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Wang D, Liu Y, Wen L, Li S, Zhu S, Wang T, Yu D. Oncological Outcomes of Transoral Laser Microsurgery for Early Stage Glottic Cancer with Involvement of the Anterior Commissure. Otolaryngol Head Neck Surg 2024; 171:172-179. [PMID: 38639320 DOI: 10.1002/ohn.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To assess the value of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for early-stage glottic cancer with special regard to involvement of the anterior commissure (AC). STUDY DESIGN Single-center retrospective cohort study. SETTING Grade-A tertiary hospital. METHODS A retrospective analysis of patients with early-stage (Tis-T2) glottic cancer who underwent CO2 TOLMS. All patients had at least 2 years of follow-up. The univariate and multivariate survival analyses were used to identify the risk factors for recurrence and the Kaplan-Meier method was used to analyze OS and DSS rates. RESULTS A total of 102 patients were included in the study. Eleven patients (10.78%) had recurrence. The univariate analysis showed that the recurrence was associated with the AC classification, T staging, tumor size, and tobacco use (P < .05). However, on multivariate analysis, the AC classification was the only independent risk factor for recurrence (P < .001, HR = 3.179). AC classification were distributed as follows: 59 (57.84%) AC0, 29 (28.43%) AC1, 8 (7.84%) AC2, and 6 (5.88%) AC3, 2-year/5-year OS and DSS rates were progressively reduced in the AC0, AC1, AC2, and AC3 groups (P < .001). At the same T staging, the OS rates incrementally decreased as the level of involvement of the AC became higher (P = .004). CONCLUSION CO2 TOLMS is an effective treatment for early-stage glottic cancer. AC involvement is an independent risk factors for recurrence and poor prognosis. The AC classification system may be better at grading the prognosis of patients with early-stage glottic cancer and has prognostic value independent of T staging.
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Affiliation(s)
- Di Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Yan Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Lianji Wen
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Shuang Li
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Shuna Zhu
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Tuanjie Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Dan Yu
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
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Eker C, Surmelioglu O, Dagkiran M, Kaya O, Tanrisever I, Arpaci B, Kaya B, Yucel Karakaya SP, Onan E. Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome. Eur Arch Otorhinolaryngol 2024; 281:2597-2608. [PMID: 38424299 PMCID: PMC11023970 DOI: 10.1007/s00405-024-08513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The involvement of the anterior commissure (AC) is regarded to be a risk factor for poor results after transoral laser microsurgery (TLM) for early glottic cancer. The objective of this study was to determine how AC-related clinical and radiological factors affected oncological outcomes in a cohort of patients with T1 stage early glottic carcinoma involving the anterior commissure who were treated with TLM with negative surgical margins. METHODS Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics. RESULTS In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041). CONCLUSION TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.
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Affiliation(s)
- Caglar Eker
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey.
| | - Ozgur Surmelioglu
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Muhammed Dagkiran
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Omer Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Burak Arpaci
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Bedir Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | | | - Elvan Onan
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
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Chen S, Gong H, Huang N, Yang F, Wang M. Horizontal middle partial laryngectomy with cricothyroidopexy: an effective treatment for stage T1b glottic carcinoma. Acta Otolaryngol 2023; 143:823-828. [PMID: 37837405 DOI: 10.1080/00016489.2023.2265436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The current treatment options for T1b glottic carcinoma often lead to poor treatment outcomes or voice quality. OBJECTIVES This study evaluates the therapeutic efficacy of horizontal middle partial laryngectomy with cricothyroidopexy (HMPL-CTP) for stage T1b glottic carcinoma. MATERIAL AND METHODS A retrospective analysis was conducted on 73 patients with T1b glottic carcinoma. The patients were categorized into three groups: Group A (n = 22) underwent transoral laser microsurgery (TLMS), Group B (n = 21) received frontolateral vertical partial laryngectomy (FVPL), and Group C (n = 30) underwent HMPL-CTP. The study analyzed the 5-year overall survival rate (OS), recurrence rate, phonatory status, and incidence of laryngeal stenosis. RESULTS Voice quality scores varied significantly in the three groups, while the 5-year OS were similar. The local recurrence rate is higher in Group A than in the other two groups. The laryngeal stenosis rate in Group B is higher than in Groups A and C. Adhesions in the anterior commissure were observed in 18 cases in Group A and nine cases in Group C. CONCLUSIONS AND SIGNIFICANCE HMPL-CTP demonstrates efficacy as a treatment for stage T1b glottic carcinoma, offering favorable preservation of laryngeal function and minimal complications.
