1
|
Laccourreye O, Garcia D, Haroun F, Nguyen DH, Giraud P, Mirghani H. Primary Total Laryngectomy for Endolaryngeal cT3-4M0 Squamous Cell Carcinoma: A STROBE Analysis. Laryngoscope 2024; 134:2288-2294. [PMID: 37921374 DOI: 10.1002/lary.31129] [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: 06/06/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES To document 10-year oncologic outcome of primary total laryngectomy (TL) for patients with cT3-4M0 endolaryngeal squamous cell carcinoma (SCC). STUDY DESIGN Observational inception cohort of 531 patients with isolated untreated endolaryngeal cT3-4M0 SCC review over 40 years using STROBE guideline. 94% of patients were followed until death or for a minimum of 10 years. SETTING Academic tertiary referral care center. METHODS All patients underwent primary TL. Prior tracheotomy, induction chemotherapy, thyroid gland resection, level II-IV neck dissection, level VI dissection, and postoperative radiation therapy were associated in 6%, 40%, 43%, 89%, 47%, and 74% of cases, respectively: The main objective was to determine the 10-year actuarial local control estimate. Accessory objectives comprised screening for clinical variables increasing the risk of local recurrence, and analysis of long-term oncologic consequences of local recurrence. RESULTS The 10-year actuarial local control estimate was 89.7%. Local recurrence was salvaged in 11% of cases, resulting in 92% overall local control. On multivariate analysis, none of the study variables correlated with local recurrence. Local recurrence resulted in significantly reduced nodal control, distant metastasis control, and survival. Postoperative complications, persistent index SCC, intercurrent disease, and metachronous second primary cancer accounted for respectively 3%, 37%, 33%, and 28% of the 334 deaths noted during the 10 years following TL. CONCLUSION The present study underscored the long-term oncologic efficacy of primary TL, the dangers of local recurrence, the key role of local control for survival, and the importance of a long-term oncologic watch policy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2288-2294, 2024.
Collapse
Affiliation(s)
- Ollivier Laccourreye
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale HEGP, AP-HP, Paris, France
| | | | - Fabienne Haroun
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale HEGP, AP-HP, Paris, France
| | - Dac H Nguyen
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale HEGP, AP-HP, Paris, France
| | - Philippe Giraud
- Université Paris Cité, Service de Radiothérapie-Oncologie, HEGP, AP-HP, Paris, France
| | - Haitham Mirghani
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale HEGP, AP-HP, Paris, France
| |
Collapse
|
2
|
Bradley PJ. Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes. Curr Opin Otolaryngol Head Neck Surg 2023; 31:94-104. [PMID: 36730566 DOI: 10.1097/moo.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer. RECENT FINDINGS Peristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (para- and pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention. SUMMARY Research is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.
Collapse
Affiliation(s)
- Patrick J Bradley
- Department Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
| |
Collapse
|
3
|
Zhou L, Qin S, Zhang Q, Xu J. Clinical characteristics and risk factors of central lymph node and thyroid metastasis in patients with hypopharyngeal carcinoma. Am J Otolaryngol 2023; 44:103742. [PMID: 36610248 DOI: 10.1016/j.amjoto.2022.103742] [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: 08/17/2022] [Revised: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Our study sought to analyze the clinical characteristics and risk factors of central lymph node and thyroid metastasis in patients with hypopharyngeal carcinoma. METHODS The current study included a total of 152 patients who suffered from hypopharyngeal cancer in our hospital from January 2019 to December 2020. Univariate/multivariate Logistic regression analyses were applied to analyze the risk factors of both central lymph nodes and thyroid metastasis in patients with hypopharyngeal cancer. RESULTS Significant differences were found in tobacco use, drinking history, PS score, site of tumor, pT and pN stage, pathological stage, differentiation degree, postoperative calcium ion level and postoperative FT3 level between the thyroid metastasis group and the non-thyroid metastasis group, and between the central lymph node metastasis group and the non-central lymph node metastasis group (P < 0.05). The multivariate logistic regression analysis showed that the risk factors of thyroid metastasis in patients with hypopharyngeal cancer were pathological stage and differentiation degree. CONCLUSIONS Patients with hypopharyngeal cancer complicated by thyroid metastasis or central lymph node metastasis may be associated with tobacco use, drinking history, PS score, site of tumor, pT and pN stage, pathological stage, differentiation degree, postoperative calcium ion level, and postoperative FT3 level. Moreover, the risk factors responsible for central lymph node and thyroid metastasis in hypopharyngeal cancer patients were thought related to pathological stage and differentiation degree.
