Transoral laser microsurgery or total laryngectomy for recurrent squamous cell carcinoma of the larynx: Retrospective analysis of 199 cases

Vertical Partial Laryngectomy With Temporoparietal Free-Flap Reconstruction for Recurrent Laryngeal Cancer: Long-Term Study

Objective

Treatment options for recurrent early glottic carcinoma's include conservative and radical surgical options. These options offer similar survival benefits with different impacts of patient's quality of life. We previously present our experience with vertical partial laryngectomy (VPL) and showed high locoregional control rates with high-quality voice results and normal swallowing.

Study Design

A long-term retrospective review.

Setting

Tertiary Care Center.

Methods

We analyzed all patients underwent VPL between the years 1995 to 2018. Long-term oncologic and functional outcomes were collected.

Results

A total of 40 patients were included. The majority of whom were male (n = 38, 95%) with a mean age of 64.9 years (SD ± 9.5). With a median follow up time of 12 years (range 0-24), 9 patients (22.5%) had disease recurrence; the majority of whom (8 patients), had local recurrence and all were salvaged with total laryngectomy. Eight patients (20%) developed second primaries in the head and neck region with a median time to diagnosis of 77 months (range 8-227 months). Ten-years overall survival, disease specific survival, and local disease-free survival were 80%, 90%, and 80%, respectively. Five patients had postoperative laryngeal dysfunction with a total 10-years laryngectomy free survival of 70%.

Conclusion

VPL has a sustainable oncologic outcome with a high long-term laryngectomy free survival rate. This entity is an acceptable conservative salvage option for selected postradiated recurrent laryngeal squamous cell carcinoma patients.

Salvage transoral laser microsurgery for early local recurrence of glottic squamous cell cancer

BACKGROUND

For recurrent laryngeal cancer, the feasibility of salvage transoral laser microsurgery (TLM) remains controversial. This study compared the efficacy of TLM and open partial laryngectomy (OPL) for treatment of early local recurrence of glottic squamous cell cancer (GSCC) and confirm the effectiveness of salvage TLM as a treatment option.

METHODS

This retrospective study involved 55 patients with early local recurrent GSCC treated with TLM, and the oncologic outcomes, functional outcomes, hospitalization time and complications were compared with a group of 40 recurrent GSCC patients matched for clinical variables of TLM group, treated by OPL by the same team of surgeons.

RESULTS

The 5-year overall survival and disease-specific survival rates were 65.8% and 91.5%, respectively, for 55 patients with rT_is-rT₂ stage treated by TLM and 77.1% and 94.7%, respectively, for 40 patients with rT_is-rT₂ stage treated by OPL (OPL group). In the TLM and OPL groups, the local control rates after 5 years were 77.5% and 79.3%, respectively, and the laryngeal preservation rates were 94.4% and 83.6%, respectively (p > 0.05). Compared with the OPL group, the complication rate (1.82%) and hospitalization duration (5.42 ± 2.26 days) were significantly lower in the TLM group (p < 0.05). Compared with the OPL group, postsurgical health-related quality of life and quality of voice were significantly better in the TLM group (p < 0.001).

CONCLUSION

Salvage TLM can be used as an effective treatment option for suitable patients after a full, comprehensive, and careful assessment of the characteristics of early locally recurrent glottic carcinoma.

Transoral Laser Microsurgery in Recurrent Laryngeal Cancer: A Systematic Review and Meta‐analysis

OBJECTIVE

To determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer.

METHODS

PubMed/MEDLINE, Cochrane Library, and Scopus databases were searched. English language, original studies investigating oncological outcomes of TLM in adult patients with recurrent laryngeal cancer were included. Data were pooled using a distribution-free approach for estimating summary local control (LC), disease-specific survival (DSS), and overall survival (OS) curves with random effects.

