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Filauro M, Caprioli S, Lovino Camerino P, Sampieri C, Conforti C, Iandelli A, Benzi P, Gabella G, Bellini E, Mora F, Cittadini G, Peretti G, Marchi F. Depth of Invasion Assessment in Laryngeal Glottic Carcinoma: A Preoperative Imaging Approach for Prognostication. Laryngoscope 2024; 134:3230-3237. [PMID: 38407326 DOI: 10.1002/lary.31369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The prognostic value of depth of invasion (DOI) in oral squamous cell cancer carcinoma and cutaneous melanoma is well established, while there is a lack of reports investigating the role of DOI in laryngeal cancer. This study aims to explore the association of glottic cancer DOI with other established pathological risk factors and nodal metastasis and evaluate the feasibility of measuring DOI preoperatively using tomographic imaging. METHODS The medical records of glottic cancer patients treated between 2015 and 2020 in a single tertiary referral center were screened retrospectively. Pathologically measured DOI (pDOI) value was also reviewed and registered. Preoperative computer tomography (CT) was used to obtain the radiological DOI (rDOI) measured by two dedicated radiologists. Their inter-rated agreement was assessed and the correlation between pDOI and rDOI was calculated. pDOI association with the main pathology report features was assessed with univariable analysis. Cox univariable and multivariable models were used to explore the role of pDOI on survival. RESULTS Ninety-one patients had pDOI data available, of which 59 also had rDOI data. A strong concordance between the two radiologists was found (concordance correlation coefficient = 0.96); rDOI and pDOI were highly and significantly correlated (R = 0.85; p < 0.001). pDOI was significantly higher in patients with perineural invasion (PNI; p < 0.001), lymphovascular invasion (LVI; p < 0.001), and nodal metastasis (p < 0.001). pDOI was associated with disease-free survival at univariable analysis (p = 0.04) while it did not show a significant impact (p = 0.10) at multivariable analysis. CONCLUSION Glottic carcinoma DOI correlates with PNI, LVI, and nodal metastasis and it can be reliably assessed in a preoperative setting using CT imaging. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3230-3237, 2024.
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Affiliation(s)
- Marta Filauro
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Caprioli
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genova, Genoa, Italy
| | - Paola Lovino Camerino
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Department of Otorhinolaryngology, Ospedale S. Paolo, Savona, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - Cristina Conforti
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Benzi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giulia Gabella
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Elisa Bellini
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Mora
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giuseppe Cittadini
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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2
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Ferrari M, Mularoni F, Taboni S, Crosetti E, Pessina C, Carobbio ALC, Montalto N, Marchi F, Vural A, Paderno A, Caprioli S, Gaudioso P, Fermi M, Rigoni F, Saccardo T, Contro G, Ruaro A, Lo Manto A, Varago C, Baldovin M, Bandolin L, Filauro M, Sampieri C, Missale F, Ioppi A, Carta F, Ramanzin M, Ravanelli M, Maiolo V, Bertotto I, Del Bon F, Lancini D, Mariani C, Marrosu V, Tatti M, Cağlı S, Yüce I, Gündoğ M, Dogan S, Anile G, Gottardi C, Busato F, Vallin A, Gennarini F, Bossi P, Ghi MG, Lionello M, Zanoletti E, Marioni G, Maroldi R, Mattioli F, Puxeddu R, Bertolin A, Presutti L, Piazza C, Succo G, Peretti G, Nicolai P. How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group. Oral Oncol 2024; 152:106744. [PMID: 38520756 DOI: 10.1016/j.oraloncology.2024.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.
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Affiliation(s)
- M Ferrari
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy.