Collapse
Affiliation(s)
- Liangfa Zhou
- Department of Oncology, Wuhan No.1 Hospital (Wuhan Hospital of Traditional Chinese and Western Medicine), Wuhan, Hubei Province, China
| | - Shuanglai Qin
- Department of Oncology, Wuhan No.1 Hospital (Wuhan Hospital of Traditional Chinese and Western Medicine), Wuhan, Hubei Province, China
| | - Qiu Zhang
- Department of Otorhinolaryngology, Wuhan No.1 Hospital (Wuhan Hospital of Traditional Chinese and Western Medicine), Wuhan, Hubei Province, China
| | - Jian Xu
- Department of Abdominal and Pelvic Medical Oncology, Huangshi Central Hospital Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei Province, China.
| |
Collapse
|
4
|
Obongo Anga R, Abbaci M, Guerlain J, Breuskin I, Casiraghi O, Marhic A, Benmoussa-Rebibo N, de Kermadec H, Moya-Plana A, Temam S, Gorphe P, Hartl DM. Intraoperative Autofluorescence Imaging for Parathyroid Gland Identification during Total Laryngectomy with Thyroidectomy. Cancers (Basel) 2023; 15:cancers15030875. [PMID: 36765832 PMCID: PMC9913419 DOI: 10.3390/cancers15030875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Hypoparathyroidism is a known complication of total laryngectomy, although parathyroid preservation and/or reimplantation are not routine. Autofluorescence is a new technique for identifying parathyroid glands intraoperatively. The aim of this study was to evaluate the feasibility of autofluorescence in this context. MATERIALS AND METHODS A retrospective study of patients undergoing total laryngectomy/pharyngectomy with concomitant thyroidectomy using the Fluobeam® (Fluoptics, Grenoble, France) and frozen section of a parathyroid fragment in case of reimplantation. The rates of identification using autofluorescence, reimplantation, and hypoparathyroidism were evaluated. RESULTS Eighteen patients (16 males, median age 67) underwent total laryngectomy/pharyngectomy with total thyroidectomy (n = 12) or hemithyroidectomy (n = 6). A median of 2 parathyroid glands were identified per patient. Ninety-two percent were identified by autofluorescence before visualisation. All parathyroids were reimplanted due to devascularization. Temporary hypoparathyroidism occurred in nine patients, and was permanent in one patient. After 34 months of median follow-up (range 1-49), no tumor recurrence was observed in the reimplantation sites. CONCLUSIONS To our knowledge, this is the largest study to evaluate autofluorescence during total laryngectomy with thyroidectomy. No tumor recurrence occurred in the sites of parathyroid reimplantation.
