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Botti C, Lotto C, Tesauro P, Guidotti M, Borghi A, Molteni G, Presutti L, Fernandez IJ. Voice quality after open partial horizontal laryngectomy vs. total laryngectomy with voice prosthesis: a comparative study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08735-5. [PMID: 39048757 DOI: 10.1007/s00405-024-08735-5] [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: 02/06/2024] [Accepted: 05/13/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES The aim of this study is to compare voice outcomes in open partial horizontal laryngectomy vs. total laryngectomy (TL) with voice prosthesis. METHODS In this retrospective monocentric study patients undergoing OPHL or TL with voice prosthesis were enrolled during the usual oncological follow-up consultations at the Otolaryngology and Audiology Unit of a University Hospital in the period between July 2022 and June 2023. Acoustic analysis (F0, HNR, NHR), maximum phonation time, I-SECEL and INFV0 scale were used to assess voice outcome. RESULTS Forty-three patients were enrolled. Voices of patients undergoing LT were better in quality of voice (V0) at INFV0 scale. The scores in I-SECEL and acoustic analysis were comparable. CONCLUSIONS Voice quality could be slight better in patients undergoing TL with voice prosthesis than those undergoing OPHL.
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Affiliation(s)
- Cecilia Botti
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cecilia Lotto
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Tesauro
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Monica Guidotti
- Speech Language Therapist in Otolaryngology and Audiology Unit, Department of Head and Neck Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aurora Borghi
- Speech Language Therapist in Otolaryngology and Audiology Unit, Department of Head and Neck Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriele Molteni
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Crosetti E, Fantini M, Bertotto I, Bertolin A, Arrigoni G, Lorenzi A, Succo G. Current Status of Partial Laryngeal Surgery for Advanced Laryngeal Cancer: When and Why? Curr Oncol Rep 2024; 26:614-624. [PMID: 38647994 PMCID: PMC11168980 DOI: 10.1007/s11912-024-01516-7] [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] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This paper aims to evaluate the evolution and current status of partial laryngeal surgery in the treatment of advanced laryngeal cancer (LC). Specifically, recent progress in the selection of both patients and tumors, together with surgical and rehabilitation innovations, have contributed to balancing oncological control with the maintenance of quality of life in naïve and radiorecurrent patients. The main aspect is represented by the recognized role of open partial horizontal laryngectomies (OPHLs) in this new era of laryngeal cancer treatment. RECENT FINDINGS Recent advancements highlight OPHLs' efficacy for conservative management of intermediate to advanced stages of LC. Innovations such as supratracheal partial laryngectomy have expanded surgical options, offering a modular approach to complex cases. Improved understanding of tumor biology, enhanced imaging techniques, and more precise preoperative planning have led to better patient outcomes, emphasizing the importance of a conservative function-preserving surgical treatment. These advancements reflect a broader trend towards individualized treatment plans that prioritize both survival and quality of life. OPHLs play an important role in current management of intermediate/advanced LC, effectively balancing oncological control with the preservation of laryngeal functions. Critical factors include meticulous patient and tumor selection, the impact of surgical and technological refinements on functional outcomes, and the necessity of a multidisciplinary approach in treatment planning. Current evidence justifies the use of these interventions in many intermediate T-stage laryngeal tumors, even at risk of upstaging on pathological examination. The oncological results, the preservation of laryngeal function and the laryngectomy-free survival achieved with OPHLs appear to be highly competitive with those of non surgical organ-preservation protocols, aiming to introduce a new standard in the LC treatment.
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Affiliation(s)
- Erika Crosetti
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Marco Fantini
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Department, Candiolo Cancer Institute - IRCCS, Candiolo, TO, Italy
| | - Andy Bertolin
- ENT Department, Vittorio Veneto Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giulia Arrigoni
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Lorenzi
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy.
- Department of Oncology, University of Turin, Turin, Italy.