RESULTS

Two hundred and thirty-five patients underwent salvage TLM after primary (chemo)radiotherapy. The mean follow-up time was 60.8 months (95% CI: 32.7-88.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 74.2% (61.7-89.4), 53.9% (38.5-75.3), and 39.1% (25.2-60.8). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 88.4% (82.0-95.3), 67.8% (50.9-90.3), and 58.9% (42.7-81.1). Two hundred and seventy-one patients underwent TLM after primary laser treatment. The mean follow-up time was 70.9 months (95% CI: 36.9-104.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 72.2% (64.7-80.6), 53.2% (42.2-66.9), and 40.4% (29.6-55.2). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 92.1% (85.5-99.1), 77.0% (64.4-92.0), and 67.1% (51.6-87.3).

CONCLUSIONS

TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage-based clinical guidelines.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:1425-1433, 2023.

Clinical anatomy of superior laryngeal artery via transoral approach

Objective

Hemorrhage is the most common complication caused by transoral laryngopharyngeal surgery. It is believed that proper management of the superior laryngeal artery (SLA), the main feeding artery for the larynx and pharynx, may reduce intra- and postoperative hemorrhage incidence. The aim of this study was to illustrate the anatomy of the SLA via transoral endoscopic approach.

Methods

Fourteen sides of SLA from heads of seven fresh-frozen and silicone-injected cadavers were dissected. Transoral dissections were performed for the intra-laryngeal segment of SLA, and transcervical dissections were performed to confirm the anatomical measurements.

Results

SLA had a slightly descending course from the origin to the larynx, and there was a major branch supplying the epiglottis, named pharyngo-epiglottic artery (PEA). Parallel with the internal superior laryngeal nerve (ISLN), SLA passed through the thyrohyoid membrane and ended into the hypopharynx. The distance from SLA to the superior horn of thyroid cartilage (SHTC) was (9.11 ± 0.58)mm on the left and (9.01 ± 0.37)mm on the right; the distance from SLA to the inferior margin of the hyoid bone (IMHB) was (2.00 ± 0.11)mm on the left and (1.95 ± 0.08)mm on the right; the distance from SLA to ISLN was (5.98 ± 0.48)mm on the left and (5.78 ± 0.36)mm on the right. No significant difference was found between bilateral sides (p > 0.05). Moreover, the distance from SLA to superior margin of thyroid cartilage (SMTC) was (5.52 ± 0.24)mm on the left and (5.80 ± 0.15)mm on the right. A significant difference was also found between bilateral sides (p = 0.03), which might suggest the SLA is located further from the SMTC on the right side.

Conclusion

SHTC, SMTC, and IMHB could be regarded as anatomical landmarks to locate SLA when applying a transoral approach. Moreover, a complete understanding of the detailed anatomy of the superior laryngeal artery may improve the detection of hemostasis in transoral laryngeal or hypo-pharyngeal surgery.

Factors Associated with Outcomes Following Salvage Surgery for Recurrent Laryngeal Cancer: A Retrospective Study of 50 Cases from a Single Center in Poland

BACKGROUND This retrospective study from a single center in Poland aimed to identify factors associated with outcomes following salvage surgery in 50 patients with recurrent laryngeal cancer. MATERIAL AND METHODS The study group consisted of 50 patients with recurrent laryngeal cancer after primary organ preservation treatment (12 patients after partial surgery, 30 patients after radiation therapy, and 8 patients after prior treatment using both methods). None of the patients received chemotherapy before salvage surgery. All patients with recurrence of laryngeal cancer underwent total laryngectomy with elective bilateral nodal surgery. Local and/or nodal recurrence was considered the failure of primary organ preservation treatment. Efficacy of treatment was assessed in relation to overall survival (OS), disease-free survival (DFS), local control (LC), and locoregional control (LRC). RESULTS Treatment results showed a poor prognosis in patients with local and/or nodal recurrence of laryngeal cancer. In the study group, the updated 5-year rates were as follows: OS rate of 26%; DFS rate of 25%; LC rate of 44%; and LRC rate of 39%. Univariate analysis showed that the stage before primary treatment was a predictive factor of OS (P=0.012). CONCLUSIONS The findings from this retrospective study of 50 patients with recurrent laryngeal carcinoma showed that salvage surgery following organ preservation treatment resulted in a 5-year OS rate of 26%.