Collapse
Affiliation(s)
- Raïs Obongo Anga
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Department of Head and Neck Cancer and ENT Surgery, Henri Becquerel Cancer Center, 76038 Rouen, France
| | - Muriel Abbaci
- Plateforme d’Imagerie et de Cytométrie, UMS AMMICa, Gustave-Roussy Cancer Campus—Grand Paris, Université Paris-Saclay, 94805 Villejuif, France; Laboratoire d’Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, CEA, CNRS, Inserm, 91401 Orsay, France
| | - Joanne Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Ingrid Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Odile Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Alix Marhic
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Nadia Benmoussa-Rebibo
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Héloïse de Kermadec
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Dana M. Hartl
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Correspondence:
| |
Collapse
|
5
|
Barbieri D, Melegatti MN, Vinciguerra A, Indelicato P, Giordano L, Bondi S, Biafora M, Trimarchi M, Bussi M. The use of near-infrared autofluorescence during total laryngectomy with hemi- or total thyroidectomy. Eur Arch Otorhinolaryngol 2023; 280:365-371. [PMID: 35920893 DOI: 10.1007/s00405-022-07584-4] [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: 05/13/2022] [Accepted: 07/29/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study is to describe the use of near-infrared autofluorescence (NIR-AF) to identify and preserve parathyroid glands (PGs) in a group of patients with advanced hypopharyngeal/laryngeal cancer undergone total (pharyngo)laryngectomy with hemi- or total thyroidectomy. METHODS At San Raffaele Hospital, Milan (Italy), from January 2021 to May 2021, 7 patients affected by cT4a laryngeal squamous cell carcinoma (SCC) underwent surgery using an autofluorescence detection system (Fluobeam-Fluoptics®). For proper surgical planning, the demolition phase envisaged extension of the intervention to 4 hemithyroidectomies and 3 total thyroidectomies associated, respectively, with homolateral or bilateral CCND. Serum calcium, ionized calcium, and parathyroid hormone (PTH) levels at post-operative day (POD) 1 and 2 and at 2 weeks after surgery were monitored. Finally, we compared the data obtained with a cohort of patients who underwent surgery without the adoption of NIR-AF. RESULTS With the use of NIR-AF, 18/20 PGs were identified, of which 7/18 were preserved exclusively thanks to the use of autoflorescence. The technique also made it possible to identify and isolate three PGs from the surgical specimen, which were subsequently transplanted only after intraoperative histological confirmation. On POD-1, 3/7 patients (42.8%) were hypocalcemic; on POD-2 and after 2 weeks only 1/7 patient (14.2%) was hypocalcemic. Comparing the two groups, we highlighted that the utilization of NIR-AF was related to a significant decrease of median serum (p = 0.026) and ionized calcium levels (p = 0.017) 2 weeks after surgery. Using this new technology, in no case did definitive histological examination reveal the presence of PGs in the surgical specimen, reaching an accuracy of 100%. CONCLUSIONS In our cohort of patients who underwent total (pharyngo)laryngectomy with hemi- or total thyroidectomy, the use of near-infrared autofluorescence improved medium term postoperative hypocalcemia rates. This new technology helps to achieve a better calcemic outcome compared to the standard naked eye approach, since it helps the surgeon to identify and preserve parathyroid glandular tissue with a lower incidence of post-operative hypocalcemia.
Collapse
Affiliation(s)
- Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Nicole Melegatti
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina, 60, 20133, Milan, Italy.
| | | | - Pietro Indelicato
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Leone Giordano
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Bondi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Matteo Biafora
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
6
|
Xie J, Liu H, Wu P, Chen L, Ge P, Chen S, Zhang S, Lu Z. Predictors of Thyroid Gland Invasion in Total Laryngectomy for Advanced Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221098300. [PMID: 35533678 DOI: 10.1177/01455613221098300] [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: 11/15/2022] Open
Abstract
Objectives: Thyroidectomy for advanced laryngeal squamous cell carcinoma (LSCC) is controversial. This study aimed to identify predictors of thyroid gland invasion in patients with LSCC and management of the thyroid gland during total laryngectomy. Patients and Methods: Clinical data and pathological characteristics of 113 patients, who underwent laryngectomy with thyroidectomy for advanced LSCC in Guangdong Provincial People's Hospital between 2009 and 2019, were retrospectively analyzed. The incidence and predictors of thyroid gland invasion were analyzed, and a new predictor was proposed using a parallel test. Results: Of 113 patients, 25.7% exhibited thyroid invasion. A new predictor that combined the lower third of thyroid cartilage invasion and thyroid gland invasion on computed tomography/magnetic resonance imaging (CT/MRI) was associated with pathological thyroid gland invasion (P = 0.001; sensitivity, 88.2%; negative predictive value, 95%). Conclusion: Thyroidectomy may be required during total laryngectomy in those with invasion of the lower third of thyroid cartilage and/or thyroid gland invasion revealed on CT/MRI instead of being performed routinely.