| | - F Mularoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - S Taboni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - E Crosetti
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - C Pessina
- Radiology Unit, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - A L C Carobbio
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - N Montalto
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - F Marchi
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - A Vural
- Otorhinolaryngology Unit, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Paderno
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - S Caprioli
- Radiology Unit, San Martino Hospital, Genoa, Italy
| | - P Gaudioso
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - M Fermi
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - F Rigoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - T Saccardo
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Contro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Ruaro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Lo Manto
- Otorhinolaryngology Unit, Infermi Hospital, Rimini, Italy
| | - C Varago
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - M Baldovin
- Otorhinolaryngology Unit, San Martino di Belluno Hospital, Belluno, Italy
| | - L Bandolin
- Otorhinolaryngology Unit, Hospital of Santorso, Vicenza, Italy
| | - M Filauro
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - C Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Italy; Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - F Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands
| | - A Ioppi
- Department of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - F Carta
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Ramanzin
- Radiology Unit, Hospital of Vicenza, Vicenza, Italy
| | - M Ravanelli
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - V Maiolo
- Pediatric and Adult Cardiothoracic and Vascular, Oncohematologic and Emergency Radiology Unit (IRCCS AOUBO), University of Bologna, Italy
| | - I Bertotto
- Radiology Unit, IRCCS Istituto di Candiolo, Turin, Italy
| | - F Del Bon
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - D Lancini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - C Mariani
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - V Marrosu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Tatti
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - S Cağlı
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - I Yüce
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - M Gündoğ
- Department of Radiation Oncology, Erciyes University, Kayseri, Turkey
| | - S Dogan
- Department of Radiology, Erciyes University, Kayseri, Turkey
| | - G Anile
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - C Gottardi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - F Busato
- Unit of Radiation Oncology, Policlinico Abano, Padova, Italy
| | - A Vallin
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - F Gennarini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - P Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M G Ghi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - M Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - E Zanoletti
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Marioni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - R Maroldi
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - F Mattioli
- Otorhinolaryngology Unit, University of Modena, Modena, Italy
| | - R Puxeddu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy; King's College Hospital London, Dubai, United Arab Emirates
| | - A Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - L Presutti
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - C Piazza
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - G Succo
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy; Oncology Department, University of Turin, Turin, Italy
| | - G Peretti
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - P Nicolai
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
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Eker C, Surmelioglu O, Dagkiran M, Kaya O, Tanrisever I, Arpaci B, Kaya B, Yucel Karakaya SP, Onan E. Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome. Eur Arch Otorhinolaryngol 2024; 281:2597-2608. [PMID: 38424299 PMCID: PMC11023970 DOI: 10.1007/s00405-024-08513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The involvement of the anterior commissure (AC) is regarded to be a risk factor for poor results after transoral laser microsurgery (TLM) for early glottic cancer. The objective of this study was to determine how AC-related clinical and radiological factors affected oncological outcomes in a cohort of patients with T1 stage early glottic carcinoma involving the anterior commissure who were treated with TLM with negative surgical margins. METHODS Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics. RESULTS In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041). CONCLUSION TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.
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Affiliation(s)
- Caglar Eker
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey.
| | - Ozgur Surmelioglu
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Muhammed Dagkiran
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Omer Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Burak Arpaci
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Bedir Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | | | - Elvan Onan
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
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Iandelli A, Gabella G, Marchi F, Campagnari V, Filauro M, Sampieri C, Tsai TY, Vilaseca I, Peretti G. The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08610-3. [PMID: 38564009 DOI: 10.1007/s00405-024-08610-3] [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: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS. DATA SOURCES PubMed, EMBASE, and Cochrane Library. METHODS We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported. RESULTS Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97). CONCLUSIONS Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.
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Affiliation(s)
- Andrea Iandelli
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Giulia Gabella
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Valentina Campagnari
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Marta Filauro
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Claudio Sampieri
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | - Tsung-You Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taoyuan, Taiwan
| | - Isabel Vilaseca
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Catalunya, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Giorgio Peretti
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
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5
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Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
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Khan U, MacKay C, Rigby M, Trites J, Corsten M, Taylor SM. Management of positive resection margins following transoral laser microsurgery for glottic cancer. Laryngoscope Investig Otolaryngol 2023; 8:1579-1583. [PMID: 38130264 PMCID: PMC10731511 DOI: 10.1002/lio2.1184] [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: 04/25/2023] [Revised: 08/31/2023] [Accepted: 10/11/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The current literature provides limited guidance on the management of positive margins (PMs) following transoral laser microsurgery (TLM) for glottic squamous cell carcinoma (SCC). Long-term data exploring the treatment of PMs with both initial observation and re-resection are limited. Our objective was to determine the optimal treatment for PM patients following TLM for glottic SCC. Methods Clinical information on glottic SCC patients with PMs following treatment with TLM was prospectively collected at our institution from 2007 to 2018. We use a laryngeal template during the initial TLM where the area of resection is outlined for future reference. Data were compared with univariate analysis and survival plots were generated using the Kaplan-Meier method. Results A total of 29 patients with PMs were treated with either re-resection (19 patients), close observation (6 patients), or adjuvant radiation alone (4 patients). Re-resection patients had SCC or severe dysplasia on initial margin pathology and 23% with early-stage disease had recurrence (T1-T2). Five (83%) patients who underwent close observation required re-resection based on clinical suspicion of recurrence (confirmed on final pathology), which was significantly different from the re-resection patients (p < .05). Close observation was therefore discontinued as a management of PMs. Four patients (21%) had no residual malignancy on re-resection specimens. Deep margins only accounted for 17% of all PMs. Disease-specific survival for all PM patients at 5 years was 82.4% (SE 9.6%, CI 53.4%-91.6%). Conclusions Our long-term experience with treating early-stage glottic SCC with TLM supports re-resection as an appropriate management for cases of PMs. Level of Evidence 4.
