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Cunha B, Lancini D, Rondi P, Ravanelli M, Maroldi R, Paderno A, Zigliani G, Bertotto I, Piazza C, Farina D. Magnetic resonance diagnosis of laryngeal chondritis after transoral laser microsurgery for laryngeal cancer. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:32-41. [PMID: 36860148 PMCID: PMC9978306 DOI: 10.14639/0392-100x-n2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/06/2022] [Indexed: 03/03/2023]
Abstract
Objective Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been previously described. This study aims to characterise a cohort of patients who developed LC after CO2 TOLMS and describe its clinical and MR findings. Methods Clinical records and MR images of all patients presenting with LC after CO2 TOLMS between 2008 and 2022 were reviewed. Results Seven patients were analysed. Timing of LC diagnosis ranged from 1 to 8 months after CO2 TOLMS. Four patients were symptomatic. Abnormal endoscopic findings included suspected tumour recurrence in 4 patients. MR documented focal or extensive signal changes involving the thyroid lamina and para-laryngeal space with T2 hyperintensity, T1 hypointensity and intense contrast enhancement (n = 7), and minimally reduced mean apparent diffusion coefficient (ADC) values (1.0-1.5 x 10-3 mm2/s) (n = 6). A favourable clinical outcome was achieved in all patients. Conclusions LC after CO2 TOLMS has a distinctive MR pattern. When tumour recurrence cannot be confidently excluded based on imaging, antibiotic therapy, close clinical and radiological follow-up and/or biopsy are recommended.
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Affiliation(s)
- Bruno Cunha
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal,Correspondence Bruno Cunha Neuroradiology Department, Hospital São José, Centro Hospitalar Universitário de Lisboa Central, R. José António Serrano, 1150-199 Lisboa, Portugal Tel. +35 1218841000. Fax +35 1218841023 E-mail:
| | - Davide Lancini
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paolo Rondi
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Gabriele Zigliani
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Ilaria Bertotto
- Radiology Unit, Surgery Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
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Ravanelli M, Lancini D, Maroldi R, Paderno A, Rondi P, Battocchio S, Ardighieri L, Vezzoli M, Del Bon F, Farina D, Piazza C. Magnetic resonance imaging to assess cartilage invasion in recurrent laryngeal carcinoma after transoral laser microsurgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:531-537. [PMID: 36654519 PMCID: PMC9853105 DOI: 10.14639/0392-100x-n2090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/20/2022] [Indexed: 01/19/2023]
Abstract
Objective To evaluate the diagnostic performance of magnetic resonance (MR) with surface coils in assessing cartilage invasion in recurrent laryngeal carcinoma after carbon dioxide transoral laser microsurgery (CO2 TOLMS). Methods Two expert head and neck radiologists assessed cartilage invasion (infiltrated or non-infiltrated) in submucosal recurrences of laryngeal carcinoma after CO2 TOLMS: results were compared with histopathological report after salvage laryngectomy. Results Thirty patients met the inclusion criteria and 90 cartilages were assessed. Overall sensitivity, specificity, and positive and negative predictive values for cartilage infiltration were 76, 93, 72 and 94%, respectively; for thyroid cartilage, the values were 82, 79, 69 and 88% respectively; for cricoid cartilage, all values were 100%; and for arytenoids, the values were 33, 96, 56 and 93% respectively. Conclusions MR with surface coils was able to detect most thyroid and cricoid infiltration in the complex setting of post-CO2 TOLMS laryngeal carcinoma recurrence. In particular, the optimal performance in assessing cricoid invasion can be valuable in choosing the most appropriate treatment among total laryngectomy, open partial horizontal laryngectomies and non-surgical strategies.
