospective study from a single center in Poland aimed to identify factors associated with outcomes following salvage surgery in 50 patients with recurrent laryngeal cancer. MATERIAL AND METHODS The study group consisted of 50 patients with recurrent laryngeal cancer after primary organ preservation treatment (12 patients after partial surgery, 30 patients after radiation therapy, and 8 patients after prior treatment using both methods). None of the patients received chemotherapy before salvage surgery. All patients with recurrence of laryngeal cancer underwent total laryngectomy with elective bilateral nodal surgery. Local and/or nodal recurrence was considered the failure of primary organ preservation treatment. Efficacy of treatment was assessed in relation to overall survival (OS), disease-free survival (DFS), local control (LC), and locoregional control (LRC). RESULTS Treatment results showed a poor prognosis in patients with local and/or nodal recurrence of laryngeal cancer. In the study group, the updated 5-year rates were as follows: OS rate of 26%; DFS rate of 25%; LC rate of 44%; and LRC rate of 39%. Univariate analysis showed that the stage before primary treatment was a predictive factor of OS (P=0.012). CONCLUSIONS The findings from this retrospective study of 50 patients with recurrent laryngeal carcinoma showed that salvage surgery following organ preservation treatment resulted in a 5-year OS rate of 26%.
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Affiliation(s)
- Katarzyna Miśkiewicz-Orczyk
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Wojciech Ścierski
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Grażyna Lisowska
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Natalia Zięba
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Maciej Misiołek
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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León X, Montoro V, Rovira C, Neumann E, López M, García J, Quer M. Resultados oncológicos de la laringectomía de rescate en pacientes con carcinomas escamosos de laringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:70-77. [DOI: 10.1016/j.otorri.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 11/16/2022]
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Oncological Results of Salvage Laryngectomy in Patients With Laryngeal Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Databases. Stat Med 2020. [DOI: 10.1016/b978-0-12-815328-4.00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Elbers JBW, Veldhuis LI, Bhairosing PA, Smeele LE, Jóźwiak K, van den Brekel MWM, Verheij M, Al-Mamgani A, Zuur CL. Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation. Eur Arch Otorhinolaryngol 2019; 276:647-655. [PMID: 30673847 DOI: 10.1007/s00405-019-05292-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/12/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. METHODS Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. RESULTS 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30-45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (pheterogeneity = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days. CONCLUSIONS Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.
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Affiliation(s)
- Joris B W Elbers
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lars I Veldhuis
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Patrick A Bhairosing
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands.
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Elbers JBW, Al-Mamgani A, van den Brekel MWM, Jóźwiak K, de Boer JP, Lohuis PJFM, Willems SM, Verheij M, Zuur CL. Salvage Surgery for Recurrence after Radiotherapy for Squamous Cell Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2018; 160:1023-1033. [PMID: 30526317 DOI: 10.1177/0194599818818443] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Most studies that report on salvage surgery after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) are small and heterogeneous. Subsequently, some relevant questions remain unanswered. We specifically focused on (1) difference in prognosis per tumor subsite, corrected for disease stage, and (2) differences in prognosis after salvage surgery for local, regional, and locoregional recurrences. STUDY DESIGN Retrospective analysis. SETTING Single-center study (2000-2016). SUBJECTS AND METHODS Patients treated with salvage surgery for HNSCC recurrence after (chemo)radiotherapy. RESULTS In total, 189 patients were included. Five-year overall survival (OS) was 33%, and median OS was 18 (95% confidence interval [CI], 11-26) months. Treatment-related mortality was 2%. Larynx carcinoma was associated with more favorable local (adjusted hazard ratio [HR] = 4.02; 95% CI, 1.46-11.10; P = .007) and locoregional control (adjusted HR = 5.34; 95% CI, 1.83-15.61; P = .002) than pharyngeal carcinoma. American Society of Anesthesiologists (ASA) score (≥3 vs 1-2: adjusted HR = 3.04; 95% CI, 1.17-7.91; P = .023), pT stage (3-4 vs 1-2: adjusted HR = 4.41; 95% CI, 1.65-11.82; P = .003), and salvage surgery for locoregional recurrences (locoregional vs local: adjusted HR = 3.81; 95% CI, 1.13-11.82; P = .021) were independent predictors for disease-free survival (DFS). CONCLUSION Salvage surgery for larynx carcinoma, regardless of disease stage and other prognostic factors, results in more favorable loco(regional) control but not favorable DFS than pharyngeal carcinoma. The observed difference in DFS between salvage surgery for local and regional recurrences was not significant after correction for confounders. However, survival following salvage surgery for locoregional disease is significantly worse. For this subgroup, we propose to consider T status and comorbidity for clinical decision making, as high pT stage and ASA score are independent predictors for worse DFS.