Collapse
Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Hui Liu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Peiyan Wu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liangsi Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingjiang Ge
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siyi Zhang
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
7
|
Xie J, Wu P, Liu H, Zhang S, Lu Z. Thyroid gland invasion in total laryngectomy: A systematic review and meta-analysis. Int J Surg 2022; 99:106262. [PMID: 35172203 DOI: 10.1016/j.ijsu.2022.106262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical indications remain controversial. Some researchers believe that thyroid invasion is uncommon and that thyroid preservation should be considered in most cases. OBJECTIVE This study aimed to identify the incidence and predictors of thyroid invasion in patients with laryngeal cancer to facilitate decision-making regarding whether to perform thyroidectomy during total laryngectomy. MATERIALS AND METHODS The author conducted a systematic review and meta-analysis of all published articles retrieved from a search of the MEDLINE (1982-2020) and EMBASE (1971-2020) databases. The published studies of advanced laryngeal cancer with total laryngectomy and partial or total thyroidectomy for laryngeal cancer were selected. The incidence and predictors of thyroid invasion were analyzed. RESULTS We analyzed 25 studies (2177 cases), of which 176 people (8.08%) had thyroid invasion. Subglottic tumors (odds ratio [OR], 3.74; 95% CI, 1.75-7.99), T4 stage tumors (OR, 2.39; 95% CI, 1.20-4.75), subglottic extension (OR, 3.85; 95% CI,2.09-7.11), and thyroid cartilage invasion (OR, 3.98; 95% CI, 1.47-10.75) are risk factors for thyroid invasion, and no statistically significant difference was noted between recurrent tumor and thyroid invasion. CONCLUSION The risk of thyroid invasion was significantly higher when advanced laryngeal cancer involved subglottic tumors, T4 stage tumors, subglottic extension, and thyroid cartilage invasion. The overall incidence of thyroid gland invasion was low; therefore, thyroidectomy may be performed for cases deemed risky rather than as a routine measure of total laryngectomy. RESEARCH REGISTRY UIN: reviewregistry1226.
Collapse
Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China Shantou University Medical College, Shantou, Guangdong, China The Second School of Clinical Medicine, Southern Medical University, China
| | | | | | | | | |
Collapse
|
8
|
Pasha HA, Wasif M, Ikram M, Hammad M, Ghaloo SK, Rashid Z. Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension. Int Arch Otorhinolaryngol 2022; 26:e574-e578. [PMID: 36405478 PMCID: PMC9668439 DOI: 10.1055/s-0041-1740200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously.
Objective
To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained.
Methods
We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study.
Results
We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (
p
= 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI.
Conclusion
Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.