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Colizza A, Ralli M, Di Stadio A, Cambria F, Zoccali F, Cialente F, Angeletti D, Greco A, de Vincentiis M. Outcomes of Laryngeal Cancer Surgery after Open Partial Horizontal Laryngectomies with Lateral Cervical Approach. J Clin Med 2022; 11:jcm11164741. [PMID: 36012980 PMCID: PMC9410219 DOI: 10.3390/jcm11164741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell carcinoma (LSCC) treated with OPHL, performed using a minimally invasive technique. Methods: This is a prospective case−control study. We enrolled 17 consecutive patients with LSCC treated with OPHL through a lateral cervical approach (LCA). Patients were evaluated using their Penetration Aspiration Scale score (liquid, semiliquid and solid) and Voice Handicap Index (VHI) at three different endpoints: 15 days (T1), 3 months (T2), and 6 months (T2) after surgery. Results: The functional outcomes of the LCA are stackable with that of the classical anterior cervical approach in terms of respiration, swallowing, and speech. One-way ANOVA was performed to evaluate the variances of PAS and VHI scores at the three different observation points. No statistically significant differences were observed between OPHL- PAS scores for liquid (p = 0.1) at the three different observation points. A statistically significant improvement was observed in the OPHL- PAS score for semisolids and solids (p < 0.00001) between T1 and T3 (p = 0.0001) and for solids between T2 and T3 (p < 0.00001). The improvement of VHI-10 was statistically significative (p < 0.00001) at the three different observation points (T1−T2 and T2−T3). Conclusion: The LCA is a potential approach for laryngeal surgery in selected cases. The preoperative staging and planning are of the utmost importance to ensure oncological radicality. The main advantage of this approach is the preservation of the healthy tissues surrounding the larynx and the functional and oncological outcomes are stackable with the classic anterior cervical approach.
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Affiliation(s)
- Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
- Correspondence: ; Tel.: +39-340-380-7820
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Arianna Di Stadio
- Department GF Ingrassia, University of Catania, 95125 Catania, Italy
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Federica Zoccali
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Diletta Angeletti
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
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Fantini M, Crosetti E, Pizzorni N, Sprio AE, Bertolin A, Rizzotto G, Schindler A, Succo G. Voice and communication after open partial horizontal laryngectomies: A cross-sectional outcome study. Head Neck 2022; 44:2248-2256. [PMID: 35792420 DOI: 10.1002/hed.27132] [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: 01/31/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study evaluates voice and communication after open partial horizontal laryngectomies (OPHLs), according to surgery and patient-related variables. METHODS Fifty-eight patients were included: 18 type I OPHL, 20 type II OPHL and 20 type III OPHL. Acoustic, aerodynamic, endoscopic, perceptual and self-assessment analyses were carried out. Surgery-related variables and patient-related variables were considered for the analysis. RESULTS Type I OPHL revealed the best phonatory outcomes. Type II and type III OPHL showed similar and poor results, with a highly deteriorated voice quality. A significant difference in MTP was found for patients who had both arytenoids/cricoarytenoid units preserved. Age and time from surgery showed significant correlations with voice quality after OPHLs. CONCLUSIONS Voice and communication outcomes after OPHLs are heterogeneous and might be influenced by several factors. Knowing variables with a substantial impact on phonatory outcomes may help clinicians in the preoperative decision-making process and the postoperative rehabilitative program.