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Affiliation(s)
- Shiyan Chen
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Hongxun Gong
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Ning Huang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Fan Yang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Maoxin Wang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
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Eckel HE, Simo R, Quer M, Odell E, Paleri V, Klussmann JP, Remacle M, Sjögren E, Piazza C. European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up. Eur Arch Otorhinolaryngol 2020; 278:1723-1732. [PMID: 33058010 PMCID: PMC8131286 DOI: 10.1007/s00405-020-06406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/16/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the current knowledge regarding the diagnosis, treatment, and follow-up of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. The diagnosis of LD largely relies on endoscopic procedures and on histopathology. Diagnostic efficiency of endoscopy may be improved using videolaryngostroboscopy (VLS) and bioendoscopic tools such as Narrow Band Imaging (NBI) or Storz Professional Image Enhancement System (SPIES). Current histological classifications are not powerful enough to clearly predict the risk to carcinoma evolution and technical issues such as sampling error, variation in epithelial thickness and inflammation hamper pathological examination. Almost all dysplasia grading systems are effective in different ways. The 2017 World Health Organization (WHO) system should prove to be an improvement as it is slightly more reproducible and easier for the non-specialist pathologist to apply. To optimize treatment decisions, surgeons should know how their pathologist grades samples and preferably audit their transformation rates locally. Whether carcinoma in situ should be used as part of such classification remains contentious and pathologists should agree with their clinicians whether they find this additional grade useful in treatment decisions. Recently, different studies have defined the possible utility of different biomarkers in risk classification. The main treatment modality for LD is represented by transoral laser microsurgery. Radiotherapy may be indicated in specific circumstances such as multiple recurrence or wide-field lesions. Medical treatment currently does not have a significant role in the management of LD. Follow-up for patients treated with LD is a fundamental part of their care and investigations may be supported by the same techniques used during diagnosis (VLS and NBI/SPIES).
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Affiliation(s)
- Hans Edmund Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt am Wörthersee, Austria
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edward Odell
- Department of Head and Neck Pathology, King's College London Guy's Hospital, London, UK
| | - Vinidh Paleri
- Department of Otorhinolaryngology Head and Neck Surgery, Royal Marsden Hospital, London, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
| | - Elisabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Involvement of the Anterior Commissure in Early Glottic Cancer (Tis-T2): A Review of the Literature. Cancers (Basel) 2019; 11:cancers11091234. [PMID: 31450795 PMCID: PMC6769981 DOI: 10.3390/cancers11091234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The impact of the anterior commissure (AC) involvement on prognosis in laryngeal cancer remains a topic of discussion with inconsistent results in the literature. This review examines AC involvement as a prognostic factor in patients with early glottic cancer (Tis-T2) treated with radiotherapy or transoral laser microsurgery (TLM). Methods: A systematic literature search was performed. Due to the heterogeneity of the data, no meta-analysis was implemented. Weighted averages were calculated if the appropriate data were extractable. Results: Thirty-four studies on radiotherapy and 23 on TLM fit the inclusion criteria. The majority of studies for both radiotherapy (67.7%) and TLM (75.0%) did not report a significant impact on oncological outcomes. Weighted averages were slightly lower in patients with AC involvement. The two studies that applied a more detailed classification showed a significant impact on the amount of AC involvement. Conclusions: Binary variables (yes/no) for AC involvement lead to inconsistent results. Studies that use more detailed classifications of the AC show that there is a significant impact on the outcome. To further elucidate the role of the AC, detailed stratification of tumors involving the AC need to be investigated in further studies for both treatment modalities.
