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Li Y, Ruan S, Hong Y, Zhuang F, Zheng C, Lu M, Chen X. Reconstruction of laryngeal function by thyroid cartilage fenestration and draw-out resection followed by internal fixation with titanium microplates for early glottic carcinoma: a novel and efficient surgical approach. Am J Transl Res 2024; 16:2589-2598. [PMID: 39006276 PMCID: PMC11236634 DOI: 10.62347/atpe6857] [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: 03/28/2024] [Accepted: 05/25/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To explore the clinical effectiveness of reconstructing laryngeal function using thyroid cartilage fenestration and "draw-out" resection, supplemented by internal fixation with titanium microplates in early glottic carcinoma. METHODS Data from 99 patients with glottic carcinoma treated in the Second Affiliated Hospital of Fujian Medical University between January 2014 and September 2021 were retrospectively analyzed. Forty-eight patients who underwent thyroid cartilage fenestration and resection followed by internal fixation with titanium microplates for laryngeal function reconstruction were assigned to the thyroid cartilage fenestration group (TCF group), while the other 51 patients who underwent sternohyoid muscle and fascia repair for laryngeal function reconstruction were assigned to the sternohyoid muscle repair group (SMR group). Patients were followed up for 1-8 years. Data on postoperative phonatory function, respiratory function, swallowing function, and survival status were collected. RESULTS Compared to the SMR group, patients in the TCF group showed better postoperative recovery in phonatory function and verbal communication (all P<0.05). In the TCF group, patients demonstrated stable respiration and the extubation rate was 100.00%, which was significantly higher than 82.35% in the SMR group (P<0.05). Patients in both groups showed good postoperative recovery of swallowing function (P>0.05). CONCLUSION One-stage reconstruction of laryngeal function by thyroid cartilage fenestration and "draw-out" resection with adjuvant internal titanium microplate fixation in early glottic carcinoma demonstrates good postoperative recovery and good preservation of the laryngeal function.
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Affiliation(s)
- Yahong Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Shenjiong Ruan
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Yuming Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Feiyi Zhuang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Chaohui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Ming Lu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
| | - Xiaofang Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Fujian Medical University Quanzhou 362000, Fujian, China
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Rosow DE, Keidar E, Pasick LJ, Casellas NJ, Anis MM. Use of the 445-nm Blue Laser for Management of Early Glottic Carcinoma: Preliminary 1-Year Results. Laryngoscope 2024. [PMID: 38860434 DOI: 10.1002/lary.31569] [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: 02/26/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To analyze oncological efficacy and voice outcomes of the 445-nm blue laser (BL) in the treatment of early glottic carcinoma and compare results with the 532-nm potassium-titanyl-phosphate (KTP) laser. STUDY DESIGN Single institution, retrospective chart review. METHODS All patients who underwent microlaryngoscopic KTP or BL laser excision of early glottic carcinoma from 2018 to the present day with at least 1-year follow-up were included. Primary and recurrent disease, including radiation and surgical failures, were included. Demographic data, voice outcomes and oncologic outcomes were compared between the two laser groups. RESULTS Forty-nine patients met the inclusion criteria for the BL group and 88 for the KTP group, with average follow-up of 635 and 1236 days, respectively. Oncologic outcomes were not significantly different, with disease-specific survival rates of 95.9% for BL and 100% for KTP (p = 0.13), organ preservation rates of 98.0% for BL and 95.6% for KTP (p = 0.39), and local control rates of 93.9% for BL and 92.1% for KTP (p = 0.81). Both BL and KTP groups showed significant improvement in CAPE-V (p = 0.04, 0.006 respectively) and VHI-10 scores (p = 0.003, <0.00001) following surgery. CONCLUSIONS Photoangiolytic removal of early glottic carcinoma with BL appears to be equally safe and effective as with KTP laser at minimum one-year follow-up, and with excellent voice outcomes. Additional study will be warranted over time to assess long-term outcomes in BL patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- David E Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eytan Keidar
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luke J Pasick
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas J Casellas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mursalin M Anis
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Fang L, Tuohuti A, Shi L, Chen X. Comparison of prognostic and treatment between T1a and T1b glottic cancer: a propensity score-matched SEER database analysis. Eur Arch Otorhinolaryngol 2023; 280:3313-3322. [PMID: 37039896 DOI: 10.1007/s00405-023-07953-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The prognoses of T1a and T1b glottic cancers are still controversial. This study aimed to compare the prognosis difference between the two groups based on the population-based Surveillance, Epidemiology, and End Results database (SEER). METHODS Data for patients with T1a or T1b glottic cancers were extracted from the SEER database. The bias between T1a and T1b glottic cancers was minimized with Propensity Score Matching (PSM), and disease-specific survival (DSS) was analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards models. RESULTS A total of 5,272 patients were extracted from the database, including 847 patients with T1b glottic cancer that were 1:1 propensity score-matched with patients with T1a glottic cancer. After propensity score-matching, there was no statistical difference in disease-specific survival between T1a and T1b patients, whilst survival was impaired by old age. However, on the multivariate analysis, the T1a stage was associated with improved DSS compared with the T1b stage. CONCLUSION Our analysis showed that T1a glottic cancers didn't have a significantly better prognosis compared with T1b after PSM. However, the DSS of T1a patients is superior to that of T1b patients in multivariate analysis.