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Affiliation(s)
- Usman Khan
- Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Colin MacKay
- Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Matthew Rigby
- Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Jonathan Trites
- Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Martin Corsten
- Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - S. Mark Taylor
- Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
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Priya SR, Dandekar M, Paul P, Dravid CS, Anand A, Keshri S. Imaging for Laryngeal Malignancies: Guidelines for Clinicians. Indian J Otolaryngol Head Neck Surg 2023; 75:3386-3395. [PMID: 37974698 PMCID: PMC10645718 DOI: 10.1007/s12070-023-03986-w] [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: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 11/19/2023] Open
Abstract
Radiology has always been an important component in the evaluation of patients with head and neck cancers. Images that are appropriately acquired and systematically interpreted provide comprehensive information on local, regional, and distant disease extent. This impacts treatment decisions for primary or recurrent disease, and aids in prognostication and patient counselling. The recent significant advances in technology and instrumentation for treatment of head neck cancers have taken place in parallel with an increasing sophistication in radiodiagnostic systems. This is especially true for laryngeal neoplasms where there is now greater focus on functional outcomes and personalised treatment, thus expanding the scope and value of imaging. PURPOSE To formulate evidence-based guidelines on imaging for cancers of the larynx, from diagnosis and staging to monitoring of disease control after completion of treatment. METHODS AND MATERIALS A multidisciplinary analysis of current guidelines and published studies on the topic was performed. RESULTS On the basis of evidence gathered, guidelines were drawn up; optimal suggestions were included for low-resource situations. CONCLUSION These guidelines are intended as an aid to all clinicians dealing with patients of laryngeal cancers. It is hoped that these will be instrumental in facilitating patient care, and in improving outcomes.
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Affiliation(s)
- S. R. Priya
- Head Neck Surgeon, Independent, Visakhapatnam, India
| | - Mitali Dandekar
- Department of Surgical Oncology (Head Neck), Paras Cancer Centre, Patna, India
| | - Peter Paul
- Department of Radiology, Maria Theresa Hospital, Thrissur, Kerala India
| | | | - Abhishek Anand
- Department of Medical Oncology, Paras Cancer Centre, Patna, India
| | - Shekhar Keshri
- Department of Radiation Oncology, Paras Cancer Centre, Patna, India
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8
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Kommentar zu „Glottiskarzinom: präoperative Diagnostik zur Einschätzung der Tumorausbreitung“. Laryngorhinootologie 2023; 102:810-811. [PMID: 37918379 DOI: 10.1055/a-2093-3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
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9
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Chen S, Gong H, Huang N, Yang F, Wang M. Horizontal middle partial laryngectomy with cricothyroidopexy: an effective treatment for stage T1b glottic carcinoma. Acta Otolaryngol 2023; 143:823-828. [PMID: 37837405 DOI: 10.1080/00016489.2023.2265436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The current treatment options for T1b glottic carcinoma often lead to poor treatment outcomes or voice quality. OBJECTIVES This study evaluates the therapeutic efficacy of horizontal middle partial laryngectomy with cricothyroidopexy (HMPL-CTP) for stage T1b glottic carcinoma. MATERIAL AND METHODS A retrospective analysis was conducted on 73 patients with T1b glottic carcinoma. The patients were categorized into three groups: Group A (n = 22) underwent transoral laser microsurgery (TLMS), Group B (n = 21) received frontolateral vertical partial laryngectomy (FVPL), and Group C (n = 30) underwent HMPL-CTP. The study analyzed the 5-year overall survival rate (OS), recurrence rate, phonatory status, and incidence of laryngeal stenosis. RESULTS Voice quality scores varied significantly in the three groups, while the 5-year OS were similar. The local recurrence rate is higher in Group A than in the other two groups. The laryngeal stenosis rate in Group B is higher than in Groups A and C. Adhesions in the anterior commissure were observed in 18 cases in Group A and nine cases in Group C. CONCLUSIONS AND SIGNIFICANCE HMPL-CTP demonstrates efficacy as a treatment for stage T1b glottic carcinoma, offering favorable preservation of laryngeal function and minimal complications.
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Affiliation(s)
- Shiyan Chen
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Hongxun Gong
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Ning Huang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Fan Yang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Maoxin Wang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
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10
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Papazian MR, Chow MS, Jacobson AS, Tran T, Persky MS, Persky MJ. Role of transoral robotic surgery in surgical treatment of early-stage supraglottic larynx carcinoma. Head Neck 2023; 45:972-982. [PMID: 36825894 DOI: 10.1002/hed.27325] [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: 09/28/2022] [Revised: 12/23/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND There are several options for primary surgical treatment of early-stage supraglottic squamous cell carcinoma (SCC), including transoral robotic surgery (TORS). The purpose of this study was to compare outcomes of TORS to open partial laryngectomy and transoral laser microsurgery (TLM). METHODS Patients with clinical classification T1-2 supraglottic SCC diagnosed 2010-2019, treated with TORS, open partial laryngectomy, or TLM in the National Cancer Database were selected. RESULTS One thousand six hundred three patients were included: 17% TORS, 26.5% TLM, 56.5% open. TORS patients had the lowest rates of adjuvant treatment (28.4% vs. TLM: 45.0%, open: 38.5%, p < 0.001), and lower positive margin rates than TLM (16.9% vs. 30.5%, p < 0.001). Thirty-day and ninety-day post-operative mortality did not differ between the approaches. Five-year survival was higher following TORS compared to open surgery (77.8% vs. 66.1%, p = 0.01); this difference persisted following matched-pair analysis. CONCLUSIONS TORS may be a safe and effective surgical approach for early-stage supraglottic SCC in appropriate patients.