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Osuch-Wójcikiewicz E, Rzepakowska A, Sobol M, Bruzgielewicz A, Niemczyk K. Oncological outcomes of CO 2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status. Lasers Surg Med 2019; 51:874-881. [PMID: 31286558 DOI: 10.1002/lsm.23130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Controversial prognostic factors of primary CO2 laser cordectomy are anterior commissure involvement (ACI) and status of margin. STUDY DESIGN/MATERIALS AND METHODS Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015. RESULTS The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P < 0.001). The 2-year DFS rates according to the ACI and free anterior commissure tumors were, respectively, 65.4% and 89.2%, and the ACI indicated worse prognosis (P = 0.057). The 2-year DFS rates according to margins status were higher for patients with close or positive margins, who had second resection (88.9%) compared with those of negative margins (80.9%) (P = 0.340). Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Ewa Osuch-Wójcikiewicz
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Anna Rzepakowska
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Maria Sobol
- Department of Biophysics and Human Physiology, Medical University of Warsaw, Chałubińskiego Street 5, Warsaw, 02-004, Poland
| | - Antoni Bruzgielewicz
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
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7
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Laryngeal force sensor metrics are predictive of increased perioperative narcotic requirements. Laryngoscope 2019; 129:2563-2567. [DOI: 10.1002/lary.27827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2018] [Indexed: 12/12/2022]
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8
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Jacobi C, Freundorfer R, Reiter M. Transoral laser microsurgery in early glottic cancer involving the anterior commissure. Eur Arch Otorhinolaryngol 2019; 276:837-845. [DOI: 10.1007/s00405-018-5261-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
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Oncological Outcomes Following Transoral CO 2 Laser Microsurgery for T1 Glottic Cancer. Indian J Otolaryngol Head Neck Surg 2018; 71:542-547. [PMID: 31742018 DOI: 10.1007/s12070-018-1394-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022] Open
Abstract
The objective of this study is to analyze oncological outcomes for treatment of Tis and T1 glottic squamous cell carcinoma after transoral laser microsurgery. This study is retrospective analysis of previously untreated, suspected lesion of glottis, staged cT1a and cT1b squamous cell carcinoma in a tertiary care hospital and 53 patients were included in the study. End points for analysis were local control, overall and disease specific survival rates. The local control, ultimate local control with laser alone, 3-year overall survival, 3-year disease specific survival and organ preservation rates were 86.7, 90.5, 92.4, 98.1 and 98.1% respectively. The involvement of anterior commissure did not show any significant impact on local control or survival. TLM is safe and effective treatment of early glottis cancer, associated with less morbidity and a high percentage of local control, survival and organ preservation rates.
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Aluffi Valletti P, Taranto F, Chiesa A, Pia F, Valente G. Impact of resection margin status on oncological outcomes after CO2 laser cordectomy. ACTA ACUST UNITED AC 2017; 38:24-30. [PMID: 28530251 DOI: 10.14639/0392-100x-870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 12/17/2016] [Indexed: 11/23/2022]
Abstract
The management of positive resection margins in micro-endoscopic glottic laser surgery remains a controversial and critical point. This study aims to assess the impact of margin status after transoral laser surgery on local control, survival and organ preservation rates; the decision-making process and treatment options in cases with positive margins are also discussed. We retrospectively reviewed the clinical and histological records of 308 consecutive patients with primary early glottic carcinoma (T1a, T1b, selected T2) and treated with endoscopic laser cordectomy. Recurrence rates and survival related to margin status were analysed using the Kaplan-Meier method. Local relapses and disease-free-survival rates were significantly related to excision margin status (p < 0.001). In the T1a category (n = 228) no significant differences were observed in disease-free-survival (p = 0.889) and overall survival (p = 0.426) between patients submitted to further treatment (revision endoscopic surgery or radiotherapy) for positive excision margins and patients who were left untreated. In 20 of 24 (83%) patients with positive margins that were surgically re-excised, no residual carcinoma was detected. Margin status (mainly multifocal and deep positive margins) at first surgery was significantly related to the final organ preservation rate (p < 0.001). Margin status during laser cordectomy in early glottic cancer has a prognostic impact on local control of disease without compromising survival. Patients with multifocal and deep positive borders should be surgically retreated and strictly monitored to increase the organ preservation rates. Careful preparation and mapping of the surgical specimen enhances the accuracy of pathological examination by reducing the risk of overestimate positive margins.