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Affiliation(s)
- Lucheng Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Aikebaier Tuohuti
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Licai Shi
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Ozturk K, Turhal G. Transoral Laser Surgery for Early Glottic Carcinoma: A Single Surgeon Experience of 101 Consecutive Cases. ORL J Otorhinolaryngol Relat Spec 2020; 83:41-46. [PMID: 33171472 DOI: 10.1159/000511175] [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: 02/07/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Investigate the clinical and oncological results of early-stage glottic laryngeal carcinoma patients performed by a single surgeon. METHODS This study was carried out at a tertiary academic center. A total of 101 patients were included (92 males [91.1%], 9 females [8.9%]). Mean age was 62.98 ± 10.2 years (range 33-87). Recurrence, disease-free survival, overall survival, laryngeal preservation rates were analyzed. RESULTS Tumor stage was Tis (carcinoma in situ) in 11 patients (10.9%), T1a in 66 patients (65.3%), T1b in 12 patients (11.9%), and T2 in 12 patients (11.9%). Postoperative pathology was squamous cell carcinoma in 69 patients (68.3%), carcinoma in situ in 26 patients (25.7%), and high-grade dysplasia in 6 patients (5.9%). Five patients (5.0%) underwent type 1, 7 (6.9%) type 2, 45 (44.6%) type 3, 24 (23.8%) type 4, 6 (5.9%) type 5a, 8 (7.9%) type 5c, 4 (4.0%) type 5d, and 2 (2.0%) type 6 cordectomy. Median follow-up time was 30 months (range 14-66). There were 5 recurrences (5.0%). Three-year disease-free survival was 94.4%. Three-year disease-free survival for stage I and II patients was 94.9 and 91.7%, respectively. Overall survival was 93.8%. Only 1 patient died related to cardiovascular disease. Disease-specific survival was 100%. CONCLUSIONS In conclusion, this is a large case series with good oncological outcomes presented with the perspective of a single surgeon. The data of the study is in accordance with the previous reports.
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Affiliation(s)
- Kerem Ozturk
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Goksel Turhal
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey,
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Filauro M, Paderno A, Perotti P, Marchi F, Garofolo S, Peretti G, Piazza C. Role of narrow-band imaging in detection of head and neck unknown primary squamous cell carcinoma. Laryngoscope 2018; 128:2060-2066. [DOI: 10.1002/lary.27098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/27/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Marta Filauro
- 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
| | - Pietro Perotti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Sabrina Garofolo
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - 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 Genoa; Genoa Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, Italian Research Hospital Foundation, National Cancer Institute of Milan; University of Milan; Milan Italy
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Klimza H, Jackowska J, Tokarski M, Piersiala K, Wierzbicka M. Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect. PLoS One 2017; 12:e0180590. [PMID: 28662209 PMCID: PMC5491250 DOI: 10.1371/journal.pone.0180590] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/16/2017] [Indexed: 11/19/2022] Open
Abstract
Background It is crucial to find a balance between functional and oncological outcome when choosing an adequate method for the management of vocal fold leukoplakia. Therefore, a detailed examination is a milestone in the decision-making process. Aim To examine whether narrow-band imaging (NBI) can be helpful in vocal fold assessment in the case of leukoplakia and how to overcome the “umbrella effect”- understood as the submucosal vascular pattern hidden under the plaque. Material and methods Prospective cohort of 41 consecutive patients. Inclusion criteria: vocal fold leukoplakia, no previous procedures (surgery, radiotherapy), and preoperative endoscopy with an optical filter for NBI. Two groups: “suspicious” and “normal”, according to the submucosal microvascular pattern of peripheral regions of the mucosa surrounding the plaque, were distinguished. Patients were qualified for a full-thickness or partial-thickness biopsy, respectively. Criteria defining suspected characters were well-demarcated brownish areas with scattered brown spots corresponding to type IV, Va, Vb, and Vc NI classifications. Results In 22/41 (53.7%) patients with “suspected” microvascular pattern, full-thickness biopsy was performed. Moderate and severe dysplasia was revealed in 15 type IV and 7 type Va NI patients. In 19/41 (46.3%) patients with proper NBI vessel pattern treated by partial-thickness biopsy, hyperkeratosis was diagnosed. There was a strong correlation between the NBI pattern and final histology: Chi2 (2) = 41.0 (p = 0.0000). Conclusion The results demonstrate that NBI endoscopic assessment of the submucosal microvascular pattern of mucosa surrounding the plaque can be an effective method to categorise the risk in vocal fold leukoplakia prior to treatment.
