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Ahmadi N, Stone D, Stokan M, Coleman H, Heller G, Smith M, Riffat F, Kudpaje A, Veness M, Palme CE. Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:661-667. [PMID: 37274960 PMCID: PMC10235397 DOI: 10.1007/s12070-022-03392-8] [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: 05/05/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out. Results 83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9-100%), disease free survival was 86.0% (95%CI 78.1-94.6%), locoregional control was 91.2% (95%CI: 85.1-97.7%) and larynx preservation rate of 95.1% at 5 years. Conclusion TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living.
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Affiliation(s)
- Navid Ahmadi
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Danielle Stone
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
| | - Murray Stokan
- Department of Anaesthetics, Westmead Hospital, Sydney, NSW Australia
| | - Hedley Coleman
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Douglass Hanly Moir Pathology, Sydney, NSW Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW Australia
| | - Mark Smith
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Faruque Riffat
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Akshay Kudpaje
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Cytecare Cancer Hospitals, Bangalore, India
| | - Michael Veness
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
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2
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Kusunoki T, Wada R. Case of anterior glottic web with bilateral vocal cord cancers. BMJ Case Rep 2022. [PMCID: PMC9454062 DOI: 10.1136/bcr-2022-250411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We experienced a case of anterior glottic web with bilateral vocal cord cancers. The laryngoscopic findings showed milky tumour lesions on bilateral vocal cords and a web-like formation with an adhesion in the anterior commissure. In this case, we performed laryngomicrosurgery to remove the bilateral vocal cord tumours and the anterior glottic web. This case was diagnosed as bilateral glottic carcinoma (laryngeal carcinoma TNM classification: pT1bN0M0) with an anterior glottic web. Therefore, this patient underwent radiation therapy (66 Gy). At present, one and a half years have passed since the end of radiotherapy. There is no recurrence of the glottic cancer or web. The airway at the glottis was patent. It has been reported that cutting-off the anterior glottic web could easily lead to readhesion. Accordingly, we continued to follow-up to determine whether there was a recurrence of readhesion of the anterior glottic web or glottic cancer.
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Affiliation(s)
- Takeshi Kusunoki
- Department of Otorhinolaryngology, Juntendo University of Medicine Shizuoka Hospital, Izunokuni-shi, Japan
| | - Ryo Wada
- Department of Pathology, Juntendo Daigaku Igakubu Fuzoku Shizuoka Byoin, Izunokuni, Japan
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3
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Kozhanov AL, Kozhanov LG, Kravtsov SA, Sdvizhkov AM. [Modern aspects of organ-preserving surgery for laryngeal cancer]. Vestn Otorinolaringol 2022; 87:44-50. [PMID: 35605271 DOI: 10.17116/otorino20228702144] [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: 11/17/2022]
Abstract
A review of the literature on modern aspects of organ-preserving surgery for laryngeal cancer - endolaryngeal and open resections - is presented. The indications for these operations are determined depending on the location and extent of the tumor, as well as on the anatomical features. The advantages and disadvantages of each method, complications, functional and oncological results are shown.
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Affiliation(s)
- A L Kozhanov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia
| | - L G Kozhanov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - S A Kravtsov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia.,Peoples' Friendship University, Moscow, Russia
| | - A M Sdvizhkov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia
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4
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Tans L, Al-Mamgani A, Kwa SLS, Elbers JBW, Keskin-Cambay F, Sewnaik A, Dorr M, Nout R, Heemsbergen W. Single vocal cord irradiation for early-stage glottic cancer: Excellent local control and favorable toxicity profile. Oral Oncol 2022; 127:105782. [PMID: 35276637 DOI: 10.1016/j.oraloncology.2022.105782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To validate the earlier reported promising oncologic outcomes and favorable toxicity profile following single vocal cord irradiation (SVCI) in an expanded cohort of patients with early-stage glottic cancer treated at our institute with longer follow-up time. MATERIALS AND METHODS Between February 2011 and January 2020, 111 consecutive patients with early-stage glottic cancer were treated with SVCI to the whole involved vocal cord (58.08 Gy, given in 16 fractions of 3.63 Gy). Setup verification was done using cone-beam CT, prior to each fraction. The endpoints were local control (LC), overall survival (OS), grade ≥ 3 toxicity and voice quality assessment using voice-handicap index (VHI) questionnaires. RESULTS Median follow-up was 41 months (range; 8-84). Two patients developed in-field local failure (LF). The 3- and 5-year LC rates were 99.1% and 97.1%, respectively. As both patients with LF were successfully salvaged with total laryngectomy, the 5-year ultimate LC-rates was 99%. The 5-years OS was 80.6%. All patients finished treatment without any interruption. No patients developed acute grade ≥ 3 toxicity. Late grade 3 toxicity was reported in 7 patients (6.5%) out of 108 patients evaluable for late toxicity; 2 because of severe hoarseness and 5 because of laryngeal radionecrosis (4.5%). The 5-years laryngectomy-free survival was 98.1%. The VHI-scores improved over time, only 22% of patients had VHI > 30 at 3-years post-radiotherapy, compared to 38% at baseline. CONCLUSIONS Local control rate and laryngectomy-free survival of SVCI are excellent with favorable toxicity profile and good VHI-score. These results validate our early results.