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Affiliation(s)
- Marco Ravanelli
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology, Head and Neck Cancer, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Alberto Paderno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy, Unit of Otorhinolaryngology, Head and Neck Cancer, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paolo Rondi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy,Correspondence Paolo Rondi Unit of Radiology, University of Brescia, Spedali Civili di Brescia, piazzale Spedali Civili 1, 25123 Brescia, Italy E-mail:
| | - Simonetta Battocchio
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Ardighieri
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marika Vezzoli
- Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology, Head and Neck Cancer, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Cesare Piazza
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy, Unit of Otorhinolaryngology, Head and Neck Cancer, ASST Spedali Civili of Brescia, Brescia, Italy
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Vilaseca I, Aviles-Jurado FX, Valduvieco I, Berenguer J, Grau JJ, Baste N, Muxí Á, Castillo P, Lehrer E, Jordana M, Ramírez-Ruiz RD, Costa JM, Oleaga L, Bernal-Sprekelsen M. Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments. Head Neck 2021; 43:3832-3842. [PMID: 34569120 DOI: 10.1002/hed.26878] [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: 05/14/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. METHODS Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. RESULTS The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537-8.495]) and posterior (HR = 5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. CONCLUSIONS Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.
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Affiliation(s)
- Isabel Vilaseca
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Francesc Xavier Aviles-Jurado
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Izaskun Valduvieco
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Joan Berenguer
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Juan José Grau
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Neus Baste
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - África Muxí
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Eduardo Lehrer
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain
| | - Marta Jordana
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,Rehabilitation Department, Hospital Clínic, Barcelona, Spain
| | | | - José Miguel Costa
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Laura Oleaga
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
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Chien PJ, Hung LT, Wang LW, Yang MH, Chu PY. Oncologic results and quality of life in patients with T3 glottic cancer after transoral laser microsurgery. Eur Arch Otorhinolaryngol 2021; 278:2983-2992. [PMID: 33403435 DOI: 10.1007/s00405-020-06445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE CO2 transoral laser microsurgery (CO2 TOLMS) is an alternative approach to non-surgical organ preservation in selected T3 glottic squamous cell carcinoma (SCC). This study aimed to assess the oncologic results and quality of life (QOL) of patients with T3 glottic SCC after CO2 TOLMS. METHODS Of the 44 patients who underwent CO2 TOLMS, 38 underwent QOL evaluations. QOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and head and neck module, Voice Handicap Index-30, and M. D. Anderson Dysphagia Inventory at least 6 months postoperatively. RESULTS The patients were predominantly male (98%), with a median age of 61 years. Cordectomy type included 1 type III, 4 type IV, 31 type V, and 8 type VI according to European Laryngological Society classification. Two patients (5%) had cervical lymph node metastasis and 21 patients (48%) underwent postoperative radiotherapy. With a mean follow-up of 65 months for all patients, 10 (23%) had tumor recurrence (9 local, 1 distant). After salvage surgery, four patients lived without disease, and the larynx was preserved in two. The 5-year local control and overall and disease-specific survival rates were 78%, 75%, and 84%, respectively. The overall laryngeal preservation rate was 82% (36/44). Most patients had satisfactory QOL. CONCLUSIONS In selected T3 glottic SCC cases, CO2 TOLMS can achieve favorable oncologic results and a satisfactory QOL.
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Affiliation(s)
- Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Ling-Wei Wang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Muh-Hwa Yang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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5
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Damiani M, Mercante G, Abdellaoui M, Guerlain J, Moya-Plana A, Casiraghi O, Temam S, Tao Y, Gorphe P. Prognostic Features in Intermediate-Size Supraglottic Tumors Treated With Open Supraglottic Laryngectomy. Laryngoscope 2021; 131:E1980-E1986. [PMID: 33399237 DOI: 10.1002/lary.29367] [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: 11/06/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS We investigated growth patterns and pathological features in intermediate-size laryngeal carcinoma amenable to supraglottic laryngectomy. STUDY DESIGN Retrospective cohort study. METHODS We reviewed patients who underwent an open partial horizontal laryngectomy (OPHL) type I. We analyzed pathological data, tumor sizes, overall survival, disease-specific survival, local control, and laryngeal preservation. Results were stratified between three groups: group I comprised patients with endolaryngeal carcinoma, group II comprised patients with anterior epilaryngeal carcinoma who underwent an OPHL type I + base of tongue (BOT), group III comprised patients with lateral epilaryngeal carcinoma who underwent an OPHL type I + pyriform sinus (PIR). RESULTS Sixty-eight patients were analyzed. The 5-year rates of overall survival, disease-specific survival, local control, and laryngeal preservation were 68.4%, 83.7%, 91.6%, and 98.3%, respectively. The tumor sizes at pathological examination were similar between the three groups (mean 27 mm, P = .80) and were associated with pathological features, notably pre-epiglottic space (PES) invasion (24.9 mm vs. 32.2 mm, P = .01), occult invaded lymph nodes (22.6 mm vs. 29.9 mm, P = .03), and trends for margins status (26.5 mm vs. 29.3 mm, P = .45). The risks of PES invasion, occult lymph nodes, and positive margins, respectively, predominated in group I (41.7%), group II (56.3%), and group III (23.3%). CONCLUSION In intermediate-size tumors amenable to supraglottic laryngectomy, pathological features are associated with tumor size according to group stratification based on tumor location. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1980-E1986, 2021.