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Affiliation(s)
- H. Klimza
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
- * E-mail:
| | - J. Jackowska
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - M. Tokarski
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - K. Piersiala
- Student Research Group at the Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Poznań, Poland
| | - M. Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Shuang Y, Li C, Zhou X, Huang Y, Zhang L. Outcomes of radiofrequency ablation (RFA) and CO2 laser for early glottic cancer. Am J Otolaryngol 2016; 37:311-6. [PMID: 27105975 DOI: 10.1016/j.amjoto.2016.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/03/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the present study, the voice and functional outcomes of radiofrequency ablation (RFA) and CO2 laser for early glottic cancer were evaluated. METHODS One hundred sixty eight patients with early glottic cancer from October 2007 to June 2015 were included. Ninety-seven patients underwent RFA and seventy-one patients underwent CO2 laser. The operation time and score of visual analog scale (VAS) for pain on the second day after surgery were recorded. The electronic laryngoscopy was performed at one week, one month and three months of postoperation. RESULTS The operation time in RFA was shorter than that in CO2 laser (8.52±1.43min vs. 11.76±1.67min, P<0.05). There was no statistical difference in VAS scores between two operation methods (2.86±0.52 vs. 2.89±0.68, P>0.05). One month after operation, the mucosal recovery in RFA group was better than that in CO2 laser group (P<0.05). The alterations of acoustic parameters Jitter, Shimmer and HNR at three time points after operation showed statistical significances in both RFA and CO2 laser groups (P<0.05). The significant differences in acoustic parameters between two groups were also observed (P<0.05). There were no differences in three-year survival rate, local recurrence rate, recurrence rate with anterior commissure involvement and postoperative adhesion rate with anterior commissure between the patients with RFA and CO2 laser (P>0.05). No patient underwent tracheotomy and had symptoms of bucking, dyspnea, severe pain, hemoptysis and other serious complications. CONCLUSION Both RFA and CO2 laser are safe and effective for the treatment of early glottic cancer. RFA has the advantage of quick voice recovery, low mucosa injury and short operation time, which is worthy for wide clinical application.
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Peng Z, Li Y, Jin L, Tao X, Cai X, Feng J, Liu R, Zhang Q, Li L. Retrospective analysis of therapeutic effect and prognostic factors on early glottic carcinoma. Photodiagnosis Photodyn Ther 2016; 15:167-71. [PMID: 27378675 DOI: 10.1016/j.pdpdt.2016.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the therapeutic effect of surgery, radiotherapy and photodynamic therapy on early glottic carcinoma and prognostic factors. METHODS Retrospective analysis of 202 cases with early glottic carcinoma (Tis-T2N0M0) underwent surgery (n=152), radiotherapy (n=20) and PDT (n=30) from 2000 to 2013 The KPS score, the disease-free survival (DFS), overall survival (OS), local control (LC), larynx preservation rate, laryngeal function were evaluated. The methods of χ (2)test or Fisher's exact probability method, Kaplan Meier method, log-rank test of Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. RESULTS There was no statistical significance in OS, DFS and LC among the three groups. The laryngeal function preservation rate of RT group, PDT group and Surgery group were 90%, 86.7% and 65.1% respectively, with the former two groups significantly superior to Surgery group. While there is no statistical significance between RT group and PDT group. Single factor analysis showed that KPS score before treatment, vocal fold mobility limitation and differentiation degree could have an effect on prognosis. Multivariate regression analyses indicated that anterior commissure invasion, T stage and KPS score before treatment were independent adverse prognostic factors for OS. T stage and differentiation degree were adverse prognostic factors for DFS. T stage was also an adverse factor of LC. Thirty-three cases experienced local recurrence or cervical lymph node metastasis. Three groups showed no statistical difference in local recurrence or lymph node metastasis, with twenty-two cases in Surgery group, four in RT group and seven in PDT group. CONCLUSIONS The therapeutic effect was approximate in surgery group, radiotherapy group and photodynamic group, and all three treatment regimens achieved good clinical effect. Radiotherapy and photodynamic therapy may be the first or very important treatment on early stage glottic squamous cell cancer (Tis∼T2N0M0). However only 6 patients underwent PDT for T2 disease, making definitive treatment conclusions for this subgroup unclear.