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Affiliation(s)
- P Aluffi Valletti
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - F Taranto
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - A Chiesa
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - F Pia
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - G Valente
- Dipartimento di Medicina Traslazionale, Laboratory of Pathology, Università del Piemonte Orientale, Novara, Italy
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Comparison of CT and MRI in Diagnosis of Laryngeal Carcinoma with Anterior Vocal Commissure Involvement. Sci Rep 2016; 6:30353. [PMID: 27480073 PMCID: PMC4969597 DOI: 10.1038/srep30353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/04/2016] [Indexed: 02/02/2023] Open
Abstract
This study aimed to compare the accuracy of CT and MRI in determining the invasion of thyroid cartilage by and the T staging of laryngeal carcinoma with anterior vocal commissure (AVC) involvement. A total of 26 cases of laryngeal carcinomas with AVC involvement from May 2012 to January 2014 underwent enhanced CT and MRI scan, out of whom 6 patients also underwent diffusion-weighted magnetic resonance imaging(DWI). T staging and thyroid cartilage involvement were evaluated. All the surgical specimens underwent serial section and were reviewed by two senior pathologists independently. When compared with pathologic staging, the accuracy was 88.46% (23/26) of MRI scan (with a 95% confidence interval 37~77%) and 57.69% (15/26) of CT scan (with a 95% confidence interval 70~98%), respectively (P < 0.01). We also reported three cases who were misdiagnosed on CT or MRI about either the thyroid cartilage was involved or not, and one case of preliminary study of DWI. Compared to CT, MRI exhibited a higher accuracy rate on T staging of laryngeal carcinomas with AVC involvement. Combined utility of CT and MRI could help improve the accuracy of assessment of thyroid cartilage involvement and T staging of laryngeal carcinomas with AVC involvement.
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Bergauer B, Knipfer C, Amann A, Rohde M, Tangermann-Gerk K, Adler W, Schmidt M, Nkenke E, Stelzle F. Does Laser Surgery Interfere with Optical Nerve Identification in Maxillofacial Hard and Soft Tissue?--An Experimental Ex Vivo Study. SENSORS 2015; 15:25416-32. [PMID: 26437416 PMCID: PMC4634421 DOI: 10.3390/s151025416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/09/2015] [Accepted: 09/28/2015] [Indexed: 11/16/2022]
Abstract
The protection of sensitive structures (e.g., nerves) from iatrogenic damage is of major importance when performing laser surgical procedures. Especially in the head and neck area both function and esthetics can be affected to a great extent. Despite its many benefits, the surgical utilization of a laser is therefore still limited to superficial tissue ablation. A remote feedback system which guides the laser in a tissue-specific way would provide a remedy. In this context, it has been shown that nerval structures can be specifically recognized by their optical diffuse reflectance spectra both before and after laser ablation. However, for a translation of these findings to the actual laser ablation process, a nerve protection within the laser pulse is of utmost significance. Thus, it was the aim of the study to evaluate, if the process of Er:YAG laser surgery--which comes with spray water cooling, angulation of the probe (60°) and optical process emissions--interferes with optical tissue differentiation. For the first time, no stable conditions but the ongoing process of laser tissue ablation was examined. Therefore, six different tissue types (nerve, skin, muscle, fat, cortical and cancellous bone) were acquired from 15 pig heads. Measurements were performed during Er:YAG laser ablation. Diffuse reflectance spectra (4500, wavelength range: 350-650 nm) where acquired. Principal component analysis (PCA) and quadratic discriminant analysis (QDA) were calculated for classification purposes. The clinical highly relevant differentiation between nerve and bone was performed correctly with an AUC of 95.3% (cortial bone) respectively 92.4% (cancellous bone). The identification of nerve tissue against the biological very similar fat tissue yielded good results with an AUC value of 83.4% (sensitivity: 72.3%, specificity: of 82.3%). This clearly demonstrates that nerve identification by diffuse reflectance spectroscopy works reliably in the ongoing process of laser ablation in spite of the laser beam, spray water cooling and the tissue alterations entailed by tissue laser ablation. This is an essential step towards a clinical utilization.