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Affiliation(s)
- Marialessia Damiani
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Giuseppe Mercante
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mohammed Abdellaoui
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Joanne Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Odile Casiraghi
- Department of Pathology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Yungan Tao
- Department of Radiotherapy, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
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Benazzo M, Sovardi F, Preda L, Mauramati S, Carnevale S, Bertino G, Berton F, Meroni M, Herman I, Trisolini G, Morbini P. Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers. Cancers (Basel) 2020; 12:cancers12051074. [PMID: 32357419 PMCID: PMC7281313 DOI: 10.3390/cancers12051074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Preoperative imaging impacts treatment planning and prognosis in laryngeal cancers. We investigated the accuracy of standard computed tomography (CT) in evaluating tumor invasions at critical glottic areas. Methods: CT scans of glottic cancers treated by partial or total laryngectomy between Jan 2015 and Aug 2019 were reviewed to assess levels of tumor invasion at critical glottic subsites. CT accuracy in the identification of tumor extensions was determined against the gold standard of histopathological analysis of surgical samples. Results: This study included 64 patients. In the anterior commissure, CT showed high rates of false positives at all levels (sensitivity 56.2–70%, specificity 87.8–92.3%); in the anterior vocal fold, it overestimated the deep invasion (19.5% specificity, 90.3% sensitivity), while it underestimated the extralaryngeal spread (63.6% sensitivity, 98.1% specificity). In the posterior paraglottic space (pPGS), false negative results were more frequent for superficial extensions (25% sensitivity, 95.8% specificity) and deep invasions (58.8% sensitivity, 82.3% specificity). Shorter disease-specific and disease-free survivals were associated with pStage IV (p: 0.045 and 0.008) and with the pathological involvement of pPGS (p: 0.045 and 0.015). Conclusions: Negative prognostic correlation of pPGS involvement was confirmed on histopathological data. CT staging did not provide a satisfactory prognostic stratification and should be complemented with magnetic resonance imaging.
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Affiliation(s)
- Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Fabio Sovardi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
- Correspondence: ; Tel.: +39-331-229-2171
| | - Lorenzo Preda
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Simone Mauramati
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Sergio Carnevale
- Section of Anatomic Pathology, Cerba Healthcare Italia, 20139 Milan, Italy;
| | - Giulia Bertino
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Francesca Berton
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Matteo Meroni
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Irene Herman
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Giuseppe Trisolini
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
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Hussain T, Lang S, Haßkamp P, Holtmann L, Höing B, Mattheis S. The Flex robotic system compared to transoral laser microsurgery for the resection of supraglottic carcinomas: first results and preliminary oncologic outcomes. Eur Arch Otorhinolaryngol 2020; 277:917-924. [PMID: 31893297 DOI: 10.1007/s00405-019-05767-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Transoral robotic surgery (TORS) has the potential to improve some inherent disadvantages of transoral laser microsurgery (TLM). Here, we retrospectively assessed the application of the Medrobotics Flex system for the resection of supraglottic carcinomas compared to TLM. METHODS 84 patients underwent surgery for supraglottic carcinomas with the Flex robotic system (n = 19, T-stage distribution in %: T1 42, T2 47, T3 11, T4 0) or TLM (n = 65, T-stage distribution in %: T1 40, T2 44, T3 14, T4 2). Clinical and oncologic parameters were compared. RESULTS All surgeries were successfully completed with the Flex system and tracheostomy rate was 13%. For patients with adequate follow-up, 24-month disease-free survival was 71.4% (n = 5/7) after TORS compared to 64.9% (n = 24/37) after TLM. Local recurrence rates were 0% for TORS and 11% for TLM. CONCLUSIONS Initial results for supraglottic carcinoma resection using the Medrobotics Flex system are encouraging with excellent local tumor control.