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Affiliation(s)
- Zhongzhong Peng
- Cancer Center, Southern Medical University, Guangzhou 510315, China; Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou 510315, China
| | - Yanbing Li
- Department of Oncology, Jiujiang First Hospital, Jiujiang, China
| | - Longwei Jin
- Cancer Center, Southern Medical University, Guangzhou 510315, China; Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou 510315, China
| | - Xiaopeng Tao
- Department of Endoscopy, Cancer Center of Guangzhou Medical University, China
| | - Xiaojun Cai
- Cancer Center, Southern Medical University, Guangzhou 510315, China; Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou 510315, China
| | - Jieni Feng
- The Third Hospital of Wenzhou Medical University, Ruian, Zhejiang 325200, China
| | - Rengeng Liu
- Cancer Center, Southern Medical University, Guangzhou 510315, China; Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou 510315, China
| | - Qianyu Zhang
- Cancer Center, Southern Medical University, Guangzhou 510315, China; Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou 510315, China
| | - Libo Li
- Cancer Center, Southern Medical University, Guangzhou 510315, China; Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou 510315, China.
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Bertino G, Degiorgi G, Tinelli C, Cacciola S, Occhini A, Benazzo M. CO₂ laser cordectomy for T1-T2 glottic cancer: oncological and functional long-term results. Eur Arch Otorhinolaryngol 2015; 272:2389-95. [PMID: 25895574 DOI: 10.1007/s00405-015-3629-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess the validity of CO2 laser cordectomy in the treatment of early glottic cancer and to determine the impact of margin status on disease-free survival and of the operation on voice quality. This is a retrospective review of 169 patients. Quantitative and qualitative variables were statistically compared. The impact on overall and disease-free survivals of different variables was calculated by univariate and multivariate analyses. Ten-year overall and disease free-survivals were 75 % and 60 %, respectively. Age and clinical stage showed a significant negative impact on overall survival, while margin status both on overall and disease-free survivals. The degree of dysphonia was directly related to the extension of the resection. This series confirms the good oncologic and functional outcomes of laser surgery for Tis, T1 and selected T2 glottic tumors. Patients with positive margins should undergo a further treatment or a very close follow-up.
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Affiliation(s)
- Giulia Bertino
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Policlinico S. Matteo Foundation, University of Pavia, P.le Golgi 2, 27100, Pavia, Italy
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Garofolo S, Piazza C, Del Bon F, Mangili S, Guastini L, Mora F, Nicolai P, Peretti G. Intraoperative Narrow Band Imaging Better Delineates Superficial Resection Margins During Transoral Laser Microsurgery for Early Glottic Cancer. Ann Otol Rhinol Laryngol 2014; 124:294-8. [DOI: 10.1177/0003489414556082] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM. Methods: Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test. Results: At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort ( P < .001). Conclusion: Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer.
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Affiliation(s)
- Sabrina Garofolo
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Stefano Mangili
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Luca Guastini
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
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Schultz P. Vocal fold cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:301-8. [PMID: 21959270 DOI: 10.1016/j.anorl.2011.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 04/03/2011] [Accepted: 04/16/2011] [Indexed: 11/17/2022]
Abstract
Ninety percent of vocal fold cancers take the form of squamous cell carcinoma. Since the 1980s, incidence in France has been constantly falling in males while increasing in females. The main risk factor is smoking, alcohol being less implicated than in other laryngeal or extralaryngeal locations. Vocal fold squamous cell carcinoma generally develops on healthy mucosa, although primary precancerous lesions such as leukoplakia or papillomatous keratosis are also frequent. The tumor usually originates in the non-lymphophilic mucosal free edge of the vocal fold then invades the various anatomic subunits of the larynx, acquiring lymph-node metastatic potential. Dysphonia is the first presenting symptom, initially caused by defective mucosal vibration and then by impaired mobility and finally fixation of the vocal fold. Extension, risk factor and pretreatment assessments are as in other upper-aerodigestive-tract cancer locations. The possibilities of laryngoscopic exposure and the tumor limits, however, need to be precisely determined if transoral resection is to be considered. For small tumors, surgery or exclusive radiation therapy can be suggested to the patient as part of an individual treatment plan, each having its advantages and drawbacks. Cutting-edge teams report 5-year local control rates of 85-95% in T1-class tumor and 60-90% in T2. Whatever the treatment option, smoking cessation, close surveillance and cardiovascular prevention enable screening of other oncologic locations and limit onset of the other pathologies implicated in most deaths.