Clinical Management of Early-Stage Hypopharyngeal Squamous Cell Carcinoma: A Single-Institution Clinical Analysis

OBJECTIVE

Early detection of hypopharyngeal squamous cell carcinoma (SCC) is important for both an improved prognosis and less-invasive treatment. We retrospectively analyzed the detection rates of early hypopharyngeal SCCs according to the evaluation methods and the clinical management of early hypopharyngeal SCCs.

METHODS

Sixty-eight patients with early hypopharyngeal SCC who were diagnosed were reviewed.

RESULTS

The number of early hypopharyngeal cancer patients with asymptomatic or synchronous or metachronous esophageal cancer examined by upper gastrointestinal endoscopy with narrow-band imaging (NBI) was significantly higher than those examined by laryngopharyngeal endoscopy with NBI. The 3-year disease-specific survival rates according to T classification were as follows: Tis, 100%; T1, 100%; T2, 79.8%; and overall, 91.2%, respectively.

CONCLUSIONS

Early-stage hypopharyngeal SCC can be cured by minimally invasive transoral surgery or radiotherapy. Observation of the pharynx using NBI in patients with a history of head and neck cancer, esophageal cancer, gastric cancer, or pharyngeal discomfort is very important, and routinely examining the pharynx with NBI, even in patients undergoing endoscopy for screening purposes, is recommended.

Early glottic cancer recurrence: A critical review on its current management

INTRODUCTION

Recurrent early glottic cancer (rEGC) poses several issues in terms of timely diagnosis, correct re-staging, and treatment. We want to critically review the latest evidence about rEGC considering its epidemiology, biology, diagnostic challenges, and treatment strategies.

METHODS

A systematic search of the literature using PubMed from 1990 to October 31, 2020 was performed.

RESULTS

There are many different treatment options available (open surgery, transoral mini-invasive surgery, radiotherapy), and many factors related to the patient's status and previous treatments must be considered when planning the best management strategy for rEGC. While its overall prognosis remains satisfactory, it is of the utmost importance to appreciate all the clinical implications derived from the choice of the initial therapeutic modality, and from a correct primary and recurrent staging.

CONCLUSION

The balance between oncological and voice and swallowing functions represents the fundamental principle underlying rEGC management. Future studies should focus on molecular profiling of rEGC, and on the results of the emerging radiation delivery techniques and mini-invasive procedures.

Transoral Laser-Assisted Total Laryngectomy: Expanding the TLM's World

Introduction

The introduction of laryngeal transoral procedures has created a shift in the treatment of laryngeal cancers towards the primary surgical management of patients. In this study, we aimed to evaluate the safety, efficacy, and feasibility of the transoral laser-assisted total laryngectomy (TLM-TL) in advanced laryngeal cancer. Case presentation. In this case report, we describe a case of a 50-year-old male patient presented to the otorhinolaryngology clinic with a history of hoarseness and odynophagia since 6 months. Based on the pathological and imaging findings, the diagnosis of stage IVa laryngeal squamous cell carcinoma with the involvement of the base, tongue, and left palatine tonsil was made for the patient, and transoral total laryngectomy with partial glossectomy via the TLM technique was planned.

Result

The tumor was successfully resected by TLM-TL with clear surgical margins. No complication was observed after the surgery. Good functional recovery was obtained regarding swallowing and speech. The patient's oncologic and functional outcomes were evaluated for 2 years. Everything was satisfactory with good long-term cosmetic and laryngopharyngeal functional outcome and no sign of tumor recurrence.

Conclusions

TLM-TL is a minimally invasive and cost-benefit endoscopic surgical procedure feasible in advanced laryngeal cancer with good long-term oncological and functional outcome. It could limit postoperative complications, mainly the incidence of pharyngocutaneous fistulae. It is also associated with better satisfaction after TL due to cosmetic benefits.