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Affiliation(s)
- Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Pia Haßkamp
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Laura Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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8
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CO 2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review. MEDICINES 2019; 6:medicines6030077. [PMID: 31336581 PMCID: PMC6789531 DOI: 10.3390/medicines6030077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.
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Del Bon F, Piazza C, Lancini D, Paderno A, Bosio P, Taboni S, Morello R, Montalto N, Missale F, Incandela F, Marchi F, Filauro M, Deganello A, Peretti G, Nicolai P. Open Partial Horizontal Laryngectomies for T3⁻T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization. Cancers (Basel) 2019; 11:cancers11030289. [PMID: 30832209 PMCID: PMC6468624 DOI: 10.3390/cancers11030289] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 01/16/2023] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate–advanced laryngeal cancers (LC). T–N categories are well-known prognosticators: herein we tested if “anterior” vs. “posterior” tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor. We analyzed a retrospective cohort of 85 T3–4a glottic LCs, treated by Type II or III OPHL (according to the European Laryngological Society classification) from 2005 to 2017 at two academic institutions. Five-year overall survival (OS), disease-specific survivals (DSS), and recurrence-free survivals (RFS) were compared according to tumor location and pT category. Anterior and posterior tumors were 43.5% and 56.5%, respectively, 78.8% of lesions were T3 and 21.2% were T4a. Five-year OS, DSS, and RFS for T3 were 74.1%, 80.5%, and 63.4%, respectively, and for T4a 71.8%, 71.8%, and 43%, respectively (p not significant). In relation to tumor location, the survival outcomes were 91%, 94.1%, and 72.6%, respectively, for anterior tumors, and 60.3%, 66.3%, and 49.1%, respectively, for posterior lesions (statistically significant differences). These data provide evidence that laryngeal compartmentalization is a valid prognosticator, even more powerful than the pT category.
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Affiliation(s)
- Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Bosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Taboni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Riccardo Morello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Nausica Montalto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Francesco Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Marta Filauro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Prediction of Posterior Paraglottic Space and Cricoarytenoid Unit Involvement in Endoscopically T3 Glottic Cancer with Arytenoid Fixation by Magnetic Resonance with Surface Coils. Cancers (Basel) 2019; 11:cancers11010067. [PMID: 30634566 PMCID: PMC6356606 DOI: 10.3390/cancers11010067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
Discrimination of the etiology of arytenoid fixation in cT3 laryngeal squamous cell carcinoma (SCC) is crucial for treatment planning. The aim of this retrospective study was to differentiate among possible causes of arytenoid fixation (edema, inflammation, mass effect, or tumor invasion) by analyzing related signal patterns of magnetic resonance (MR) in the posterior laryngeal compartment (PLC) and crico-arytenoid unit (CAU). Seventeen patients affected by cT3 glottic SCC with arytenoid fixation were preoperatively studied by state-of-the-art MR with surface coils. Different signal patterns were assessed in PLC subsites. Three MR signal patterns were identified: A, normal; B, T2 hyperintensity and absence of restriction on diffusion-weighted imaging (DWI); and C, intermediate T2 signal and restriction on DWI. Signal patterns were correlated with the presence or absence of CAU and PLC neoplastic invasion. Patients were submitted to open partial horizontal or total laryngectomy and surgical specimens were analyzed. Pattern A and B did not correlate with neoplastic invasion, while Pattern C strongly did (Spearman’s coefficient = 0.779, p < 0.0001; sensitivity: 100%; specificity: 78%). In conclusion, MR with surface coils is able to assess PLC/CAU involvement with satisfactory accuracy. In absence of Pattern C, arytenoid fixation is likely related to mass effect and/or inflammatory reaction and is not associated with neoplastic invasion.