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Affiliation(s)
- Joris B W Elbers
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- 2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,3 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- 4 Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J P de Boer
- 5 Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Peter J F M Lohuis
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,3 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan M Willems
- 6 Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel Verheij
- 2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L Zuur
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,3 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Tamaki A, Miles BA, Lango M, Kowalski L, Zender CA. AHNS Series: Do you know your guidelines? Review of current knowledge on laryngeal cancer. Head Neck 2017; 40:170-181. [PMID: 29076227 DOI: 10.1002/hed.24862] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/22/2017] [Indexed: 11/07/2022] Open
Abstract
The following article is part of a series in an initiative by the American Head and Neck Society's Education Committee and will review clinical practice guidelines for head and neck oncology. The primary goal is to increase awareness of current best practices pertaining to head and neck surgery and oncology. This manuscript is a review of current knowledge in laryngeal cancer with a focus on anatomy, epidemiology, diagnosis, evaluation, and treatment.
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Affiliation(s)
- Akina Tamaki
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Miriam Lango
- Department of Surgical Oncology, Division of Head and Neck Surgery, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Luiz Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Chad A Zender
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Scharpf J, Ward M, Adelstein D, Koyfman S, Li M. Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation. Laryngoscope 2017; 128:823-830. [DOI: 10.1002/lary.26782] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/12/2017] [Accepted: 06/01/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Joseph Scharpf
- Head and Neck Institute; Cleveland Clinic Foundation; Cleveland Ohio U.S.A
| | - Matthew Ward
- Radiation Oncology; Cleveland Clinic Foundation; Cleveland Ohio U.S.A
| | - David Adelstein
- Solid Tumor Oncology; Cleveland Clinic Foundation; Cleveland Ohio U.S.A
| | - Shlomo Koyfman
- Radiation Oncology; Cleveland Clinic Foundation; Cleveland Ohio U.S.A
| | - Mingsi Li
- Head and Neck Institute; Cleveland Clinic Foundation; Cleveland Ohio U.S.A
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Wulff N, Andersen E, Kristensen C, Sørensen C, Charabi B, Homøe P. Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10-year retrospective longitudinal study in eastern Denmark. Clin Otolaryngol 2016; 42:336-346. [DOI: 10.1111/coa.12726] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/15/2022]
Affiliation(s)
- N.B. Wulff
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - E. Andersen
- Department of Oncology; Herlev Hospital; University Hospital of Copenhagen; Herlev
| | - C.A. Kristensen
- Department of Oncology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - C.H. Sørensen
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - B. Charabi
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - P. Homøe
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
- Department of Otorhinolaryngology and Maxillofacial Surgery; Zealand University Hospital; Køge
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References and Data Sources. Stat Med 2012. [DOI: 10.1016/b978-0-12-384864-2.00039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Varghese BT, Sebastian P, Mathew A. Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study. Acta Otolaryngol 2009; 129:1480-5. [PMID: 19922101 DOI: 10.3109/00016480902748520] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Compared with larynx cancers salvage rates are poorer for hypopharyngeal cancers and the role of primary surgery seems to be significantly higher and more decisive in overall survival (OS). Hypopharyngeal cancers therefore warrant a closer follow-up after an organ preservation protocol, to detect recurrence at the earliest stage and plan for an effective salvage surgery. OBJECTIVE To evaluate the survival and morbidity of patients treated by surgery for carcinoma of the larynx and hypopharynx according to site. PATIENTS AND METHODS All patients who had undergone laryngectomy at the Division of Surgical Oncology Regional Cancer Center (RCC) from June 1995 to December 2005 were included in the study, which retrospectively recorded the age and sex distribution, TNM stage, indication, type of