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Ambrosch P, Meuret S, Dietz A, Fazel A, Fietkau R, Tostmann R, Schroeder U, Lammert A, Künzel J, Jäckel MC, Boeger D, Scherl C, Deitmer T, Breitenstein K, Delank KW, Hilber H, Vester S, Knipping S, Harreus U, Scheich M, Bartel S, Plontke SK, Koscielny S, Veit JA, Greve J, Schilling V, Linxweiler M, Weiß S, Psychogios G, Arens C, Wittekindt C, Oeken J, Grosheva M, Borzikowsky C. Transoral laser microsurgery for supraglottic carcinomas: results of a prospective multicenter trial (SUPRATOL). Front Oncol 2024; 14:1440024. [PMID: 39372873 PMCID: PMC11449847 DOI: 10.3389/fonc.2024.1440024] [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: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 10/08/2024] Open
Abstract
Background A limited number of single institutions have published retrospective cohort studies on transoral laser microsurgery for supraglottic laryngectomy (TLM-SGL). These studies have shown that the oncologic outcomes of TLM-SGL are comparable to those of open SGL. However, there is limited information available regarding swallowing rehabilitation and quality of life (QoL). Patients and methods SUPRATOL is a prospective, multicenter trial assessing the functional outcomes of TLM-SGL +/- adjuvant radio-(chemo)-therapy. The primary endpoint was aspiration-free swallowing at 12 months, as established using fibreoptic endoscopic evaluation of swallowing (FEES) and defined as a grade < 6 on the penetration-aspiration scale. Secondary endpoints were swallowing- and voice-related QoL, the prevalence of temporary and permanent tracheostomy and percutaneous gastrostomy, local control, laryngectomy-free survival, overall survival, and disease-free survival, as well as the influence of treatment centers on outcomes. Results From April 2015 to February 2018, 102 patients were recruited from 26 German Otorhinolaryngology (ORL) hospitals. All patients had TLM-SGL and 96.1% underwent uni- or bilateral, mostly selective neck dissection. To 47.0% of patients, adjuvant radio-(chemo)-therapy (R(C)T) was administered. The median follow-up period was 24.1 months. At 12-month follow-up, completed by 84.3% of patients, 98.2%, 95.5%, and 98.8% were free of aspiration when tested with saliva, liquid, or pulp. Adjuvant R(C)T, pT category, and type of resection had no significant influence on swallowing rehabilitation. A total of 40.2% of patients had been tracheotomized, and in 46.1% of patients, a PEG tube was inserted. At the 24-month follow-up, 5.3% of patients still required a tracheostomy, and 8.0% continued to use a percutaneous endoscopic gastrostomy (PEG) tube. Deterioration of swallowing- and voice-related QoL was observed immediately after treatment, but patients recovered, and baseline values were reached again. The Kaplan-Meier 2-year rates for local control, laryngectomy-free survival, overall survival, and disease-free survival were 88%, 92%, 93%, and 82%, respectively. Conclusions Our prospective multicenter trial shows that, at 12 months post-TLM-SGL +/- R(C)T, 95.5%-98.8% of patients achieved aspiration-free swallowing. Morbidity was higher than previously reported. The rates of permanent tracheostomy and gastrostomy tube placement correspond to previous cohort studies. The 2-year oncologic outcomes are within the reported range. Clinical trial registration https://drks.de/search/en/trial/DRKS00004641, identifier (DRKS00004641).
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Kiel, Kiel, Germany
| | - Sylvia Meuret
- Section of Phoniatrics and Audiology, Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany
| | - Asita Fazel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Kiel, Kiel, Germany
| | - Rainer Fietkau
- Department of Radiooncology, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Tostmann
- Clinical Trial Unit UMG, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Ursula Schroeder
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Luebeck, Luebeck, Germany
| | - Anne Lammert
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, Regensburg, Germany
| | - Martin C. Jäckel
- Department of Otorhinolaryngology, Helios-Kliniken Schwerin, Schwerin, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Claudia Scherl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Deitmer
- German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC), Bonn, Germany
| | | | - K.-Wolfgang Delank
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Hermann Hilber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg and Private Medical Practice for Otorhinolaryngology, Regensburg, Germany
| | - Sarah Vester
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, Regensburg, Germany
| | - Stephan Knipping
- Department of Otorhinolaryngology, Head and Neck Surgery, Städtisches Klinikum Dessau, Dessau, Germany
| | - Ulrich Harreus
- Department of Otorhinolaryngology, Krankenhaus Bad Tölz, Bad Tölz, Germany
| | - Matthias Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Julius-Maximilians-University Hospital Würzburg, Würzburg, Germany
| | - Sylva Bartel
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Stefan K. Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sven Koscielny
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Jena, Jena, Germany
| | - Johannes A. Veit
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- Private Medical Practice for Nasal Surgery, Muenchen, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany
| | - Volker Schilling
- Department of Otorhinolaryngology, Head and Neck Surgery, Vivantes Klinikum Neukölln, Germany
| | | | - Sonja Weiß
- Department of Otorhinolaryngology, Klinikum Kassel, Kassel, Germany
| | | | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Jens Oeken
- Department of Otorhinolaryngology, Hospital Chemnitz, Chemnitz, Germany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany
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Freitas ASD, Zica GM, Salles M, Silva ACAE, Silva TH, Dias FL, Santos IC. DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy. Int Arch Otorhinolaryngol 2022; 26:e357-e364. [PMID: 36109048 PMCID: PMC9282976 DOI: 10.1055/s-0041-1730306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Supracricoid laryngectomy (SCL CHEP) removes ∼ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global ( p < 0.001) and total ( p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol ( p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.