Collapse
Affiliation(s)
- Hamdan Ahmed Pasha
- Department of Otolaryngology and Head and Neck Surgery, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Wasif
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Hammad
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shayan Khalid Ghaloo
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Zafar Rashid
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
9
|
El-Sebai Ali M, Atef Ebada H, El-Shaheed MA, Musaad AbdElFattah A, Kamal ELS. Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial. Ann Med Surg (Lond) 2022; 74:103309. [PMID: 35145675 PMCID: PMC8818527 DOI: 10.1016/j.amsu.2022.103309] [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: 12/08/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background We investigated the incidence of thyroid gland invasion in patients with advanced laryngeal carcinoma who were treated with total laryngectomy, also the impact of different preoperative and intraoperative predictors on thyroid gland invasion. Moreover, the impact of thyroid gland preservation on the locoregional tumor control and the recurrence rates after surgery were investigated. Materials and methods This study was conducted over 5 years on 100 patients with advanced laryngeal carcinoma who underwent total laryngectomy. The adopted protocol in our hospital is to perform an ipsilateral thyroid lobectomy if there is subglottic extension, thyroid or cricoid cartilage invasion or true invasion of the thyroid gland. The patients of the study were divided into thyroid sparing and thyroid sacrificing groups. The two groups were compared in terms of demographic data, tumor characteristics, incidence of postoperative hypothyroidism and tumor recurrence. Results There was no significant difference between groups regarding the tumor profile. Regarding local tumor spread, the only two subsites that showed significant difference is anterior commissure and thyroid cartilage invasion. In the thyroid sacrificing group, invasion of the thyroid gland was proved histopathologically in only one patient. Postoperatively, the incidence of hypothyroidism was significantly higher in the thyroid sacrificing group. However, there was no statistically significant difference between the two groups regarding the incidence of tumor recurrence. Conclusion The incidence of thyroid gland invasion by an advanced laryngeal carcinoma is low. Preservation of the thyroid gland during laryngectomy to reduce the risk of thyroid dysfunction does not affect the oncological control. Thyroid gland invasion incidence in advanced laryngeal carcinoma is low. Thyroid gland Preservation during laryngectomy does not affect the oncological control. There was no statistically significant difference between the thyroid sparing and thyroid sacrificing group regarding the incidence of recurrence. Due toding author”. Due toding author".
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Aslıer M, Uçurum BE, Kaya HC, Coskun H. The prognostic value of thyroid gland invasion in locally advanced laryngeal cancers. Acta Otolaryngol 2021; 141:865-872. [PMID: 34406113 DOI: 10.1080/00016489.2021.1962013] [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: 10/20/2022]
Abstract
BACKGROUND Locally advanced laryngeal cancers can spread to the thyroid gland by direct invasion of cricothyroid membrane. The prevalence of thyroid gland invasion (TGI) and the predictive factors of TGI were well described in literature. However, the association of TGI with survival was undetermined yet. OBJECTIVES The aim of this study is to analyze the effects of TGI on survival rates in patients with locally advanced laryngeal cancer. MATERIALS AND METHODS Medical records of 91 patients who underwent total laryngectomy with thyroidectomy were retrospectively reviewed. Demographical, clinical, and histopathological characteristics of the patients were noted. Kaplan-Meier test was used for survival analysis. RESULTS Histopathology reports revealed the prevalence of TGI as 14.3% (13/91). Survival analyses showed that TGI did not affect recurrence free (p = .078) and overall (p = .080) survival rates. CONCLUSIONS Thyroid gland invasion is one of the characteristic features of locally aggressive laryngeal tumors. In this study, TGI is not a statistically significant prognostic factor that has impact on survival of the patients with locally advanced laryngeal cancer.