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Affiliation(s)
| | - Michael S Chow
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Adam S Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Theresa Tran
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Mark S Persky
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael J Persky
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Kienle LL, Schild LR, Böhm F, Grässlin R, Greve J, Hoffmann TK, Schuler PJ. A novel 3D-printed laryngoscope with integrated working channels for laryngeal surgery. Front Surg 2023; 10:906151. [PMID: 36998594 PMCID: PMC10043209 DOI: 10.3389/fsurg.2023.906151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundFor the surgical treatment of early-stage laryngeal cancer, the use of transoral laser microsurgery (TLM) has emerged as the gold standard. However, this procedure requires a straight line of sight to the operating field. Therefore, the patient's neck needs to be brought into a hyperextended position. In a considerable number of patients, this is not possible due to anomalies in the cervical spine anatomy or soft tissue scarring, e.g., after radiation. In these cases, adequate visualization of relevant laryngeal structures cannot be ensured using a conventional rigid operating laryngoscope, which may negatively affect the outcome of these patients.MethodsWe present a system based on a 3D-printed prototype of a curved laryngoscope with three integrated working channels (sMAC). The curved profile of the sMAC-laryngoscope is specifically adapted to the nonlinear anatomy of the upper airway structures. The central working channel provides access for flexible video endoscope imaging of the operating field while the two remaining channels provide access for flexible instrumentation. In a user study (n = 11), visualization and reachability of relevant laryngeal landmarks as well as the feasibility of basic surgical procedures with the proposed system were examined in a patient simulator. In a second setup, the system was evaluated for its applicability in a human body donor.ResultsAll participants of the user study were able to visualize, reach and manipulate the relevant laryngeal landmarks. Reaching those took significantly less time in the second attempt compared to the first one (27.5 s ± 5.2 s vs. 39.7 s ± 16.5 s, p = 0.008) indicating a significant learning curve for handling the system. Instrument changes were performed quickly and reliably by all participants (10.9 s ± 1.7 s). All participants were able to bring the bimanual instruments into position for a vocal fold incision. Relevant laryngeal landmarks could be visualized and reached in the human body donor setup.ConclusionPossibly, the proposed system may develop into an alternative treatment option for patients with early-stage laryngeal cancer and restricted mobility of the cervical spine in the future. Further improvements of the system could include finer end effectors and a flexible instrument with a laser cutting tool.
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Affiliation(s)
- Linus L. Kienle
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Leon R. Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Rene Grässlin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
- Correspondence: Patrick J. Schuler
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12
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Joshna BM, Kudpaje A, Rajendran D, Subash A. Transoral Laryngeal Surgery in Low-grade Myofibroblastic Sarcoma of Larynx: A Plausible Treatment Option. Indian J Otolaryngol Head Neck Surg 2022; 74:4911-4913. [PMID: 36742924 PMCID: PMC9895197 DOI: 10.1007/s12070-021-02441-y] [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: 01/01/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
The laryngeal tumor type, location and disease extent are essential determinants in deciding the type of surgery and the potential voice and swallowing outcomes. The surgical options available are conservative laryngeal surgeries like transoral laser microsurgery (TLM) or open conservative laryngeal surgery and Total laryngectomy. We report an unusual case of low-grade Myofibroblastic sarcoma of vocal cord which was managed by TLM.