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Long Term Oncological Results of Transoral Laser Microsurgery for Early and Moderately Advanced Glottic Carcinoma in Primary and Salvage Settings. Indian J Otolaryngol Head Neck Surg 2018; 70:463-470. [PMID: 30464899 DOI: 10.1007/s12070-018-1505-2] [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: 08/31/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
The aim of the study is to document the long term oncological results of trans-oral laser microsurgery (TLM) for early and moderately advanced glottic cancer in primary and salvage settings. In this prospective cohort study 43 consecutive patients of glottic cancer (T1-30, T2-7, and selected T3 with mobile cords-6) were recruited. TLM was performed in these 35 primary and 8 previously treated cases. In our series, the local disease control rate with TLM was 90% (27/30) for T1 disease, 71.4% (5/7) for T2 cancer and 66.6% (4/6) for T3 lesions. The overall disease control rates after subsequent treatment for locoregional recurrences were 100% (30/30), 85.7% (6/7) and 83.3% (5/6) for T1, T2, and T3 glottic cancers respectively. The 5-years disease free survival rate for primary cases was 100% and 50% for salvage cases. The 5-years local disease control rate was 96.4% and 41.67% in primary and salvage TLM settings respectively. The 5-years laryngectomy free rates were 96.3% and 18.75% for primary and salvage cases respectively. TLM offers a minimally invasive and oncologically robust treatment option for early glottic cancer with an overall disease free survival of 100% at 5 years noted for primary untreated cases in this experience. TLM for post radiation salvage cases has however been disappointing and alternate larynx preserving option of open partial laryngectomy needs to be considered in this setting.
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Piazza C, Filauro M, Paderno A, Marchi F, Perotti P, Morello R, Taboni S, Parrinello G, Incandela F, Iandelli A, Missale F, Peretti G. Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy. Front Oncol 2018; 8:175. [PMID: 29872643 PMCID: PMC5972218 DOI: 10.3389/fonc.2018.00175] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. Methods We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology—Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes. Results The 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively). Conclusion The present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Marta Filauro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Riccardo Morello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Andrea Iandelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Missale
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
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Ambrosch P, Gonzalez-Donate M, Fazel A, Schmalz C, Hedderich J. Transoral Laser Microsurgery for Supraglottic Cancer. Front Oncol 2018; 8:158. [PMID: 29868479 PMCID: PMC5954241 DOI: 10.3389/fonc.2018.00158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/25/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. Early supraglottic carcinoma has excellent outcomes independently of the treatment approach. The role of TLM for the treatment of locally advanced tumors is debated. Particularly, the functional outcomes after TLM have to be proven by functional assessment of large cohorts of patients. This study analyzes the oncologic and functional outcomes after TLM for supraglottic carcinomas. PATIENTS AND METHODS Ninety-one patients with pT1-pT4a supraglottic carcinomas treated between January 2002 and December 2012 were analyzed. Distribution of tumors (UICC 2010) was 11 patients with pT1, 31 patients with pT2, 36 patients with pT3, and 13 patients with pT4a tumors. Node status was positive in 40 (43.6%) patients; 61 (67.1%) patients had stage III or IVa disease. Local control and survival were estimated using the Kaplan-Meier method. For the assessment of functional outcomes, the MD Anderson Dysphagia Inventory (MDADI), the Voice Handicap Index-10 (VHI-10), and the performance status scale for head and neck cancer [Performance Status Scale for Head and Neck (PSS-HN)] were used. RESULTS The median age was 62 years (range, 33-88 years). Fourteen (15.4%) patients developed a local or locoregional recurrence. The 5-year local control rate and 5-year ultimate local control rate were 72 and 92%, respectively. The 5-year overall survival rate was 63%. Twelve (13.2%) patients needed temporary tracheostomy. Sixty-eight (74.0%) patients had a nasogastric feeding tube post-operatively. At 1-year post-operative follow-up, only three patients were PEG dependent. The median VHI-10 score was 35, the median MDADI composite score was 80, and the median score of the domain "normalcy of diet" in the PSS-HN was 91. CONCLUSION The oncologic outcomes are comparable to the results of open surgery for early and advanced supraglottic carcinomas. Functional swallowing outcome is superior to open surgery and to concomitant chemoradiation. Patients treated with TLM perceive low levels of voice- and swallowing-related quality of life impairment.