Collapse
Affiliation(s)
- Mustafa Aslıer
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Bahar Ezgi Uçurum
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Hilmi Cem Kaya
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Hakan Coskun
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| |
Collapse
|
12
|
Muhammad T, Dhanani R, Mohtasham S, Hussain M, Faisal M, Malik KI, Jamshed A, Hussain R. Incidence of thyroid gland invasion in advanced laryngeal cancers and its impact on disease-specific survival; a retrospective review at a tertiary care center. Acta Otolaryngol 2020; 140:882-885. [PMID: 32633590 DOI: 10.1080/00016489.2020.1778786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Incidence of thyroid gland invasion in advanced laryngeal cancers is low. Ipsilateral or total thyroidectomy along with total laryngectomy has been controversial and there has been no consensus over the management of thyroid gland in advanced laryngeal cancers.Objective: To determine the frequency of thyroid gland invasion in locally advanced laryngeal squamous cell carcinoma and the risk factors associated with it.Material and methods: A retrospective review of patients with laryngeal squamous cell carcinoma operated at our center between January 2011 and December 2018 was carried out. Patients undergoing upfront or salvage laryngectomy with or without neck dissection along with hemi or total thyroidectomy were included. Histopathology reports were reviewed to record the involvement of thyroid gland.Results: Invasion of thyroid gland by squamous cell carcinoma larynx was seen in 10 (10.9%) patients out of 92. All of the cases showed direct extension of the tumor. Trans-glottic, subglottic, and tumors with extra laryngeal spread were found to be significantly associated with thyroid gland invasion. Patients with thyroid gland invasion showed higher rate recurrence.Conclusion and significance: Incidence of thyroid gland invasion in squamous cell carcinoma larynx is low, allowing us not to address thyroid routinely in patients undergoing total laryngectomy for laryngeal carcinoma.
Collapse
Affiliation(s)
- Tahir Muhammad
- Department of Otolaryngology/Head & Neck Surgery, Peshawar Medical College & Kuwait Teaching hospital, Peshawar, Pakistan
| | - Rahim Dhanani
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Sameen Mohtasham
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muntazir Hussain
- Department of Surgery, Cancer Foundation Hospital, Karachi, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Kashif Iqbal Malik
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| |
Collapse
|
13
|
Does Thyroid Gland Preserving Total Laryngectomy Affect Oncological Control in Laryngeal Carcinoma? Laryngoscope 2019; 130:1465-1469. [DOI: 10.1002/lary.28235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/07/2022]
|
14
|
Panda S, Kumar R, Konkimalla A, Thakar A, Singh CA, Sikka K, Sharma SC, Kakkar A, Bhasker S. Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes. Indian J Surg Oncol 2019; 10:608-613. [PMID: 31857751 DOI: 10.1007/s13193-019-00935-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
Thyroidectomy conventionally accompanies total laryngectomy. This study intends to analyze the incidence and factors leading to thyroid gland involvement in carcinoma larynx and hypopharynx. Retrospective chart review from March 2011 to December 2016 of all patients who had undergone total laryngectomy at our institute. A total of 125 patients entered into the analysis. Subsites involved were glottis (n = 32), supraglottis (n = 28), transglottis (n = 52), pyriform sinus (n = 12), and subglottis (n = 1). TNM distribution according to AJCC 7th edition is as follows: T2 (n = 1), T3 (n = 34), T4 (n = 90); N0 (n = 97), N1 (n = 13), N2a (n = 5), N2b (n = 5), N2c (n = 4), and N3 (n = 1). Total thyroidectomy was performed in 16 patients, near total thyroidectomy in 5, and hemithyroidectomy in 104. Histopathologically thyroid gland involvement was seen in 11/125 (8.8%). The overall incidence of hypothyroidism was 48% (hemithyroidectomy, 43/104; total thyroidectomy, 16/16; near total thyroidectomy, 1/5). The incidence of permanent hypoparathyroidism was 12.8% (total thyroidectomy, 11; hemithyroidectomy, 5). On multivariate analysis (Cox proportional hazards model), extralaryngeal spread into level 6 (HR = 5.5, p = .006, C.I = 1-18.8) and extracapsular extension (HR = 9.3, p = 0.02, C.I = 1.29-67.5) were statistically significant predictors for thyroid gland involvement. Survival analysis of patients with thyroid gland involvement (n = 11) revealed 5-year overall survival (OS) of 100% and 5-year disease-free survival (DFS) of 59.3% compared with patients without thyroid gland involvement, 71% and 51.7%, respectively (median follow-up, 30 months). Thyroid gland involvement did not show a statistically significant effect on OS/DFS on multivariate analysis. In view of the endocrine abnormalities and lack of survival benefit seen, thyroidectomy should be performed judiciously during total laryngectomy.