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Affiliation(s)
- Marco Fantini
- Otorhinolaryngology Service, Koelliker Hospital, Turin, Italy.,Otorhinolaryngology Service, San Feliciano Hospital, Rome, Italy
| | - Erika Crosetti
- Otolaryngology Head and Neck Surgery Unit, San Luigi Gonzaga Hospital, Turin, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Andy Bertolin
- Otolaryngology Head and Neck Surgery Unit, Ospedale Civile of Vittorio Veneto, Vittorio Veneto, Italy
| | - Giuseppe Rizzotto
- Otolaryngology Head and Neck Surgery Unit, Ospedale Civile of Vittorio Veneto, Vittorio Veneto, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Department of Oncology, University of Turin, Turin, Italy.,Otolaryngology Head and Neck Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy
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5
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Fantini M, Crosetti E, Firino A, Gallia M, Borrelli G, Stacchini M, Ricci Maccarini A, Succo G. Phonosurgical Injection Approaches for Voice Restoration After Open Partial Horizontal Laryngectomies: A Pilot Study. J Voice 2022:S0892-1997(22)00099-6. [PMID: 35473913 DOI: 10.1016/j.jvoice.2022.03.024] [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: 01/30/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the efficacy of phonosurgical corrective approaches based on injection laryngoplasties and pharyngoplasties followed by speech therapy for voice restoration after unsatisfactory phonatory results of open partial horizontal laryngectomies. METHODS Ten patients with not satisfying phonatory results despite speech therapy after type II or type III open partial horizontal laryngectomies (OPHLs) were included. Each patient underwent a voice restoration program based on phonosurgery (injection laryngoplasty and/or injection pharyngoplasty) with hyaluronic acid and/or calcium hydroxyapatite, followed by post-surgical voice rehabilitation. Voices were recorded and analysed through spectrographic, aerodynamic, perceptual, laryngoscopic and self-assessment evaluations before the treatment (T0), after 1 month (T1) and after three months (T2). RESULTS Significant improvements in the patients voices were found between T0, T1 and T2 concerning acoustic, perceptual, aerodynamic, laryngoscopic and self assessment evaluations. CONCLUSIONS The results of the present study support phonosurgical injection procedures followed by speech therapy as an effective strategy for voice restoration after type II or type III OPHLs in selected patients.
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Affiliation(s)
- Marco Fantini
- Otorhinolaryngology Service, Koelliker Hospital, Turin, Italy; Otorhinolaryngology Service, San Feliciano Hospital, Rome, Italy.
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Arianna Firino
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Michela Gallia
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Gabriella Borrelli
- Physical Medicine and Rehabilitation Service, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Marco Stacchini
- Otorhinolaryngology Unit, Head and Neck Department, Bufalini Hospital, Cesena, Italy
| | | | - Giovanni Succo
- Otolaryngology Head and Neck Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy; Oncology Department, University of Turin, Turin, Italy
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6
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de Vincentiis M, Greco A, Campo F, Candelori F, Ralli M, Di Traglia M, Colizza A, Cambria F, Zocchi J, Manciocco V, Spriano G, Pellini R. Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals. Eur Arch Otorhinolaryngol 2022; 279:2997-3004. [PMID: 34978589 DOI: 10.1007/s00405-021-07238-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. METHODS A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. RESULTS Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. CONCLUSION The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.
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Affiliation(s)
- Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.,Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Candelori
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Mario Di Traglia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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7
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Zorzi SF, Lazio MS, Pietrobon G, Chu F, Zurlo V, Bibiano D, De Benedetto L, Cattaneo A, De Berardinis R, Mossinelli C, Alterio D, Rocca MC, Gandini S, Gallo O, Chiocca S, Tagliabue M, Ansarin M. Upfront surgical organ-preservation strategy in advanced-stage laryngeal cancer. Am J Otolaryngol 2022; 43:103272. [PMID: 34757315 DOI: 10.1016/j.amjoto.2021.103272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Advanced-stage laryngeal cancer is a challenging disease that needs multimodal treatment. Medical and surgical organ-preservation strategies have been developing in the last decades to spare these functions while granting cancer cure. The current work presents the experience of a tertiary-care center in conservative surgery for advanced-stage laryngeal cancer. MATERIALS AND METHODS We collected clinical data of patients submitted to open partial horizontal laryngectomies (OPHLs) and any possible adjuvant treatment from 2005 to 2018. Outcomes were also compared to the most recent studies reporting on both medical and surgical organ-preservation strategies. RESULTS One hundred ten patients were included in the analysis. Adjuvant therapy was employed in 51% of cases. The local control rate was 96.4%, while overall survival (OS) was 67%, and laryngo-esophageal dysfunction free survival (LEDFS) was 66%. Stage IV and vascular invasion were associated with a statistically-significant worse survival. CONCLUSIONS OPHLs are valid as upfront treatment in fit patients affected by advanced-stage laryngeal cancer. Disease control and function preservation are granted in a significant percentage of cases, even when followed by adjuvant therapy.