laryngectomy and reconstructive option used. The therapeutic outcome, disease-free survival (DFS), OS, voice preservation and postoperative voice rehabilitation were analysed. RESULTS Of a total of 167 cases, 123 (74%) had salvage surgery for failed chemoradiotherapy/radical radiotherapy and 44 (26%) had primary surgical treatment. Conservation surgery was undertaken in 4 cases, near total laryngectomy or pharyngectomy (NTL/NTLP) was done in 14 and total laryngectomy (TLPE) with gastric pull up was done in 5. Total laryngectomy (TL) or TL with partial or subtotal pharyngectomy was done in 144 cases. Concomitant neck dissection (ND) was done in 46 cases, 14 posterolateral selective, 15 radical neck dissections (RNDs), 2 extended RNDs, 12 bilateral NDs and 3 modified neck dissections (MNDs). Five patients received platinum-based neoadjuvant chemotherapy and nine had postoperative chemotherapy. In 116 patients the pharyngeal remnant was closed primarily, 21 patients had pectoralis major myocutaneous flap patch reconstruction, 18 had tubed pectoralis major myocutaneous (PMMC) flap reconstruction, 4 had folded (bipaddled) PMMC flap reconstruction, 7 had PMMC and 3 patients had deltopectoral (DP) flap for skin cover. Pathological margin positivity was seen in seven cases and perinodal disease was seen in nine. There was a statistically significant survival difference between salvage and primary surgical cases among cancers of the larynx and hypopharynx. Hypopharyngeal salvage rate was significantly lower in the present study. Sixty-two (37%) patients had postoperative leaks. Five leaks persisted to form pharyngocutaneous fistulae. All of these patients had either wound infection with or without flap necrosis or previous radiation. Two were repaired and in two cases speech prosthesis insertion was possible due its anatomical position. One patient refused further surgical closure after a partially failed repair. Fifty-six (34%) patients recurred locoregionally, 4 (2.3%) patients developed a second primary and 5 (2.9%) had distant metastasis. Thirty patients were voice rehabilitated with an electronic larynx. Seventeen patients had voice prosthesis insertion (6 primary and 10 secondary), 3 patients developed good oesophageal speech and voice preservation was possible in 18 patients. Seventy-nine patients were alive at the time of completing the study.
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Affiliation(s)
- Bipin T Varghese
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India.
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Kim AJ, Suh JD, Sercarz JA, Abemayor E, Head C, Funk G, Blackwell KE. Salvage surgery with free flap reconstruction: factors affecting outcome after treatment of recurrent head and neck squamous carcinoma. Laryngoscope 2007; 117:1019-23. [PMID: 17545864 DOI: 10.1097/mlg.0b013e3180536705] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine factors predicting the outcome after salvage surgery with microvascular flap reconstruction for recurrent squamous cell cancer (SCC) of the head and neck. STUDY DESIGN This is a retrospective analysis of patients treated at an academic medical center. METHODS One hundred six patients underwent salvage surgery and microvascular flap reconstruction after prior unsuccessful cancer treatment using surgery, radiation, or chemotherapy. All patients had a follow-up interval after salvage surgery of at least 24 months unless cancer rerecurrence occurred within 24 months after salvage surgery. Factors including age, sex, comorbidity level, tobacco use, alcohol use, disease-free interval since prior therapy, prior radiation, prior chemotherapy, prior surgery, recurrent tumor T class, recurrent tumor N class, recurrent cancer stage, and tumor location were examined to determine their association with cancer rerecurrence after salvage surgery. Successful treatment was defined as patients who remained free from cancer rerecurrence for a minimum 2 year period after salvage surgery. RESULTS Advanced recurrent T class (P = .02) was significantly associated with cancer recurrence. Recurrent cancer stage and patient smoking status approached statistical significance (P = .06). CONCLUSION Patients with recurrent T1 and T2 class are the best candidates for salvage surgery and microvascular flap reconstruction for treatment of recurrent SCC of the head and neck. Patients with T3 and T4 class recurrent cancers and patients who continue to smoke after initial diagnosis and treatment of head and neck SCC are poor candidates to undergo salvage surgery.
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Affiliation(s)
- Alyn J Kim
- Division of Head and Neck Surgery, David Geffen School of edicine at UCLA, Los Angeles, California 90095-1624, USA
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