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Affiliation(s)
- B. M. Joshna
- Division of Minimal Invasive Surgery, Department of Head and Neck Surgical Oncology, HCG Cancer Centre, No 8, HCG Towers, P. Kalinga Rao Road, Sampangi Ram Nagar, Bangalore, Karnataka 560020 India
| | - Akshay Kudpaje
- Division of Minimal Invasive Surgery, Department of Head and Neck Surgical Oncology, HCG Cancer Centre, No 8, HCG Towers, P. Kalinga Rao Road, Sampangi Ram Nagar, Bangalore, Karnataka 560020 India
| | - Dinesh Rajendran
- Department of Otolaryngology Head and Neck Surgery, Rajarajeshwari Medical College, Bangalore, India
| | - Anand Subash
- Division of Minimal Invasive Surgery, Department of Head and Neck Surgical Oncology, HCG Cancer Centre, No 8, HCG Towers, P. Kalinga Rao Road, Sampangi Ram Nagar, Bangalore, Karnataka 560020 India
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13
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Hans S, Baudouin R, Circiu MP, Couineau F, Lisan Q, Crevier-Buchman L, Lechien JR. Laryngeal Cancer Surgery: History and Current Indications of Transoral Laser Microsurgery and Transoral Robotic Surgery. J Clin Med 2022; 11:jcm11195769. [PMID: 36233637 PMCID: PMC9571943 DOI: 10.3390/jcm11195769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
The development of transoral laser microsurgery (TLM) was an important step in the history of conservative laryngeal surgery. TLM reported comparable oncological outcomes and better functional postoperative and rehabilitation outcomes than open partial laryngectomy. TLM is currently considered as the standard surgical approach for early-stage laryngeal carcinoma. However, TLM has many limitations, including the limited view of the surgical field through the laryngoscope, exposure difficulties for some tumor locations, and a long learning curve. The development of transoral robotic surgery (TORS) appears to be an important issue to overcome these limitations. The current robotic technologies used in surgery benefited from the research of the U.S. Military and National Aeronautics and Space Administration (NASA) in the 1970s and 1980s. The first application in humans started in the 2000s with the first robotic-assisted cholecystectomy in the US, performed by a surgeon located in France. The use of robots in otolaryngology occurred after the development of the Da Vinci system in digestive surgery, urology, and gynecology, and mainly concerns cT1-T2 and some selected cT3 oropharyngeal and supraglottic carcinomas. With the development of a new robotic system with smaller arms and instruments, TORS indications will probably evolve in the next few years, leading to better outcomes for laryngeal or hypopharyngeal carcinomas.
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Affiliation(s)
- Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Marta P. Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Florent Couineau
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Jerome R. Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
- Division of Laryngology and Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Polyclinic of Poitiers—Elsan, 86000 Poitiers, France
- Correspondence:
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CO 2-TOLMS for laryngeal cancer in the elderly, pushing the boundaries of partial laryngectomy. Oral Oncol 2022; 134:106088. [PMID: 36087502 DOI: 10.1016/j.oraloncology.2022.106088] [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: 05/15/2022] [Revised: 07/30/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION CO2 transoral laser microsurgery (CO2-TOLMS) has pushed the indications of partial surgery of the larynx regardless the age of the patient. OBJECTIVE To evaluate the complications and the oncologic and functional outcomes of CO2-TOLMS in patients older and younger than 70 years. METHODS Retrospective analysis of 1244 consecutive laryngeal carcinomas treated with CO2-TOLMS. Complications, length of hospitalization, functional and survival outcomes were evaluated. RESULTS The mean age was 64.2 ± 11.1 years (20-96). Four hundred and sixteen patients were older than 70 years and 104 older than 80 years. The main location was the glottis (912), followed by the supraglottis (332). There were no differences in pT classification between the age groups. No differences were observed in voice outcomes. A higher rate of signs of aspiration at the glottic location was observed for those older than 70 years (2.1 % vs 5 %, p = 0.027). The need for definitive gastrostomy in supraglottic tumours was higher in those older than 70 years (0 % vs 6.5 %, p: 0.001). In the glottis, no differences in tracheostomy or gastrostomy rates were observed. Five-year overall survival was lower in the older than 70 years. No differences in disease-specific survival were observed in early stages for both locations, but a lower survival was observed in stage III glottic cancer for the older than 70 years. CONCLUSIONS CO2-TOLMS is a valid treatment for laryngeal carcinomas in the elderly, with a reduced number of complications and good functional and oncologic outcomes.