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Affiliation(s)
- Bastian Bergauer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Andreas Amann
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Maximilian Rohde
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Katja Tangermann-Gerk
- Bavarian Laser Center GmbH (blz), Erlangen 91054, Germany.
- SAOT-Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Michael Schmidt
- Bavarian Laser Center GmbH (blz), Erlangen 91054, Germany.
- SAOT-Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
- Chair of Photonic Technologies, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
| | - Emeka Nkenke
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna 1090, Austria.
| | - Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
- SAOT-Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen 91054, Germany.
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Lei WB, Jiang AY, Chai LP, Zhu XL, Wang ZF, Wen YH, Su ZZ, Wen WP. Middle frontal horizontal partial laryngectomy (MFHPL): a treatment for stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure. PLoS One 2013; 8:e52723. [PMID: 23326350 PMCID: PMC3541376 DOI: 10.1371/journal.pone.0052723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 11/21/2012] [Indexed: 11/25/2022] Open
Abstract
Objective The therapeutic effect of middle frontal horizontal partial laryngectomy (MFHPL) in treating stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure (AVC) was compared with that of the anterior frontolateral vertical partial laryngectomy (AFVPL). The feasibility and practical significance of MFHPL in clinical application was discussed in the present study. Methods From January 1996 to January 2010, a total of 65 patients diagnosed with stage T1bN0M0 glottic laryngeal cancer were treated with MFHPL or AFVPL. The postoperative complications, glottic reconstruction, recurrence rate, voice quality and survival rates were evaluated and compared between two treatments. Results AFVPL and MFHPL were performed in 34 and 31 patients, respectively. Flexible fiberoptic laryngoscopy revealed that in the MFHPL-treated patients the reconstructed glottis was spacious and symmetric. In contrast, AFVPL treatment resulted in irregular glottic area with poor symmetry and tubular glottis. The incidence of postoperative laryngeal stenosis significantly differed between the MFHPL- and AFVPL-treated groups (P = 0.025). No significant difference was detected in the 3- and 5-year overall- or tumor-free survival rates between two treatments. The Voice Handicap Index (VHI) and maximum phonation time (MPT) after surgery were 51.0±12.99 and 12.42±3.44 sec in the AFVPL-treated group; while in the MFHPL-treated patients they were 31.81±7.48 and 7.65±1.98 sec, respectively. Both differences in VHI (P = 0.012) and MPT (P = 0.024) were significant between two treatments. Conclusions MFHPL was comparable to AFVPL with respect to postoperative complications, recurrence rate and survival rates, but possessed advantages over AFVPL in terms of the incidence of laryngeal stenosis and voice quality. Our study indicated that MFHPL has a potential value in clinical practice of treating stage T1b squamous cell carcinoma of the glottic larynx involving AVC.
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Affiliation(s)
- Wen-bin Lei
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
| | - Ai-yun Jiang
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
| | - Li-ping Chai
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
| | - Xiao-lin Zhu
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
| | - Zhang-feng Wang
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
| | - Yi-hui Wen
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
| | - Zhen-zhong Su
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
- * E-mail: (ZS); (WW)
| | - Wei-ping Wen
- Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University, National Key Department of Otorhinolaryngology of People's Republic of China, Guangzhou, People's Republic of China
- * E-mail: (ZS); (WW)
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