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Affiliation(s)
- Lisa Tans
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - Stefan L S Kwa
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
| | - Jos B W Elbers
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
| | - Fatma Keskin-Cambay
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
| | - Aniel Sewnaik
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Maarten Dorr
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Remi Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
| | - Wilma Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.
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5
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Ulmschneider C, Baker J, Vize I, Jiang J. Phonosurgery: A review of current methodologies. World J Otorhinolaryngol Head Neck Surg 2021; 7:344-353. [PMID: 34632350 PMCID: PMC8486699 DOI: 10.1016/j.wjorl.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 01/11/2023] Open
Abstract
Cold-steel has served as the gold standard modality of phonosurgery for most of its history. Surgical laser technology has revolutionized this field with its wide use of applications. Additional modalities have also been introduced such as coagulative lasers, photodynamic therapy, and cryotherapy. This review will compare the surgical modalities of cold steel, surgical lasers, phototherapy and cryotherapy. The mechanism of action, tissue effects and typical uses will be addressed for each modality.
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Affiliation(s)
| | - Jeffrey Baker
- University of Wisconsin Madison School of Medicine and Public Health, United States
| | - Ian Vize
- University of Wisconsin Madison School of Medicine and Public Health, United States
| | - Jack Jiang
- University of Wisconsin Madison School of Medicine and Public Health, United States
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6
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Zhang Q, Chen X, He S, Li L. Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure. Acta Otolaryngol 2021; 141:197-202. [PMID: 33118844 DOI: 10.1080/00016489.2020.1832254] [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: 10/23/2022]
Abstract
BACKGROUND Management of early stage glottic carcinoma involving the anterior commissure is challenging. AIMS/OBJECTIVES This study aimed to evaluate the efficacy of a thyroid cartilage window (TCW) technique for transoral laser resection of early glottic cancer with involvement of the anterior commissure. MATERIAL AND METHODS Twenty-one patient who underwent a TCW technique for transoral resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. The technical nuances, organ preservation rate and voice outcomes, local and regional recurrence, and perioperative comorbidities, were assessed. RESULTS All 21 patients underwent a TCW technique for resection, both the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%, and the 5 years recurrence free survival was 90.5%. For two patients with subglottic involvement (9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was observed. Postoperative granuloma was detected in all 21 patients, 13 of whom spontaneously disappeared (61.9%); whereas the remaining 8 patients (38.1%) demonstrated a consistent presence of granuloma more than 12 weeks, and they accepted surgical extirpation of granuloma under surface anesthesia. The laryngeal web developed in all 21 patients, while no dyspnea and local recurrence were present. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement (p = .01), while objective voice indices were not significantly altered (p > .05). CONCLUSIONS AND SIGNIFICANCE TCW technique is a valuable means for transoral resection of early glottic laryngeal cancer involving the anterior commissure, with acceptable voice quality and seemingly low comorbidities.