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Fermi M, Lo Manto A, Di Massa G, Gallo G, Lupi M, Maiolo V, Montrone G, Lovato L, Presutti L, Mattioli F. Paraglottic Space Invasion in Glottic Laryngeal Cancer: A Clinical‐Pathological Study. Laryngoscope 2022; 133:1184-1190. [PMID: 37042776 DOI: 10.1002/lary.30335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to prospectively compare endoscopic, radiological, and pathological features of a cohort of patients with glottic laryngeal squamous cell carcinoma (LSCC) undergoing open partial horizontal laryngectomy (OPHL) type II/III or total laryngectomy to better understand the reliability of preoperative endoscopy and computed tomography (CT) to predict the inferior paraglottic space (iPGS) involvement. METHODS We prospectively compared the endoscopic, radiological, and pathological findings in patients with glottic LSCC who underwent OPHL II/III, or total laryngectomy. RESULTS Endoscopy achieved a diagnostic accuracy of 87.2% for the anterior iPGS (iPGSa) and 86.1% for the posterior iPGS (iPGSp). There was no statistically significant difference in terms of histopathologic iPGSa involvement between reduced (85%-17/20 pts) and absent (92%-24/26 pts) vocal cord mobility (p = 0.39). CT alone did not improve the diagnostic performance of the endoscopy, reaching a diagnostic accuracy of 62.9% and 73.7% for the iPGSa and iPGSp, respectively. When endoscopy and CT were combined, the diagnostic performance improved for the iPGSp, achieving a sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) of 100%, 89.8%, 68.7%, and 100%, respectively. On the contrary, the combination of CT and endoscopy improved only the Se and NPV for the iPGSa with respect to the sole endoscopic assessment. CONCLUSIONS Whenever motility impairment is present, a histopathologic invasion of the iPGS should be suspected. Endoscopic assessment of laryngeal motility achieved a satisfactory value of Se, Spe, PPV, and NPV in predicting the involvement of the iPGS. CT scan is still the mainstay imaging technique in the clinical staging of patients with LSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1184-1190, 2023.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology, Head and Neck Surgery IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum Università di Bologna Bologna Italy
| | - Alfredo Lo Manto
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital of Modena Modena Italy
| | | | - Graziana Gallo
- Department of Pathology University Hospital of Modena Modena Italy
| | - Massimo Lupi
- Department of Pathology University Hospital of Modena Modena Italy
| | - Vincenzo Maiolo
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
| | - Grazia Montrone
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
| | - Luigi Lovato
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
| | - Livio Presutti
- Department of Otorhinolaryngology, Head and Neck Surgery IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum Università di Bologna Bologna Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital of Modena Modena Italy
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Russo E, Costantino A, Veneroni MV, Festa BM, Pellini R, Campo F, Petruzzi G, Spriano G, Mercante G, De Virgilio A. Transoral Laser Microsurgery in Recurrent Laryngeal Cancer: A Systematic Review and Meta‐analysis. Laryngoscope 2022; 133:1425-1433. [PMID: 37158265 DOI: 10.1002/lary.30332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer. METHODS PubMed/MEDLINE, Cochrane Library, and Scopus databases were searched. English language, original studies investigating oncological outcomes of TLM in adult patients with recurrent laryngeal cancer were included. Data were pooled using a distribution-free approach for estimating summary local control (LC), disease-specific survival (DSS), and overall survival (OS) curves with random effects. RESULTS Two hundred and thirty-five patients underwent salvage TLM after primary (chemo)radiotherapy. The mean follow-up time was 60.8 months (95% CI: 32.7-88.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 74.2% (61.7-89.4), 53.9% (38.5-75.3), and 39.1% (25.2-60.8). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 88.4% (82.0-95.3), 67.8% (50.9-90.3), and 58.9% (42.7-81.1). Two hundred and seventy-one patients underwent TLM after primary laser treatment. The mean follow-up time was 70.9 months (95% CI: 36.9-104.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 72.2% (64.7-80.6), 53.2% (42.2-66.9), and 40.4% (29.6-55.2). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 92.1% (85.5-99.1), 77.0% (64.4-92.0), and 67.1% (51.6-87.3). CONCLUSIONS TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage-based clinical guidelines. LEVEL OF EVIDENCE NA Laryngoscope, 133:1425-1433, 2023.
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Affiliation(s)
- Elena Russo
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Andrea Costantino
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | | | - Bianca Maria Festa
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Raul Pellini
- Department of Otolaryngology‐Head & Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Flaminia Campo
- Department of Otolaryngology‐Head & Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology‐Head & Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
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17
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Sampieri C, Costantino A, Spriano G, Peretti G, De Virgilio A, Kim SH. Role of surgical margins in transoral robotic surgery: A question yet to be answered. Oral Oncol 2022; 133:106043. [PMID: 35908362 DOI: 10.1016/j.oraloncology.2022.106043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Claudio Sampieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Andrea Costantino
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy.