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Affiliation(s)
- P Schultz
- Service d'ORL et de chirurgie cervicofaciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France.
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De Diego J, Prim M, Verdaguer J, Pérez-fernández E, Gavilán J. Long-term results of open cordectomy for the treatment of T1a glottic laryngeal carcinoma. Auris Nasus Larynx 2009; 36:53-6. [DOI: 10.1016/j.anl.2008.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 03/30/2008] [Accepted: 03/31/2008] [Indexed: 10/22/2022]
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Szyfter W, Wierzbicka M, Mietkiewska D, Wójtowicz J, Pastusiak T. [Early glottic cancer--treatment results]. Otolaryngol Pol 2008; 62:426-31. [PMID: 18837217 DOI: 10.1016/s0030-6657(08)70285-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Early glottic cancer (stage T1, T2) is connected with very good prognosis as well as organ and function preservation. The aim of the study was the assessment of early glottic treatment results. MATERIAL AND METHODS Between 1999-2005 1007 patients with larynx cancer were treated in Dept. of Otolaryngology Head Neck Oncological Surgery Poznań University of Medical Sciences. The majority constitute the patients with II and III stage of clinical advancement of the disease. Early glottic cancer was diagnosed in 43 patients (4.3%). The diagnose of the larynx cancer was set upon indirect and direct laryngoscopy, histological examination of larynx samples and neck ultrasonography. In all 43 patients CO2 laser surgery in Klein1 sasser microlaryngoscopy set was performed. RESULTS In all cases, confirmed in histological examination the resection was radical. Follow-up was conducted every month in the first year of observation, then every 2-3 months. The time of follow-up ranged from 40 to 64 month, mean 51 month. In 4 patients (9.3%) treated for early glottic cancer with CO2 laser surgery the local relapse occurred after 10, 15, 19 and 28 month respectively. In two patients total laryngectomy, in one reconstructive partial laryngectomy and in one radiotherapy was performed. The mean time of observation after salvage treatment is 29 months. All patients are alive and free of disease. CONCLUSION The laser surgery is an effective and non-invasive treatment of early glottic cancer but the strict follow-up regimen is demanded.
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Affiliation(s)
- Witold Szyfter
- Klinika Otolaryngologii i Onkologii Laryngologicznej UM w Poznaniu
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Thurnher D, Erovic BM, Frommlet F, Brannath W, Ehrenberger K, Jansen B, Selzer E, Grasl MC. Challenging a dogma – Surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. Eur J Surg Oncol 2008; 34:692-8. [PMID: 17686606 DOI: 10.1016/j.ejso.2007.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 06/20/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS The aim of this study was to compare laser surgery, conventional endoscopic surgery and radiotherapy in the treatment of early T1a glottic cancer. METHODS We conducted a retrospective analysis of patients with early vocal cord cancer (who underwent either conventional surgery via endoscopy or laryngofissur, or primary radiotherapy) at the Medical University of Vienna. By univariate and multivariate Cox regression models the influence of treatment and other parameters on survival and locoregional control were analysed. RESULTS 337 Patients were analyzed with a mean follow-up period of 133.8 months. Overall survival rates where similar in all three treatment groups. Five-year, 10-year and 15-year estimates of disease specific survival for laser-treated patients were 100%, for conventional surgery were 100%, 98% and 98%, and for radiotherapy were 96%, 92% and 91%, respectively. Locoregional recurrences were observed after laser surgery in 10%, after conventional surgery in 13% and after radiotherapy in 30% of the patients treated. According to the log-rank test, time to relapse was significantly shorter for irradiated patients compared to patients who underwent surgery (p < 0.0001). Mortality caused by the laryngeal tumour was significantly higher in the radiotherapy group (p = 0.003). CONCLUSION Patients undergoing laser or conventional surgery have a significantly lower incidence of locoregional recurrences and longer disease-free intervals when compared to patients treated by radiotherapy.
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Affiliation(s)
- D Thurnher
- Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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