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Affiliation(s)
- Qingxiang Zhang
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuangba He
- Department of Otolaryngology-Head & Neck Surgery, Nanjing Tongren Hospital, Nanjing, China
| | - Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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7
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Eckel HE, Simo R, Quer M, Odell E, Paleri V, Klussmann JP, Remacle M, Sjögren E, Piazza C. European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up. Eur Arch Otorhinolaryngol 2020; 278:1723-1732. [PMID: 33058010 PMCID: PMC8131286 DOI: 10.1007/s00405-020-06406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/16/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the current knowledge regarding the diagnosis, treatment, and follow-up of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. The diagnosis of LD largely relies on endoscopic procedures and on histopathology. Diagnostic efficiency of endoscopy may be improved using videolaryngostroboscopy (VLS) and bioendoscopic tools such as Narrow Band Imaging (NBI) or Storz Professional Image Enhancement System (SPIES). Current histological classifications are not powerful enough to clearly predict the risk to carcinoma evolution and technical issues such as sampling error, variation in epithelial thickness and inflammation hamper pathological examination. Almost all dysplasia grading systems are effective in different ways. The 2017 World Health Organization (WHO) system should prove to be an improvement as it is slightly more reproducible and easier for the non-specialist pathologist to apply. To optimize treatment decisions, surgeons should know how their pathologist grades samples and preferably audit their transformation rates locally. Whether carcinoma in situ should be used as part of such classification remains contentious and pathologists should agree with their clinicians whether they find this additional grade useful in treatment decisions. Recently, different studies have defined the possible utility of different biomarkers in risk classification. The main treatment modality for LD is represented by transoral laser microsurgery. Radiotherapy may be indicated in specific circumstances such as multiple recurrence or wide-field lesions. Medical treatment currently does not have a significant role in the management of LD. Follow-up for patients treated with LD is a fundamental part of their care and investigations may be supported by the same techniques used during diagnosis (VLS and NBI/SPIES).
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Affiliation(s)
- Hans Edmund Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt am Wörthersee, Austria
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edward Odell
- Department of Head and Neck Pathology, King's College London Guy's Hospital, London, UK
| | - Vinidh Paleri
- Department of Otorhinolaryngology Head and Neck Surgery, Royal Marsden Hospital, London, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
| | - Elisabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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8
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Porras Alonso E, Vilaseca González I, García Teno M, Barberá Durbán R, Viscasillas Pallàs G, Sancho Mestre M, Rebollo Otal J, Menoyo Bueno A, Díaz de Cerio Canduela P. Early glottic tumours with anterior commissure involvement. Literature review and consensus document. Head and Neck and Skull Base Commission, SEORL-CCC. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71 Suppl 1:1-20. [PMID: 32532450 DOI: 10.1016/j.otorri.2020.02.008] [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] [Received: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
Abstract
The choice of the most appropriate treatment in early-stage glottic cancer with anterior commissure involvement remains controversial. Its therapeutic management is complex because it is a significant prognostic indicator of local control with 37% recurrence, due to the difficulty in establishing tumour extension with understaging of up to 40%, and due to the comparison of results in series on tumours that behave variably as they progress, such as T1a, T1b and T2a with commissure involvement. Furthermore, the complexity of the surgical approach using transoral CO2 laser microsurgery requires surgical skill, appropriate equipment and experience. Aspects to be reviewed in this document are: an updated anatomical definition of the anterior commissure, tumour progression based on histopathological studies, usefulness of videostroboscopy and NBI in diagnostic accuracy, validity of imaging tests, oncological results published in series reviews, systematic reviews and meta-analyses, tumour margin treatment and voice evaluation.Finally, by way of a summary, the document includes a series of recommendations for the treatment of these tumours.
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9
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T1 Glottic Cancer: Does Anterior Commissure Involvement Worsen Prognosis? Cancers (Basel) 2020; 12:cancers12061485. [PMID: 32517265 PMCID: PMC7352716 DOI: 10.3390/cancers12061485] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy (RT) and transoral laser microsurgery (TLM) represent the main treatment modalities for early glottic carcinoma. Local failure is notoriously more frequent in T1b glottic cancer in comparison to T1a and T2 tumors. In this scenario, the role of anterior commissure (AC) involvement is still controversial. The aim of the present study was therefore to determine its potential prognostic power in worsening patients’ survival and outcomes. We categorized different tumor glottic fold locations with respect to the involvement of one (T1a) or both vocal cords, with or without AC involvement. We analyzed a retrospective cohort of 74 patients affected by Stage I glottic cancer, treated between 2011 and 2018 by TLM or RT at a single academic institution. There were 22 T1a (30%) and 52 T1b (70%) cases. The median follow-up period was 30 months (mean, 32.09 ± 18.738 months; range, 12–79). Three-year overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngectomy-free survival (LFS) were compared according to tumor location, extension, and cT category. According to both uni- and multivariate analyses, an increased risk for recurrence in T1b with AC involvement and T1a tumors was 7.31 and 9.45 times, respectively (p-values of 0.054 and 0.030, respectively). Among the 17 recurrences, T1b with AC involvement experienced 15 tumor relapses (88.2%), thus significantly affecting both the RFS and LFS in comparison to the other two tumor subcategories (T1a, p = 0.028 and T1b without AC involvement, p = 0.043). The deteriorating prognosis in the presence of AC involvement likely reflects the need to power the hazard consistency and discrimination of the T1b category when associated with such a risk factor, thus deserving an independent T category.