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Mireia Gonzalez-Donate
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Asita Fazel
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Jürgen Hedderich
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany
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Kim BH, Park SJ, Jeong WJ, Ahn SH. Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis. Clin Exp Otorhinolaryngol 2018; 11:1-8. [PMID: 29486540 PMCID: PMC5831661 DOI: 10.21053/ceo.2017.00717] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives This study compared the survival outcomes, local control rate, and laryngeal preservation rate of various treatment strategies in the treatment of T3 squamous cell carcinoma of the glottis using proportional meta-analyses. Methods Twenty-five retrospective case-series studies were included in these analyses. Treatment strategies were classified as total laryngectomy (TL), open partial laryngectomy (PL), transoral laser microsurgery (TLM), chemo-radiation therapy (CRT), and radiation therapy (RT) alone. Results The overall survival rate and disease-specific survival rate among laryngeal preservation treatments did not differ from the overall survival rate of TL. However, the local control rate was lower with RT than TL and PL, and laryngeal preservation rates of TLM and CRT were higher than RT alone. Conclusion Consideration of preservation of laryngeal function is necessary when treating T3 glottic squamous cell carcinoma. PL, TLM, and, CRT are considered more appropriate initial laryngeal preservation strategies if available.
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Affiliation(s)
- Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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Carta F, Bandino F, Olla AM, Chuchueva N, Gerosa C, Puxeddu R. Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients. Eur Arch Otorhinolaryngol 2018; 275:1199-1210. [DOI: 10.1007/s00405-018-4890-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/27/2018] [Indexed: 12/18/2022]
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Mannelli G, Lazio MS, Luparello P, Gallo O. Conservative treatment for advanced T3-T4 laryngeal cancer: meta-analysis of key oncological outcomes. Eur Arch Otorhinolaryngol 2017; 275:27-38. [PMID: 29119321 DOI: 10.1007/s00405-017-4799-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022]
Abstract
GOAL Controversies exist regarding the treatment of advanced laryngeal carcinomas. The purpose of this systematic review was to evaluate the oncologic outcomes of both transoral laser and open partial laryngectomies for advanced (T3-T4) squamous cell laryngeal cancers management. INTRODUCTION A systematic review of literature was led searching for articles mentioning the following terms: advanced (T3-T4) laryngeal cancer AND laser; AND open partial laryngectomy; AND transoral laser microsurgery; AND cordectomy; AND conservative surgery; AND tracheohyoidopexy or tracheohyoidoepiglottopexy; AND supratracheal partial laryngectomy; AND supracricoid partial laryngectomy; AND cricohyoidopexy or cricohyoidoepiglottopexy. Then a quantitative analysis was carried on papers published after 1980. DISCUSSION The search identified 110 publications, and a total of 21 articles satisfied inclusion criteria and were selected for quantitative synthesis. 10 out of 21 studies had a good quality score, 10 were fair and only one rated a poor score. The pooled disease-free survival (DFS) was 79% (95% CI 74-85), and pooled overall survival (OS) was 71% (95% CI 64-78) at 5 years from all 1921 patients included in the study, with significant heterogeneity (I 2 = 89.7% and I 2 = 90.4%), respectively. Significant heterogeneity value (p = 0.118) was seen by comparing transoral laser and open partial laryngectomies in terms of DFS. CONCLUSION The two surgical techniques are both valid conservative surgical options for advanced laryngeal cancer treatment.