Collapse
Affiliation(s)
- Smriti Panda
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Rajeev Kumar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Abhilash Konkimalla
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Alok Thakar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Chirom Amit Singh
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Kapil Sikka
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Suresh C Sharma
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Aanchal Kakkar
- 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- 3Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Hypocalcaemia following laryngectomy: prevalence and risk factors. The Journal of Laryngology & Otology 2018; 132:969-973. [PMID: 30305187 DOI: 10.1017/s0022215118001615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor. METHODS A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy. RESULTS Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2-181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5-117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9-376.5; model p = 0.005). CONCLUSION This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables.
Collapse
|
16
|
Coskun H, Mendenhall WM, Rinaldo A, Rodrigo JP, Suárez C, Strojan P, López F, Mondin V, Saba NF, Shaha AR, Smee R, Takes RP, Ferlito A. Prognosis of subglottic carcinoma: Is it really worse? Head Neck 2018; 41:511-521. [DOI: 10.1002/hed.25172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 10/26/2017] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hakan Coskun
- Department of Otolaryngology - Head and Neck Surgery; Uludag University School of Medicine; Bursa Turkey
| | | | | | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA; University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC); Oviedo Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and Centro de Investigación Biomédica en Red de Cancer (CIBERONC); ISCIII; Oviedo Spain
- Instituto Universitario de Oncología del Principado de Asturias; University of Oviedo; Oviedo Spain
| | - Primož Strojan
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA; University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC); Oviedo Spain
- Instituto de Investigación Sanitaria del Principado de Asturias and Centro de Investigación Biomédica en Red de Cancer (CIBERONC); ISCIII; Oviedo Spain
- Instituto Universitario de Oncología del Principado de Asturias; University of Oviedo; Oviedo Spain
| | - Vanni Mondin
- University of Udine School of Medicine; Udine Italy
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology; The Winship Cancer Institute of Emory University; Atlanta Georgia
| | - Ashok R. Shaha
- Head and Neck Service; Memorial Sloan Kettering Cancer Center; New York New York
| | - Robert Smee
- Department of Radiation Oncology; The Prince of Wales Cancer Centre; Sydney New South Wales Australia
| | - Robert P. Takes
- Department of Otolaryngology - Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
| |
Collapse
|
17
|
Semdaie D, Haroun F, Casiraghi O, Bidault F, Temam S, Janot F, Gorphe P. Laser debulking or tracheotomy in airway management prior to total laryngectomy for T4a laryngeal cancer. Eur Arch Otorhinolaryngol 2018; 275:1869-1875. [PMID: 29777295 DOI: 10.1007/s00405-018-4994-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Retrospective studies have shown that tracheotomy prior to total laryngectomy (TL) is associated with decreased survival. We sought to investigate whether this is due to higher local invasiveness associated with obstructive disease or whether it is the result of tracheotomy itself. METHODS We reviewed patients with a T4a (AJCC 7th edition) laryngeal squamous-cell carcinoma treated with a primary TL followed by adjuvant radiotherapy between 2001 and 2013. We compared patients who had obstructive lesions with those who had non-obstructive lesions in terms of preoperative data, pathological features, and treatment outcomes. Second, we compared tracheotomized patients with patients who underwent endoscopic laser debulking (ELD). RESULTS One hundred patients were reviewed. Thirty-seven of them required an airway intervention prior to a TL (tracheotomy n = 24/ELD n = 13). Patients with obstructive tumors had more frequently subglottic extension (p = 0.0066) and a shorter disease-free survival (DFS) (p = 0.046), due to a higher incidence of additional distant metastases. Tracheotomy was associated with a shorter DFS (p = 0.035) and more frequent perineural invasion (p = 0.0272) as compared to ELD, but not with a higher incidence of stomal recurrence. CONCLUSIONS A tracheotomy prior to a total laryngectomy is associated with decreased survival. We recommend laser debulking as the preferred treatment whenever management of an obstructive airway is required prior to a total laryngectomy.