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10
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Early Glottic Tumours With Anterior Commissure Involvement. Literature Review and Consensus Document. Head and Neck and Skull Base Commission, SEORL-CCC. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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CO 2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review. MEDICINES 2019; 6:medicines6030077. [PMID: 31336581 PMCID: PMC6789531 DOI: 10.3390/medicines6030077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.
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12
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Heukelom J, Navran A, Gouw ZAR, Tesselaar ME, Zuur CL, van Werkhoven E, Sonke JJ, Rasch CRN, Al-Mamgani A. Organ Function Preservation Failure after (Chemo)Radiotherapy in Head and Neck Cancer: A Retrospective Cohort Analysis. Otolaryngol Head Neck Surg 2019; 161:288-296. [DOI: 10.1177/0194599819846073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the current study was to determine the incidence of organ function preservation failure (OFPF) in patients with head and neck squamous cell carcinoma (HNSCC) treated by (chemo)radiotherapy and to identify its risk factors. Study Design Retrospective cohort analysis. Setting Tertiary cancer care center. Subjects and Methods A single-center retrospective cohort analysis was done (n = 703) in which OFPF after (chemo)radiotherapy was assessed. OFPF was defined as local failure or pure functional failure in the absence of local failure because of major surgical intervention (total laryngectomy, commando resection, permanent tracheostomy) or feeding tube dependence >2 years. Results OFPF occurred in 153 patients (21.8%). Reasons for OFPF were local failure in 103 patients (14.6%) and functional failure in 50 patients (7.2%). Evidence of functional failure included need for total laryngectomy (n = 9, 1.3%), commando resection (n = 2, 0.3%), permanent tracheostomy (n = 16, 2.3%), and/or long-term feeding tube for functional reasons (n = 23, 3.3%). In a Cox proportional hazards model, OFPF was worse for patients with T4 tumors (hazard ratio [HR] <0.5 and P < .001 for all other stages), for laryngeal vs oropharyngeal cancer (HR, 1.83; 95% confidence interval [CI], 1.20-2.79, P = .005, hypopharyngeal not significant), and for smokers (HR, 1.68; 95% CI, 1.10-2.56, P = .015). Exploratory multivariate analysis by tumor site showed that T4 tumor and pretreatment tracheostomy were the strongest predictive factors for OFPF in laryngeal and hypopharyngeal carcinoma while T4 tumor and smoking were predictive for poor OFPF in oropharyngeal carcinoma. Conclusion This work shows a detrimental effect of smoking on functional outcomes after (chemo-)radiotherapy for HNSCC. Moreover, T4 tumor, laryngeal subsite, and pretreatment tracheostomy are strong predictors of OFPF.
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Affiliation(s)
- Jolien Heukelom
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Zeno A. R. Gouw
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margot E. Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L. Zuur
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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13
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Laser transoral microsurgery in treatment of early laryngeal carcinoma. Eur Arch Otorhinolaryngol 2019; 276:1747-1755. [DOI: 10.1007/s00405-019-05453-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/25/2019] [Indexed: 01/07/2023]
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14
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Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery. Auris Nasus Larynx 2019; 46:285-293. [DOI: 10.1016/j.anl.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/22/2022]
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15
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van Loon Y, Hendriksma M, Heijnen BJ, van de Kamp VAH, Hakkesteegt MM, Böhringer S, Langeveld TPM, de Jong MA, Klop WMC, Baatenburg de Jong RJ, Sjögren EV. Voice outcome after unilateral ELS type III or bilateral type II resections for T1-T2 glottic carcinoma: Results after 1 year. Head Neck 2019; 41:1638-1647. [PMID: 30652373 PMCID: PMC6590407 DOI: 10.1002/hed.25582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/22/2018] [Accepted: 12/07/2018] [Indexed: 12/14/2022] Open
Abstract
Background Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification. Methods Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure. Results The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5. Conclusion Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.