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Affiliation(s)
- Giuditta Mannelli
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy.
| | - Maria Silvia Lazio
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
| | - Paolo Luparello
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
| | - Oreste Gallo
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
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Butler A, Rigby MH, Scott J, Trites J, Hart R, Taylor SM. A retrospective review in the management of T3 laryngeal squamous cell carcinoma: an expanding indication for transoral laser microsurgery. J Otolaryngol Head Neck Surg 2016; 45:34. [PMID: 27233357 PMCID: PMC4884416 DOI: 10.1186/s40463-016-0147-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/19/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the functional and oncological outcomes of patients treated for T3 laryngeal squamous cell carcinoma. Specifically comparing transoral laser microsurgery and radiotherapy/chemoradiotherapy treatment modalities. METHOD A retrospective review of patients treated for T3 laryngeal SCC between 2002 and 2010 was undertaken. RESULTS Forty-nine patients were included. 15 cases were glottic, (9 treated with TLM, 6 with RT/CRT), 33 supraglottic (6 treated with TLM, 27 with RT/CRT) and 1 subglottic subsite (treated with RT/CRT). There was no statistical difference between treatment groups for 24 month locoregional control (72.3 %), overall survival (glottis 86.7 %, supraglottic 70.4 %) and disease specific survival (glottic 93.3 % and supraglottic 74.1 %). Overall laryngeal preservation (84.9 %) was also similar in both groups. CONCLUSION Our institution is expanding the application of TLM to selected patients with T3 laryngeal carcinoma. Oncological outcomes have not been jeopardized by this approach and the treatment is well tolerated by patients with few complications.
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Affiliation(s)
- A Butler
- Dalhousie University, Halifax, Canada.
| | - M H Rigby
- Dalhousie University, Halifax, Canada
| | - J Scott
- Dalhousie University, Halifax, Canada
| | - J Trites
- Dalhousie University, Halifax, Canada
| | - R Hart
- Dalhousie University, Halifax, Canada
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Arroyo HH, Neri L, Fussuma CY, Imamura R. Diode Laser for Laryngeal Surgery: a Systematic Review. Int Arch Otorhinolaryngol 2016; 20:172-9. [PMID: 27096024 PMCID: PMC4835333 DOI: 10.1055/s-0036-1579741] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/11/2015] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. CONCLUSION The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.
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Affiliation(s)
- Helena Hotz Arroyo
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Neri
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Carina Yuri Fussuma
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Rui Imamura
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Endoscopic/external approaches in otorhinolaryngology and head and neck surgery. BIOMED RESEARCH INTERNATIONAL 2015; 2015:958453. [PMID: 25802874 PMCID: PMC4352752 DOI: 10.1155/2015/958453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
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Abstract
Transoral laser microsurgery (TLM) was pioneered in the early 1970s as an approach to treat laryngeal pathology with precision and minimal thermal damage to the vocal cords. Over the last four decades, TLM has become an integral part of the treatment paradigm for patients with laryngeal cancer. TLM is one of the primary treatment options for early-stage laryngeal tumors. However, in recent years, surgeons have begun to develop TLM into a more versatile approach which can be used to address advanced laryngeal tumors. Although functional outcomes following TLM for advanced laryngeal disease are scarce, survival outcomes appear to be comparable with those reported for organ preservation strategies employing external beam radiation therapy (EBRT) and chemotherapy. In addition, TLM plays an important role in the setting of recurrent laryngeal cancer following primary irradiation. TLM has been demonstrated to decrease the need for salvage total laryngectomy resulting in improved functionality while retaining comparable oncologic outcomes. The aim of this review is to elucidate the indications, techniques, and oncological outcomes of TLM for advanced laryngeal cancers.