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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18
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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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19
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Wang CC, Lin WJ, Wang JJ, Chen CC, Liang KL, Huang YJ. Transoral Robotic Surgery for Early-T Stage Glottic Cancer Involving the Anterior Commissure—News and Update. Front Oncol 2022; 12:755400. [PMID: 35174080 PMCID: PMC8841867 DOI: 10.3389/fonc.2022.755400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background About 20% of all glottic carcinomas involve the anterior commissure (AC), and AC involvement was deemed to be a risk factor of local recurrence and poor prognosis. Transoral robotic surgery (TORS) has been developed for a panoramic view of the AC and en-bloc resection of the tumor by multidirectional dissection with endo-wristed instruments. With satisfactory preliminary results, we would like to update the data with a bigger cohort and present the news on using TORS for salvage treatment of recurrence from irradiation failure. Methods From July 2010 to December 2019, 22 patients with early T1 and 2 stage primary (n = 11) or recurrent (n = 11) glottic cancer with AC involvement received TORS without adjuvant therapy. TORS exposure was found to be better than TLM by conventional laryngoscopy in diagnostic biopsy. Seven of the 22 patients had recurrent cancer from irradiation failure. The perioperative factors that may be associated with survival were retrospectively analyzed, and the 5-year overall survival (OS)/disease-specific survival (DSS)/recurrence-free survival (RFS)/and organ preservation survival (OPS) rate were estimated by the Kaplan–Meier Method. Their voice and swallowing functions were evaluated by questionnaires of Voice Handicap Index-10 (VHI-10) and Functional Outcome Swallowing Scale (FOSS). Results All 22 TORSs were completed smoothly. After a mean follow-up of 49 ± 35.9 months, the Kaplan–Meier method estimated 5-year OS/DSS/RFS/OPS was 93.8%, 93.8%, 74.6%, and 86.3%, respectively. Our 11 patients with fresh cancer had 100% recurrence-free survival. Although the recurrent rate was higher in patients with history of RT, they could be rescued by further open laryngectomy without compromising the OS and DSS. Only one patient expired. The other 21 patients had satisfactory swallowing function with FOSS of 0.33 ± 0.66. Five patients depended on tracheostomy, but the rest 17 patients had serviceable voice with VHI-10 of 18.41 ± 11.29. Conclusions TORS could be used in the primary or salvage management of glottic cancer with AC involvement while TORS was confirmed to have better exposure to TLM. The RFS was good for patients with primary cancer. In patients having irradiation failure, TORS could also be a minimally invasive transoral approach before trying open surgery to preserve the organ.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
- *Correspondence: Chen-Chi Wang,
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jing-Jie Wang
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Chih Chen
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Kai-Li Liang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Jung Huang
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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20
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Rozhnov VA, Andreev VG, Polkin VV, Spirin PI, Kaprin AD, Ivanov SA. [Vertical resections for larynx cancer with preservation of the thyroid cartridge plates]. Vestn Otorinolaringol 2022; 87:45-50. [PMID: 36107180 DOI: 10.17116/otorino20228704145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED This article presents a method of organ-preserving surgical treatment of laryngeal cancer, which has been developed and used since 1991 at the Tsyba Medical Radiological Research Center, Branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia. The indications for this method are tumors affecting the middle part of the larynx, limiting its mobility, extending to the anterior commissure, laryngeal ventricle, vestibular fold, lower larynx and one arytenoid cartilage, but retaining mobility in the scooper-cricoid articulation. OBJECTIVE To increase the functional safety of the larynx and improve the quality of life of patients with laryngeal cancer by using the developed method of organ-preserving surgical intervention in combined treatment. MATERIAL AND METHODS The study included 197 patients who were operated on by the same method for a primary tumor or in connection with a relapse of the disease. At the first stage, all primary patients underwent a course of radiation or chemoradiation therapy 40-50 Gy. In 78 patients with recurrent laryngeal cancer who underwent resection of the larynx, the previous treatment was carried out in the form of a full course of radiation or chemoradiation therapy with a above 60 Gy. RESULTS Wound healing by primary intention in patients with preoperative irradiation was observed in 92.4% of cases. With resections for a primary tumor, restoration of functions was observed in 115 (96.6%) patients, and with resections of recurrent tumors - in 71 (91%) patients. Three-year disease-free survival in these patients was 74.4%. CONCLUSION The presented data showed the high efficiency of the method. This is evidenced by the course of the postoperative period, functional and oncological results are comparable, and in some cases exceed those of other researchers.
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Affiliation(s)
- V A Rozhnov
- Tsyba Medical Radiological Research Center - Branch of the National Medical Research Center of Radiology, Obninsk, Russia
| | - V G Andreev
- Tsyba Medical Radiological Research Center - Branch of the National Medical Research Center of Radiology, Obninsk, Russia
| | - V V Polkin
- Tsyba Medical Radiological Research Center - Branch of the National Medical Research Center of Radiology, Obninsk, Russia
| | - P I Spirin
- Tsyba Medical Radiological Research Center - Branch of the National Medical Research Center of Radiology, Obninsk, Russia
| | - A D Kaprin
- National Medical Research Center of Radiology, Obninsk, Russia
- Peoples' Friendship University of Russia Medical Institute, Moscow, Russia
| | - S A Ivanov
- Tsyba Medical Radiological Research Center - Branch of the National Medical Research Center of Radiology, Obninsk, Russia
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21
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Hu X, Chen X, Cui X, Cao Y, Sun G. Tracheal rupture after vocal cord polyp resection: A case report. Medicine (Baltimore) 2021; 100:e28106. [PMID: 34918665 PMCID: PMC8678009 DOI: 10.1097/md.0000000000028106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Transoral laser microsurgery (TLM) is one of the most common operations performed for glottic lesions. Several protection measures are taken to prevent tracheal damage. However, some protection measures and common postoperative complications may still cause delayed tracheal rupture in certain situations. Cases of tracheal rupture after surgery are extremely rare, and there are no previous reports of TLM of the glottis causing tracheal rupture. PATIENT CONCERNS A middle-aged woman who underwent TLM for bilateral vocal cord polyps developed sudden neck pain, followed by cough and subcutaneous emphysema. DIAGNOSIS She underwent head, neck, and chest computed tomography (CT), which revealed a 4-cm membranous tracheal tear located 4.5 cm distal to the glottis, pneumomediastinum, and subcutaneous emphysema extending from the base of skull to the chest. INTERVENTIONS The patient underwent an emergency surgical surgical chest exploration and tracheal repair. OUTCOMES One month after the surgery, the patient fully recovered with no tracheal stenosis or respiratory dysfunction. CONCLUSIONS Conventional protective measures and common postoperative complications of TLM may also cause tracheal rupture.