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Affiliation(s)
- Yda van Loon
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Vivienne A H van de Kamp
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke M Hakkesteegt
- Department of Otorhinolaryngology, Head & Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton P M Langeveld
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M A de Jong
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology, Head & Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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16
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Jacobi C, Freundorfer R, Reiter M. Transoral laser microsurgery in early glottic cancer involving the anterior commissure. Eur Arch Otorhinolaryngol 2019; 276:837-845. [DOI: 10.1007/s00405-018-5261-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
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17
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Oncologic and functional outcomes of patients treated with transoral CO2 laser microsurgery or radiotherapy for T2 glottic carcinoma: a systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg 2018; 26:84-93. [PMID: 29278552 DOI: 10.1097/moo.0000000000000438] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the laryngeal preservation and functional outcomes of patients treated with transoral CO2 laser microsurgery (TLM) or radiotherapy for T2 glottic carcinoma. This information supports physicians and patients in treatment counselling and choices. RECENT FINDINGS A recent systematic review showed that local control rates at 5-year did not differ between radiotherapy and TLM for T2 glottic tumours. However, there is a lack of comparative data on laryngeal preservation as well as functional outcomes in T2 glottic carcinoma. SUMMARY Laryngeal preservation for T2 tumours in this review is higher for patients treated primarily with TLM (88.8 vs. 79.0%). It is important to differentiate between tumours with normal and impaired mobility (T2a and T2b) because the latter showed poorer prognosis for both TLM and radiotherapy. Involvement of the anterior commissure does not result in significantly lower oncological results, if adequately staged and treated. More studies are needed to support these data and to compare the functional outcomes between TLM and radiotherapy for T2 glottic carcinoma.
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18
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Role of supracricoid partial laryngectomy with cricohyoidoepiglottopexy in glottic carcinoma with anterior commissure involvement. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:249-253. [DOI: 10.1016/j.anorl.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Demir UL, Çevik T, Kasapoğlu F. Is There a Change in the Treatment of T1 Glottic Cancer After CO 2 Laser? A Comparative Study with Cold Steel. Turk Arch Otorhinolaryngol 2018; 56:64-69. [PMID: 30197801 DOI: 10.5152/tao.2018.3053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Carbon dioxide (CO2) laser provides high local control and disease-specific survival rates with minor morbidity and good quality of life in transoral cordectomy. We aimed to compare the oncological outcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer. Methods In this retrospective study, the participants were divided into two groups. The first group comprised patients who were operated upon between 2001 and 2007 using cold steel (group 1, n=38), and the second group comprised patients who were operated upon between 2008 and 2016 using CO2 laser (group 2, n=88). Both groups were compared regarding age, gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease-free survival (DFS). Results The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and 100% vs. 98.9%, respectively), and no association was found between surgical margin positivity and local recurrence. However, a significant association between the presence of anterior commissure involvement and recurrence was found in all 126 patients (p=0.016). Local recurrence was significantly higher in the group 2 (p=0.024), but it did not affect overall survival and DFS in these patients (100% vs. 94.1%). Conclusion Although CO2 laser excision is considered to be superior to cold steel regarding surgical time and bleeding control, the local recurrence rates were found to be higher with the laser than the cold steel. Thus, we argue that cases should be selected more carefully concerning the anterior commissure, depth of tumor invasion lateral to vocal muscle, difficulty at endoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections.