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Affiliation(s)
- Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA and
| | - Michael E. Kupferman
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- To whom correspondence should be addressed. E-mail:
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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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Peretti G, Piazza C, Del Bon F, Mora R, Grazioli P, Barbieri D, Mangili S, Nicolai P. Function preservation using transoral laser surgery for T2-T3 glottic cancer: oncologic, vocal, and swallowing outcomes. Eur Arch Otorhinolaryngol 2013; 270:2275-81. [PMID: 23568037 DOI: 10.1007/s00405-013-2461-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
Abstract
Aim of this study was to retrospectively analyze oncologic and functional results of a cohort of T2 and selected T3 glottic tumors treated by transoral laser surgery (TLS). Eighty-nine patients affected by T2 and T3 glottic tumors were treated by TLS from 2005 to 2010 at an academic institution by Type V cordectomies using an "en bloc" or, more frequently, a "piece-meal" technique depending on a number of variables. Kaplan-Meier curves were used to evaluate 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates. Univariate analysis of the impact of different variables was performed. At least 1 year after surgery, we examined: subjective voice evaluation by voice handicap index (VHI), perceptive analysis by GRBAS scale, objective measurements with multidimensional voice program (MDVP), swallowing assessment with the M.D. Anderson Dysphagia Inventory (MDADI), videonasal endoscopic evaluation of swallowing (VEES), and videofluoroscopy (VFS). Fifty-nine patients were pT2 and 30 pT3. The 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates were 92.4, 98.7, 68.5, and 82.1 %, respectively. VHI mean score was 20 (mild dysphonia). Mild and moderate dysphonias were detected by GRBAS in 82 and 18% of patients, respectively. Mean values of Jitter, Shimmer, and noise-to-harmonic ratio by MDVP resulted 7.87%, 24.8%, and 0.37, respectively. Mean value of MDADI was 95.75. Only 2% of patients at VEES and 4% at VFS showed tracheal aspiration. Our results highlight that T2 and selected T3 glottic tumors treated by TLS have favorable oncologic and functional outcomes.
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Affiliation(s)
- Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
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Canis M, Martin A, Ihler F, Wolff HA, Kron M, Matthias C, Steiner W. Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients. Eur Arch Otorhinolaryngol 2013; 270:2315-26. [PMID: 23306348 PMCID: PMC3699705 DOI: 10.1007/s00405-012-2327-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/11/2012] [Indexed: 12/01/2022]
Abstract
The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan–Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85 % for pT1/pT2, 82 % for pT3, and 76 % for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92 %, for stages III and IVa 59, 65, and 81 %, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.
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Affiliation(s)
- Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany.
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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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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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Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions. Eur Arch Otorhinolaryngol 2011; 268:1249-57. [PMID: 21562814 DOI: 10.1007/s00405-011-1620-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/12/2011] [Indexed: 01/25/2023]
Abstract
The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends.
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Rodrigo JP, Coca-Pelaz A, Suárez C. The Current Role of Partial Surgery As a Strategy for Functional Preservation in Laryngeal Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rodrigo JP, Coca-Pelaz A, Suárez C. [The current role of partial surgery as a strategy for functional preservation in laryngeal carcinoma]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:231-8. [PMID: 20684940 DOI: 10.1016/j.otorri.2010.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/07/2010] [Indexed: 11/26/2022]
Abstract
With the current advances and recent organ preservation protocols for intermediate or advanced stage laryngeal cancer, based on chemotherapy, the role of surgery seemed replaced except for surgical rescue of tumours not responding to these treatments, total laryngectomy being the surgical option. This type of non-surgical treatment is offered as a strategy for organ preservation, as opposed to total laryngectomy. However, we believe that there are two organ-preservation strategies, surgical and non-surgical. A wide spectrum of surgical techniques is available and such techniques lead to excellent results, both oncological and functional (speech and swallowing). The aim of this paper is to present options for organ-preserving surgery for laryngeal cancer. A review of surgical techniques available for functional preservation in cancer of the larynx at intermediate or advanced stage is presented. In addition to classic approaches such as vertical partial laryngectomy and horizontal or supraglottic laryngectomy, options for conservative laryngeal surgery have improved significantly over the past two decades. Minimally invasive surgery, transoral laser surgery, and supracricoid partial laryngectomy have become important laryngeal preservation approaches for patients with laryngeal cancer. Surgery must define its role in the multidisciplinary treatment of advanced cancers of the larynx, which at present often favours (chemo)radiotherapy protocols.
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Affiliation(s)
- Juan Pablo Rodrigo
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Principado de Asturias, España
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