A prospective clinical trial of the second-look procedure for transoral surgery in patients with T1 and T2 laryngeal, oropharyngeal, and hypopharyngeal cancer

Background

Transoral surgery (TOS) has been widely applied for early T‐stage head and neck cancer (HNC). The resection is performed with a minimum safety margin for function preservation under a limited surgical field; therefore, it is difficult to have a strong conviction about the complete resection. This study aims to evaluate the completeness of the initial TOS procedure; possibility of primary control by TOS alone; and predictive factors in patients with early T‐stage laryngeal, oropharyngeal, and hypopharyngeal cancer.

Methods

Patients were treated by TOS at the primary site with or without neck dissection. The patients were divided into two groups based on the pathological evaluation of their surgical specimens: the control (observation) group, in that the resection was considered complete and the intervention (second‐look procedure) group, in that incomplete tumor resection was suspected. The predictive factors for the possibility and/or limitations of complete resection by TOS were then analyzed.

Results

The study enrolled 26 and 25 patients in the control and intervention group, respectively. The success rate for single resection was 66% and the predictive factor was tumor depth obtained by enhanced computed tomography (CT) examination (odds ratio, 7.870, P = .0243). The success rate for definitive therapy by TOS alone was 83% and the predictive factor was poor differentiation observed on pathological examination (odds ratio, 6.800, P = .0248).

Conclusions

TOS has the potential for both definitive resection and function preservation with minimal invasiveness. Identification of the risk factors for TOS is advantageous for accurate treatment selection in patients with early T‐stage HNC.

Salvage surgery for recurrent larynx cancer

BACKGROUND

Despite advances in treatment, the recurrence rates for laryngeal cancer range from 16% to 40%.

METHODS

Patients with recurrent laryngeal cancer treated at Memorial Sloan Kettering (MSK) from 1999 to 2016 were reviewed. Survival outcomes were analyzed.

RESULTS

Of 241 patients, 88% were male; the median age was 67 years; 71% had primary glottic tumors. At initial treatment, 72% of patients were seen with early stage disease; primary treatment was radiation (68%), chemoradiation (29%), and surgery (3%). The most common salvage surgery was total laryngectomy (74%). Forty-seven percentage were upstaged at salvage surgery. The 2- and 5-year disease-specific survival (DSS) was 74% and 57%, respectively. Patients with cT4 disease treated with nonsurgical primary management had a 0% 5-year DSS. Independent predictors of DSS were tumor location, perineural invasion, margin, and stage.

CONCLUSIONS

Salvage surgery results in acceptable oncologic outcomes. Stage, disease site, perineural invasion, and margins are associated with inferior DSS.

Clinical, Histological and Immunohistochemical Evaluation of Larynx Cancer

ABSTRACT: Laryngeal cancer represents the malignant degeneration, of epithelial nature or from the connective tissue, which starts in the constitutive elements of the larynx. Cancer localization in the larynx represents between 1% and 3% of all malignant tumors and approximately 50% of ear, nose and throat (ENT) tumors. Squamous cell carcinoma is the most common form (around 95%) of laryngeal cancer, with high incidence in human males from southern and central Europe, Romania occupying one of the top places. Material and Methods. Our study consisted of 490 patients diagnosed with laryngeal cancer from 2010 to 2016. They have been clinically, histologically, immunohistochemically, genetically, therapeutically and prognostically analyzed. Suspended microlaringoscopy has been the standard, allowing tumor extension evaluation and biopsy. All specimens were microscopically analyzed in standard or special histology stainings. For unclear histology specimens, immunohistochemical stainings were performed. Results and discussions. Histological types have been represented as follows: 31 carcinomas in situ, 17 microinvasive carcinoma, 205 poorly differentiated carcinomas, 138 moderately differentiated carcinomas, 63 well differentiated carcinomas, 8 papillary carcinomas, 1 leiomyosarcoma, 1 chondrosarcoma, 6 basaloid squamous cell carcinomas, 4 verrucous carcinoma, 1 malignant melanoma. Conclusions. The study brings to light the importance of integrated clinical, morphological and genetic evaluation of laryngeal cancer, regarding tumoral invasion grading and establishing an adequate surgical and oncologic treatment. The importance of immunohistochemistry in laryngeal cancer concerns prognosis factors which correlate with the evolution and histopathological degree of the lesion. The analysis of tumor invasion can lead to the development of therapeutic conduct and the establishment of prognostic markers.