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Affiliation(s)
- Uygar Levent Demir
- Department of Otorhinolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Turgut Çevik
- Department of Otorhinolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Fikret Kasapoğlu
- Department of Otorhinolaryngology, Uludağ University School of Medicine, Bursa, Turkey
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20
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Gioacchini FM, Tulli M, Kaleci S, Bondi S, Bussi M, Re M. Therapeutic modalities and oncologic outcomes in the treatment of T1b glottic squamous cell carcinoma: a systematic review. Eur Arch Otorhinolaryngol 2017; 274:4091-4102. [DOI: 10.1007/s00405-017-4736-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
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21
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Piazza C, Paderno A. Conservative Surgical and Non-surgical Options in Management of T3 Laryngeal Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Gallet P, Rumeau C, Nguyen DT, Teixeira PA, Baumann C, Toussaint B. "Watchful observation" follow-up scheme after endoscopic CO 2 laser treatment for small glottic carcinomas: A retrospective study of 93 cases. Clin Otolaryngol 2017; 42:1193-1199. [PMID: 28296244 DOI: 10.1111/coa.12863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Evaluate the clinical outcome of patients treated with CO2 laser surgery for early-stage glottic carcinomas followed up with 3-month laryngoscopy regardless of tumor grade and margins. DESIGN Case series. SETTING Retrospective review of the clinical records of patients treated at the ENT department of a tertiary university hospital. PARTICIPANTS AND METHOD Clinical records from patients with early-stage glottic carcinomas (Tis/T2) treated with curative intent by CO2 laser surgery in a ten-year period were evaluated. Regardless of tumor margin status, patients underwent fiber endoscopy 6 weeks after surgery and a systematic second look by direct laryngoscopy under general anesthesia at 3 months. MAIN OUTCOME MEASURES Local control, laryngeal preservation rate. RESULTS Ninety-three patients were included. Disease control was obtained in 90/93 cases. Laryngeal preservation rate was 96.8%. Twenty patients had a local residual disease or recurrence after the first laser surgery, but 17 were salvaged (85%). Local residual disease and recurrence were more frequent in patients with advanced disease (T1b/T2), invasion of anterior commissure and "non-safe" margins. CONCLUSION The proposed follow-up scheme might be a valuable option, but with caution for positive or unevaluable margins as the latter is an independent risk factor for local recurrence. An early laser excision procedure (eg, within the first two months after surgery) or an alternative strategy may be discussed in this situation. "Watchful observation" should be reserved for compliant patients only so that the risk of missing potential recurrences is minimised.
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Affiliation(s)
- P Gallet
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
| | - C Rumeau
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
| | - D T Nguyen
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
| | - P A Teixeira
- University of Lorraine, Nancy, France.,Guilloz Imaging Department, University Hospital, Nancy, France
| | - C Baumann
- University of Lorraine, Nancy, France.,Clinical Epidemiology and Evaluation, University Hospital, Nancy, France
| | - B Toussaint
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
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23
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The anterior commissure of the human larynx revisited. Surg Radiol Anat 2017; 39:871-876. [DOI: 10.1007/s00276-017-1814-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/09/2017] [Indexed: 01/19/2023]
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24
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Abstract
PURPOSE OF REVIEW To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature. RECENT FINDINGS The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future. SUMMARY TLM for early glottic carcinoma (Tis-T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.
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Affiliation(s)
- E V Sjögren
- Department of ENT and Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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25
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Reasonable limits for transoral laser microsurgery in laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2016; 24:135-9. [PMID: 26963672 DOI: 10.1097/moo.0000000000000240] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transoral laser microsurgery (TLM) is widely acknowledged to offer several advantages in the treatment of early and selected intermediate-advanced laryngeal cancers. Nevertheless, a number of issues are still under debate. The purpose of this review is to discuss the reasonable limits for TLM in laryngeal cancer to highlight its most appropriate and reproducible indications, putting this therapeutic tool in the right perspective within a comprehensive frame of alternative treatment strategies such as open partial laryngectomies and nonsurgical organ preservation protocols. RECENT FINDINGS Inadequate laryngeal exposure, anterior commissure involvement in the cranio-caudal plane (T2), invasion of the posterior paraglottic space with arytenoid fixation, massive infiltration of the preepiglottic space, and even minor thyroid cartilage erosion (T3) represent the most controversial applications of TLM in management of glottic and supraglottic cancer. SUMMARY Published oncological results appear to be satisfactory when TLM is applied to T1-T2 and accurately selected T3 glottic and supraglottic cancers with favourable exposure. Caution should be used for more advanced tumours.