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Affiliation(s)
- Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Silvia Lazio
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Zurlo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Debora Bibiano
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi De Benedetto
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Augusto Cattaneo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Mossinelli
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Maria Cossu Rocca
- Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Oreste Gallo
- First Clinic of Otolaryngology Head-Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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8
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Freitas ASD, Zica GM, Salles M, Silva ACAE, Silva TH, Dias FL, Santos IC. DIGEST Scale Predictis More Quality of Life Than PAS: the Residue Influence on Supracricoid Laryngectomy. Int Arch Otorhinolaryngol 2021; 26:e357-e364. [PMID: 36109048 PMCID: PMC9282976 DOI: 10.1055/s-0041-1730306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction
Supracricoid laryngectomy (SCL CHEP) removes ∼ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature.
Objective
To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP.
Methods
A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST).
Results
In a group of 86 patients, there was a significant relationship between oncological staging and the global (
p
< 0.001) and total (
p
= 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (
p
= 0.045). The swallowing function proved to be relevant for QoL.
Conclusion
The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.
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Affiliation(s)
- Andressa Silva de Freitas
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Guilherme Maia Zica
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Mariana Salles
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Ana Catarina Alves e Silva
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Thiago Huaytalla Silva
- Departamento de Nutrição e Dietética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando Luiz Dias
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Izabella Costa Santos
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
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9
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Fantini M, Crosetti E, Affaniti R, Sprio AE, Bertotto I, Succo G. Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies. Head Neck 2021; 43:3459-3467. [PMID: 34405480 DOI: 10.1002/hed.26845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In minority of cases, the clinical recovery of the neolarynx after open partial horizontal laryngectomies (OPHLs) can be challenging, possibly affecting the final functional outcome. METHODS One hundred and twenty-three patients who underwent OPHLs were selected. A series of clinical preoperative independent variables were considered. All patients were monitored for the following dependent outcome variables: sequelae; need for percutaneous endoscopic gastrostomy positioning; days before tracheal cannula removal and nasogastric tube removal; and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify significant associations between preoperative clinical variables and outcomes variables. RESULTS Multivariate analysis confirmed age, cT classification, body mass index, and smoking habits as significant prognostic factors for worse functional and clinical recovery outcomes. CONCLUSIONS Knowing what variables are significantly associated with worse clinical and functional outcomes can guide clinicians in defining the best surgical choice not only from an oncological perspective, but also for a better postoperative recovery.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Riccardo Affaniti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy.,Oncology Department, University of Turin, Orbassano (TO), Italy
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10
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Bertolin A, Lionello M, Ghizzo M, Barbero E, Crosetti E, Rizzotto G, Succo G. Modular approach in OPHL: are there preoperative predictors? ACTA ACUST UNITED AC 2021; 40:352-359. [PMID: 33299225 PMCID: PMC7726649 DOI: 10.14639/0392-100x-n0782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
Abstract
Objective Open partial horizontal laryngectomies (OPHLs) nowadays represent the first line surgical choice for the conservative treatment of locally intermediate and selected advanced stage laryngeal cancers. Among the peculiarities of OPHLs, there is the possibility of intraoperatively modulating the procedure. It would be useful for the surgeon to recognise preoperative endoscopic and radiological factors that can predict the possibility to modulate the laryngectomy. Methods The present study retrospectively reviewed a cohort of 72 patients who underwent OPHL for glottic LSCC, in order to identify preoperative (endoscopic and radiological) parameters that are able to predict modulation surgery. Results The hypoglottic extension of the glottic tumour was the preoperative finding that was most informative in predicting OPHL modulation. However, it had no significant impact on oncological outcomes. Conclusions Patients affected by tumours with hypoglottic extension and eligible for OPHL type II should be preoperatively informed about the possibility of an intraoperative switch towards OPHL type III.