The Second-Look Procedure for Transoral Videolaryngoscopic Surgery for T1 and T2 Laryngeal, Oropharyngeal, and Hypopharyngeal Cancer Patients: Protocol for a Nonrandomized Clinical Trial

BACKGROUND

Transoral videolaryngoscopic surgery (TOVS) has been widely applied for early T stage head and neck cancer. The resection is performed with a minimum safety margin for function preservation under a limited surgical field of view, making it difficult to be certain of complete resection.

OBJECTIVE

Our aim is the evaluation of the completeness of resection by initial TOVS resection, and the possibility of primary control by TOVS alone, allowing for repeat procedures for function preserving treatment in early T stage laryngeal, oropharyngeal, and hypopharyngeal cancer patients.

METHODS

Patients are treated by TOVS for the primary site with or without neck dissection. Patients are divided in two groups based on the results of the pathological evaluation of the surgical specimen; the control group in which the resection is considered to be complete, and the intervention (second-look procedure) group in which incomplete tumor resection is suspected. The predictive factors for the possibility of complete resection by TOVS will then be analyzed.

RESULTS

Patient enrollment started on January 1, 2014, and closed on March 31, 2016, with 54 patients. The control group consists of 27 patients, the intervention group is 21 patients, and 6 patients were excluded. There were no clinical differences between the control and intervention groups. The observation period will end on December 31, 2018.

CONCLUSIONS

TOVS has potential for both definitive resection and function preservation with minimal invasiveness. Identifying the limitations of TOVS is beneficial to ensure accurate treatment selection in early T stage head and neck cancer patients.

TRIAL REGISTRATION

UMIN Clinical Trials Registry: UMIN000012485; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000014472 (Archived by WebCite at http://www.webcitation.org/6v1b741Iw).

Primary and salvage laser surgery of 341 glottic cancers-Comparison of treatment outcomes between University Head Neck Tertiary Referral Center and Local Head Neck Department

OBJECTIVE

The main goal was to compare the clinical data of patients with T1 and T2 glottic cancer treated with CO₂ transoral laser microlaryngoscopy (TLM) in the Tertiary Referral University Department of Otolaryngology, Head Neck Surgery, Poznan and the local Department of Otolaryngology, Oncology and Maxillofacial Surgery, Bydgoszcz.

MATERIAL AND METHODS

Unified databases for the 7-year period January 2005-December 2011 were created to compare these two cohorts. The database contained 341 patients: 231 from the tertiary center and 110 from the local department, of which 298 (87%) were men, and 43 (13%) were women.

RESULTS

Cordectomy type I-IV was performed in 250 (73%) patients, cordectomy type V-VI in 84 (25%) patients, and cordectomy enlarged to epiglottic petiole in 7 (2%) patients. Local recurrence was observed in 96 (28%) cases. Among these cases, 81 (87.5%) patients had salvage surgery: 43 re-cordectomy, 10 open partial laryngectomy, and 28 total laryngectomy. The outcomes for the whole cohort, Tertiary Referral Center and Local Department respectively were as follows: larynx preservation rate was 91.8%, 93.6%, and 88%; 3-year disease specific survival was 97.4%, 97.9%, and 93.3%; 3-year overall survival was 93.5%, 96.6%, and 85.5%; 5-year disease specific survival was 95.2%, 95.2%, and 96.3%; and 5-year overall survival was 84.5%, 88.7%, and 76%, respectively.

CONCLUSION

Comparison of the cohorts showed that outcomes of primary treatment were similar but there were noticeable differences in salvage treatment efficacy, favoring patients from the Tertiary Referral Center. Lasers Surg. Med. 50:311-318, 2018. © 2017 Wiley Periodicals, Inc.