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26
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Abstract
The purpose of this study was to investigate the aerodynamic and acoustic changes after thyroidectomy without laryngeal nerve injury by using objective methods. Voice samples of sustained /α/ recorded from 44 adults preoperatively and nearly 1 week and 3 months after thyroidectomy were analyzed for mean vocal fundamental frequency (Mean Fo, Hz), maximum fundamental frequency (Max Fo, Hz), minimum fundamental frequency (Min Fo, Hz), jitter, shimmer, glottal to noise excitation ratio (GNE), irregularity, noise, overall severity, S time, Z time, S/Z ratio, and maximum phonation time (MPT). Voice samples were analyzed using the lingWAVES software. The comparisons of preoperative and early and late postoperative acoustic parameters revealed significant differences in Mean F0, Max F0, MPT, and S Time between the early and late postoperative periods. The voice changes after thyroidectomy were not affected by age, sex, or surgical procedure, but they differed between the benign and malignant nature of the tumor. Patients with malignant tumors showed a greater decrease in Mean F0 and Max F0 compared with the patients with benign tumors, and this difference was statistically significant. Voice changes may occur after thyroidectomy even in the patients with no evidence of laryngeal nerve damage, and these changes can be assessed with objective measurement methods. This information should be explained to the patients during the preoperative counseling, and proper informed consent is ethically and legally required for all planned thyroidectomies.
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27
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Peretti G, Piazza C, Penco S, Santori G, Del Bon F, Garofolo S, Paderno A, Guastini L, Nicolai P. Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers. Head Neck 2016; 38:1107-12. [DOI: 10.1002/hed.24424] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Sara Penco
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics; University of Genoa; Genoa Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Sabrina Garofolo
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Luca Guastini
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
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28
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Wang CC, Liu SA, Wu SH, Lin WJ, Jiang RS, Wang L. Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports. Head Neck 2015; 38:913-8. [PMID: 26714200 DOI: 10.1002/hed.24354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/02/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity. METHODS Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed. RESULTS TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence. CONCLUSION TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 913-918, 2016.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-An Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shang-Heng Wu
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rong-San Jiang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Lily Wang
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
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29
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Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D. Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy. Laryngoscope 2015; 126:1817-22. [DOI: 10.1002/lary.25757] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/16/2015] [Accepted: 10/02/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Babak Sadoughi
- The Sean Parker Institute for the Voice; Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
| | - Cécile Badoual
- Department of Pathology; Hôpital Européen Georges Pompidou; Paris France
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30
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Lee HS, Kim JS, Kim SW, Noh WJ, Kim YJ, Oh D, Hong JC, Lee KD. Voice outcome according to surgical extent of transoral laser microsurgery for T1 glottic carcinoma. Laryngoscope 2015; 126:2051-6. [PMID: 26934846 DOI: 10.1002/lary.25789] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/07/2015] [Accepted: 10/27/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the outcomes of transoral laser microsurgery (TLM) for T1 glottic carcinoma using longitudinal voice analysis. STUDY DESIGN Retrospective analysis of medical records. METHODS We conducted a retrospective review of 57 patients (50 T1a, seven T1b) who underwent TLM for T1 glottic carcinoma, and longitudinal voice analysis was performed before surgery, during the early postoperative period (within 3 months), and during the late postoperative period (more than 6 months). Acoustic, perceptual (Grade, Roughness, Breathiness, Asthenia, Strain scale), and subjective voice analysis using the Voice Handicap Index (VHI) was conducted. RESULTS Voice quality deteriorated in the early postoperative period in terms of several parameters. However, no significant differences in voice quality were observed in the late postoperative period, whereas Grade (from 1.85 ± 0.83 to 1.50 ± 0.90) and Roughness (from 1.74 ± 0.73 to 1.48 ± 0.87) had improved significantly. Patients who underwent lesser-extent cordectomy (type I, II) showed improvement in VHI-Physical (from 12.93 ± 11.10 to 6.07 ± 8.69) and Grade (from 1.60 ± 0.68 to 0.98 ± 0.83), whereas improvement was not identified in those who underwent larger-extent cordectomy (type III, IV, V). Improvement in Grade (from 1.70 ± 0.80 to 1.23 ± 0.91) and Roughness (from 1.77 ± 0.73 to 1.25 ± 0.76) was identified in patients who had unilateral tumor without involvement of anterior commissure. However, those with involvement of the anterior commissure or bilateral vocal cord showed a tendency toward deterioration in voice quality. CONCLUSIONS Voice quality of patients following TLM for T1 glottic carcinoma may improve significantly over time in cases with lesser-extent types of cordectomy or unilateral tumor without involvement of the anterior commissure. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2051-2056, 2016.
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Affiliation(s)
- Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Ji Su Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Woong Jae Noh
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Young Joon Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Dasol Oh
- Kosin University College of Medicine, Busan, Korea
| | - Jong Chul Hong
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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