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Affiliation(s)
- Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | | | - Marco Ghizzo
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | - Emanuela Barbero
- Otorhinolaryngology Service, University of Eastern Piedmont, Novara, Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | | | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
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11
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Fantini M, Gallia M, Borrelli G, Pizzorni N, Ricci Maccarini A, Borragan Torre A, Schindler A, Succo G, Crosetti E. Substitution Voice Rehabilitation After Open Partial Horizontal Laryngectomy Through the Proprioceptive Elastic Method (PROEL): A Preliminary Study. J Voice 2020; 36:291.e1-291.e7. [PMID: 32553498 DOI: 10.1016/j.jvoice.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim was to investigate the efficacy of the Proprioceptive Elastic Method (PROEL) in the rehabilitation of the substitution voice after open partial horizontal laryngectomy (OPHL). STUDY DESIGN Prospective outcome study. METHODS Fifteen patients surgically treated by OPHL type II or type III for laryngeal cancer were recruited (experimental group). Each patient underwent a specific program of voice rehabilitation based on the PROEL method with the same speech and language pathologist. Acoustic-aerodynamic analysis: maximum phonation time (MPT); spectrographic classification (Titze's modified classification), perceptual analysis (INFVo rating scale) and self-assessments (SECEL questionnaire) were performed before the treatment (T0), after 3 months of rehabilitation (T1), and at the end of the 6-month rehabilitation program (T2). A control sample of other 15 patients who underwent OPHL type II or type III and who underwent a standard perioperative rehabilitation was randomly extracted from an historical database and compared to the experimental group. RESULTS Significative voice improvements between T0-T1 and T2 were found for acoustic, aerodynamic, perceptual, and self-assessments analysis in the experimental group. Significative differences were found between the experimental group at T2 and the control sample for aerodynamic, self-assessment, and perceptual analysis. CONCLUSIONS The results of the present study support PROEL method as an effective approach for substitution voice rehabilitation after OPHL type II and III. Randomized controlled trials on larger groups of patients are needed in future in order to compare PROEL with other rehabilitative approaches.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.
| | - Michela Gallia
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Gabriella Borrelli
- Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | | | | | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy; Oncology Department, University of Turin, Turin, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
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12
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Garcia AM, Dias FL, Gonçalves AJ, Cernea CR, Freitas EQ, Menezes MB, Kulcsar MAV. Supratracheal laryngectomy: a multi-institutional study. Braz J Otorhinolaryngol 2019; 86:609-616. [PMID: 31175040 PMCID: PMC9422495 DOI: 10.1016/j.bjorl.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/07/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.
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Affiliation(s)
- Ariana M Garcia
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil.
| | - Fernando L Dias
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Antônio J Gonçalves
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Claudio R Cernea
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Emilson Q Freitas
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Marcelo B Menezes
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marco Aurélio V Kulcsar
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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13
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Succo G, Crosetti E. Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs. Front Oncol 2019; 9:408. [PMID: 31192120 PMCID: PMC6540733 DOI: 10.3389/fonc.2019.00408] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022] Open
Abstract
The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.
