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Gilja S, Vasan V, Kumar A, Roof SA, Genden EM, Kirke DN. Treatment discordance in the utilization of neck dissection for stage I-II supraglottic tumors. Head Neck 2024; 46:1589-1600. [PMID: 38482913 DOI: 10.1002/hed.27736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND In 2018, the National Comprehensive Cancer Network treatment guidelines began recommending the use of neck dissection during surgical management of stage I-II supraglottic laryngeal squamous cell carcinoma (LSCC). METHODS Trends and factors associated with the use of neck dissection during larynx-preserving surgery for patients with cT1-2, N0, M0 supraglottic LSCC in the National Cancer Database (2004-2020) were evaluated using multivariable-adjusted logistic regression. RESULTS Of the 2080 patients who satisfied study eligibility criteria, 633 (30.4%) underwent neck dissection. Between 2018 and 2020, the rate of neck dissection was 39.0% (114/292). After multivariable adjustment, academic facility type, undergoing biopsy prior to surgery, and more radical surgery were significant predictors of receiving neck dissection. CONCLUSIONS The results of this national analysis suggest that the utilization of guideline-concordant neck dissection for management of stage I-II supraglottic LSCC remains low and highlight the need to promote the practice of neck dissection for this patient population.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vikram Vasan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zorzi S, Pietrobon G, Mossinelli C, Bandi F, Chu F, Tagliabue M, De Berardinis R, Zocchi J, Alterio D, Rocca MC, Ruju F, Ansarin M. Outcomes of mini-invasive transoral surgery without neck dissection in supraglottic laryngeal cancer: Real world data from a tertiary cancer center. Am J Otolaryngol 2024; 45:104113. [PMID: 37956498 DOI: 10.1016/j.amjoto.2023.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE The neck management in early-stage cN0 supraglottic cancer represents an argument of debate. The aim of our study is to evaluate the oncological and functional outcomes in patients with early-stage cN0 supraglottic carcinoma treated with a wait-and-see policy for the neck. MATERIALS AND METHODS Retrospective monocentric cohort study in a referral cancer care center. We collected a consecutive sample of patients from 2000 to 2020 with Squamous Cell Carcinoma of the supraglottis without clinical evidence of nodal metastases (cN0), surgically treated with Transoral Surgery (Laser or Robotic) without neck dissection. From 316 supraglottic cancer we finally selected 66 eligible participants that met all inclusion criteria. RESULTS Sixty-six patients (M 75.8 % vs F 24.2 %), median age 65.8 years (IQR 60.9, 70.5). The most common subsite was the epiglottis (62.1 %). Tumor stage distribution was as follows: 35 % cT1, 53 % cT2, 15.2 % cT3. Neither deaths nor major treatment-related complications were reported after surgery. The median follow-up was 62 months. For oncological outcomes, we evaluated 56 patients (10 excluded for adjuvant radiotherapy): 5-year overall survival rate 87 % (CI 95 %: 73.1-94), disease- specific survival rate 95.3 % (CI 95 %: 82-98.8) and neck recurrence-free survival rate 87 % (CI 95 %: 73.1-94). Six patients developed neck recurrence, with a median time of 13 months. CONCLUSIONS Supraglottic carcinoma has been historically associated to a considerable risk of occult metastasis. However, in early-stage cases data are still inconclusive. Our results suggest that in such patients a wait-and-see policy does not impact negatively on survival outcomes, while granting the reduced morbidity associated to a minimally invasive surgical approach.
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Affiliation(s)
- Stefano Zorzi
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giacomo Pietrobon
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Mossinelli
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Francesco Bandi
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco Chu
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marta Tagliabue
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Rita De Berardinis
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Jacopo Zocchi
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Division of Medical Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesca Ruju
- Division of Radiology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Chen M, Shi F, Wu H, Cheng L, He P, Jin Q, Huang J. Impact of Obstructive Sleep Apnea on Health-Related Quality of Life in Patients With Partial Laryngectomy for Laryngeal Cancer. EAR, NOSE & THROAT JOURNAL 2023:1455613231178955. [PMID: 37291880 DOI: 10.1177/01455613231178955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Objectives: To evaluate the possible risk factors of obstructive sleep apnea (OSA) and its impact on the health-related quality of life (HRQoL) in patients with partial laryngectomy for laryngeal cancer. Methods: A cross-sectional method was used to carry out this study. Patients who underwent partial laryngectomy for laryngeal cancer completed overnight polygraphy (PG) home sleep tests and quality of life questionnaires. The Medical Outcome Study 36-item Short-Form Health Survey (SF-36) questionnaire was used to investigate the factors influencing HRQoL. Results: A total of 59 patients completed the PG tests and quality of life questionnaires, with 74.6% demonstrating evidence of OSA. There were significant differences in tumor area and neck dissection between OSA group and non-OSA groups. Based on sleep-related parameters, patients were divided into cluster 1 (n = 14) and cluster 2 (n = 45) using principal component analysis combined with K-means clustering. Two clusters had significantly different scores of body pain, general health, and health transition in SF-36 domains. Independent factors associated with general health were identified as tobacco use (OR = 4.716), alcohol use (OR = 3.193), and OSA-related condition (OR = 11.336). Conclusions: Larger tumor area and neck dissection might be associated with an increased risk for developing OSA in patients with partial laryngectomy for laryngeal cancer. OSA partially mediated the effect on physical health, including body pain, general health, and health transition. It is important to be aware of the potential impact of OSA on diminished HRQoL of these patients.
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Affiliation(s)
- Min Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Fang Shi
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Haitao Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Lei Cheng
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Peijie He
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Qian Jin
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Jingjing Huang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
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