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Affiliation(s)
- Andressa Silva de Freitas
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Guilherme Maia Zica
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Mariana Salles
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Ana Catarina Alves e Silva
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Thiago Huaytalla Silva
- Departamento de Nutrição e Dietética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando Luiz Dias
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Izabella Costa Santos
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
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Mattioli F, Fernandez IJ, Bassano E, Luppi MP, Bonali M, Ghidini A, Trebbi M, Bergamini G, Presutti L, Botti C. Surgical rehabilitation of swallowing with polydimethylsiloxane injections after open partial horizontal laryngectomy: Long-term functional results and quality of life. Head Neck 2020; 43:1161-1173. [PMID: 33355954 DOI: 10.1002/hed.26584] [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: 02/20/2020] [Revised: 09/17/2020] [Accepted: 12/08/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Swallowing disorders are common problems after partial laryngectomy. The aim of this study is to illustrate the long-term functional results of rehabilitation of swallowing by polydimethylsiloxane (PDMS) injection. METHODS Twenty-eight patients with dysphagia after partial laryngectomy who underwent injection of PDMS for rehabilitation of swallowing were included in the study. Impairment of swallowing and quality of life (QoL) were investigated with questionnaires: M. D. Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for Head and Neck Cancer (PSS-HNC). Functional results at fiberoptic endoscopic evaluation of swallowing (FEES) were analyzed using a modified penetration-aspiration scale. RESULTS Mean follow-up was 8.5 years. Twenty-six patients showed an improvement at questionnaires (p < 0.001). Median improvement was 6 (p < 0.001) in the modified penetration-aspiration scale. Total laryngectomy was required in one patient. CONCLUSIONS PDMS injection is a good option for rehabilitation of swallowing in case of dysphagia after partial laryngectomy. It improves QoL and the results persist after a long follow-up period.
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Affiliation(s)
- Francesco Mattioli
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Bassano
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria Pia Luppi
- Department of Head and Neck, University Hospital of Modena, Modena, Italy
| | - Marco Bonali
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Trebbi
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giuseppe Bergamini
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Di Santo D, Bondi S, Giordano L, Galli A, Tulli M, Ramella B, Bussi M. Long-term Swallowing Function, Pulmonary Complications, and Quality of Life after Supracricoid Laryngectomy. Otolaryngol Head Neck Surg 2019; 161:307-314. [DOI: 10.1177/0194599819835189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives Long-term effects of supracricoid laryngectomies are nowadays under discussion. The purpose of this study was to detect the prevalence of chronic aspiration and incidence of pulmonary complications, to investigate possible influencing factors, and to analyze dysphagia-related quality of life in a cohort of patients who recovered swallowing function after undergoing supracricoid laryngectomies. Study Design Retrospective observational study. Setting San Raffaele Hospital, Vita-Salute University, Milan, Italy. Methods A cohort of 39 patients who recovered swallowing function free of disease after a minimum 3-year follow-up period was retrospectively investigated between October and December 2017—clinically with the Pearson’s Scale and M. D. Anderson Dysphagia Inventory and instrumentally with fiberoptic endoscopic evaluation of swallowing. Results Chronic aspiration was demonstrated in a significant portion of patients (clinically in 33.3% and instrumentally in 35.9%). Aspiration was influenced by advanced age at surgery ( P = .020). Type of surgical procedure, resection of 1 arytenoid cartilage, postoperative rehabilitation with a speech-language therapist, radiotherapy, age at consultation, and length of follow-up did not influence the prevalence of aspiration. Pulmonary complications affected 5 patients; incidence of pulmonary complications was related to aspiration and was favored by poor laryngeal sensation/cough reflex. Aspiration significantly affected quality of life. Conclusions Chronic aspiration is frequent and affects patients’ quality of life. However, incidence of pulmonary complications is low; therefore, oral feeding should not be contraindicated for aspirating patients. Preservation of laryngeal sensation and cough reflex is mandatory to prevent pulmonary complications.
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Affiliation(s)
- Davide Di Santo
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Stefano Bondi
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Leone Giordano
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Andrea Galli
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Michele Tulli
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Barbara Ramella
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
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