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Affiliation(s)
- Giovanni Succo
- Oncology Department, University of Turin, Turin, Italy.,Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
| | - Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
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14
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Crosetti E, Fantini M, Maldi E, Balmativola D, Succo G. Open partial horizontal laryngectomy using CO 2 fiber laser. Head Neck 2019; 41:2830-2834. [PMID: 31066480 DOI: 10.1002/hed.25797] [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: 01/04/2019] [Revised: 04/14/2019] [Accepted: 04/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The application of CO2 fiber laser technology to ENT surgery has led to new interesting scenarios, both in endoscopic and in open surgical approaches. METHODS The current video shows three examples of open partial horizontal laryngectomies (OPHLs) performed using CO2 fiber laser for resection procedures. RESULTS CO2 fiber laser helped the surgeon in improving the accuracy of resection and the quality of surgical margins on specimen. The low thermal damage on tissues resulted in minor postoperative edema and a fast recovery of laryngeal function. CONCLUSIONS In our experience, the application of CO2 fiber laser showed some very useful features for performing OPHLs: a high cutting precision with very low tissue damage, the possibility of delivering energy without touching the organ, a modulable power for the various surgical steps, a very good maneuverability of the fine fiber holder during the procedure allowing the surgeon to "draw" the resection with a great accuracy.
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Affiliation(s)
- Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Marco Fantini
- Oncology Department, University of Turin, Orbassano, Italy
| | - Elena Maldi
- Pathology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Davide Balmativola
- Pathology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.,Oncology Department, University of Turin, Orbassano, Italy
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15
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Supratracheal partial laryngectomy: indications, oncologic and functional results. Curr Opin Otolaryngol Head Neck Surg 2018; 25:127-132. [PMID: 28169863 DOI: 10.1097/moo.0000000000000344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe current evidence about supratracheal laryngectomies, focusing on indications, contraindications, oncologic results, functional outcomes and side-effects of this 'extreme' function-sparing surgical approach to laryngeal cancer. RECENT FINDINGS In the latest years, some studies have analyzed oncologic and functional results of open partial supratracheal laryngectomy, a surgical approach whose modern technique was recently described. In selected patients, supratracheal partial laryngectomies show promising long-term oncologic and functional outcomes, similar to those of supracricoid partial laryngectomies. SUMMARY The application of supratracheal laryngectomy in the context of a surgical modular approach can be considered a valid and effective therapeutic choice for selected patients with glottic or transglottic laryngeal cancer with subglottic extension, not only in terms of oncologic results, but also in regard of functional outcomes.
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16
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Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemoradiotherapy of Head and Neck Malignancy. Dysphagia 2018. [DOI: 10.1007/174_2018_179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Crosetti E, Fantini M, Arrigoni G, Salonia L, Lombardo A, Atzori A, Panetta V, Schindler A, Bertolin A, Rizzotto G, Succo G. Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant? Eur Arch Otorhinolaryngol 2016; 274:337-346. [PMID: 27435595 DOI: 10.1007/s00405-016-4217-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/14/2016] [Indexed: 11/21/2022]
Abstract
The aim was to investigate telephonic voice intelligibility in patients treated for laryngeal cancer using different approaches. In total, 90 patients treated for laryngeal cancer using different approaches and 12 healthy volunteers were recruited. Each patient and each healthy control read a list of words and sentences during a telephone call. Six auditors listened to each telephonic recording and transcribed the words and sentences they understood. Mean intelligibility rates for each treatment were assessed and compared. Regarding words, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by total laryngectomies. The best intelligibility was found for transoral laser microsurgery, followed by radiotherapy alone. For sentences, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by chemoradiotherapy. The best intelligibility was found for radiotherapy alone and transoral laser microsurgery. More aggressive surgery as well as chemoradiotherapy correlated with significantly poorer outcomes. Transoral laser microsurgery or radiotherapy alone ensured the best telephonic voice intelligibility. Intermediate-advanced T stages at diagnosis also showed significantly poorer intelligibility outcomes, suggesting that T stage represents an independent negative prognostic factor for voice intelligibility after treatment.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.
| | - Marco Fantini
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giulia Arrigoni
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Laura Salonia
- Otorhinolaryngology Service, Department of Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Agata Lombardo
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alessio Atzori
- National Institute of Metrological Research, Turin, Italy
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy and Training, Biostatistics office, Rome, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andy Bertolin
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Giuseppe Rizzotto
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Giovanni Succo
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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