Collapse
Affiliation(s)
- Djamil Semdaie
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Fabienne Haroun
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Odile Casiraghi
- Department of Pathology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - François Bidault
- Department of Radiology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| |
Collapse
|
18
|
Harris AS, Passant CD, Ingrams DR. How reliably can computed tomography predict thyroid invasion prior to laryngectomy? Laryngoscope 2017; 128:1099-1102. [PMID: 28988411 DOI: 10.1002/lary.26927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS There is little evidence to support the removal of thyroid tissue during total laryngectomy. Although oncological control of the tumor is the priority, thyroidectomy can lead to hypothyroidism and hypoparathyroidism. This study aimed to test the usefulness of preoperative computed tomography in predicting histological invasion of the thyroid. STUDY DESIGN Ambispective cohort study. METHODS All patients undergoing total laryngectomy for squamous cell carcinoma at one center from 2006 to 2016 were included. Data were recorded prospectively as part of the patients' standard care, but were collated retrospectively, giving this study an ambispective design. The histology report for thyroid invasion was taken as the gold standard. The computed tomography report was categorized by invasion of tumor into intralaryngeal, laryngeal cartilage involvement, and extralaryngeal tissues. RESULTS Seventy-nine patients were included. Nine patients had thyroid involvement on histology, translating to an incidence of 11.29% in this population. The positive predictive value for cartilage involvement on computed tomography for thyroid invasion was 52.9% (95% confidence interval [CI]: 28.5%-76.1%) and the negative predictive value was 100% (95% CI: 92.7%-100%).The positive predictive value for extralaryngeal spread on computed tomography for thyroid involvement was 100% (95% CI: 62.9%-100%), and the negative predictive value was also 100% (95% CI: 93.5%-100%). CONCLUSIONS This study has shown that preoperative computed tomography is an effective method of ruling out thyroid gland invasion. The absence of extralaryngeal spread on computed tomography has been shown to be the most useful finding, with a high negative predictive value and a narrow 95% CI. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1099-1102, 2018.
Collapse
Affiliation(s)
- Andrew S Harris
- Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom
| | - Carl D Passant
- Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom
| | - Duncan R Ingrams
- Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom
| |
Collapse
|
19
|
Management of the thyroid gland during laryngectomy. The Journal of Laryngology & Otology 2017; 131:740-744. [PMID: 28592347 DOI: 10.1017/s0022215117001244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to: describe the incidence of thyroid gland involvement in advanced laryngeal cancer, analyse patterns of spread to the thyroid and elucidate predictors of thyroid involvement. METHODS A retrospective review was performed on patients who underwent laryngectomy from 1991 to 2015 as a primary or salvage treatment for squamous cell carcinoma of the larynx, hypopharynx or base of tongue. The incidence of thyroidectomy during total laryngectomy, type of thyroidectomy, incidence of gland involvement, route of spread, and positive predictors of spread were analysed and reported. RESULTS A total of 188 patients fit the inclusion criteria. Of these, 125 (66 per cent) underwent thyroidectomy. The thyroid was involved in 10 of the 125 patients (8 per cent), 9 by direct extension and 1 by metastasis. Cartilage invasion was a predictor of thyroid gland involvement, with a positive predictive value of 26 per cent. CONCLUSION There is a low incidence of thyroid gland involvement in laryngeal carcinoma. Most cases of gland involvement occurred by direct extension. Thyroidectomy during laryngectomy should be considered for advanced stage tumours with cartilage invasion.
Collapse
|
20
|
Gorphe P, Matias M, Moya-Plana A, Tabarino F, Blanchard P, Tao Y, Janot F, Temam S. Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy. Ann Surg Oncol 2016; 23:2596-601. [DOI: 10.1245/s10434-016-5217-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/18/2022]
|