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Affiliation(s)
- Xinqi Hu
- Department of Otorhinolaryngology – Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Xidong Cui
- Department of Otorhinolaryngology – Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Yitan Cao
- Department of Otorhinolaryngology – Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Guangbin Sun
- Department of Otorhinolaryngology – Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
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22
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Abstract
State-of-the-art MR imaging of the larynx and hypopharynx with high-resolution surface coils, parallel imaging techniques, and DWI has several advantages over CT for assessing submucosal tumor spread, in particular neoplastic involvement of the paraglottic space, laryngeal cartilages, and extralaryngeal soft tissues. Current diagnostic MR imaging criteria based on a combination of distinct imaging features on morphologic sequences combined with DWI allow improved discrimination between tumor, peritumoral inflammation, and fibrosis and, ultimately, an increased precision for submucosal tumor delineation, which is a key prerequisite for tailored treatment options. Multiparametric MR imaging with DWI has a higher diagnostic performance than CT.
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Affiliation(s)
- Minerva Becker
- Diagnostic Department, Division of Radiology, Unit of Head and Neck and Maxillo-facial Radiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Geneva 1211, Switzerland.
| | - Yann Monnier
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology, Head and Neck Surgery, Unit of Cervicofacial Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Geneva 1211, Switzerland
| | - Claudio de Vito
- Diagnostic Department, Division of Clinical Pathology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Geneva 1211, Switzerland
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23
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Mattos LS, Acemoglu A, Geraldes A, Laborai A, Schoob A, Tamadazte B, Davies B, Wacogne B, Pieralli C, Barbalata C, Caldwell DG, Kundrat D, Pardo D, Grant E, Mora F, Barresi G, Peretti G, Ortiz J, Rabenorosoa K, Tavernier L, Pazart L, Fichera L, Guastini L, Kahrs LA, Rakotondrabe M, Andreff N, Deshpande N, Gaiffe O, Renevier R, Moccia S, Lescano S, Ortmaier T, Penza V. μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery. Front Robot AI 2021; 8:664655. [PMID: 34568434 PMCID: PMC8455830 DOI: 10.3389/frobt.2021.664655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.
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Affiliation(s)
| | | | | | - Andrea Laborai
- Department of Otorhinolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Brahim Tamadazte
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS, Paris, France
| | | | - Bruno Wacogne
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France.,Centre Hospitalier Régional Universitaire, Besançon, France
| | - Christian Pieralli
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Corina Barbalata
- Mechanical and Industrial Engineering Department, Louisiana State University, Baton Rouge, LA, United States
| | | | | | - Diego Pardo
- Istituto Italiano di Tecnologia, Genoa, Italy
| | - Edward Grant
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, United States
| | - Francesco Mora
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | | | - Giorgio Peretti
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Jesùs Ortiz
- Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kanty Rabenorosoa
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | | | - Lionel Pazart
- Centre Hospitalier Régional Universitaire, Besançon, France
| | - Loris Fichera
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Luca Guastini
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Lüder A Kahrs
- Department of Mathematical and Computational Sciences, University of Toronto, Mississauga, ON, Canada
| | - Micky Rakotondrabe
- National School of Engineering in Tarbes, University of Toulouse, Tarbes, France
| | - Nicolas Andreff
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | | | - Olivier Gaiffe
- Centre Hospitalier Régional Universitaire, Besançon, France
| | - Rupert Renevier
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Sara Moccia
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sergio Lescano
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Tobias Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Garbsen, Germany
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24
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Vilaseca I, Aviles-Jurado FX, Valduvieco I, Berenguer J, Grau JJ, Baste N, Muxí Á, Castillo P, Lehrer E, Jordana M, Ramírez-Ruiz RD, Costa JM, Oleaga L, Bernal-Sprekelsen M. Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments. Head Neck 2021; 43:3832-3842. [PMID: 34569120 DOI: 10.1002/hed.26878] [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: 05/14/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. METHODS Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. RESULTS The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537-8.495]) and posterior (HR = 5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. CONCLUSIONS Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.
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Affiliation(s)
- Isabel Vilaseca
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Francesc Xavier Aviles-Jurado
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Izaskun Valduvieco
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Joan Berenguer
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Juan José Grau
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Neus Baste
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - África Muxí
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Eduardo Lehrer
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain
| | - Marta Jordana
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,Rehabilitation Department, Hospital Clínic, Barcelona, Spain
| | | | - José Miguel Costa
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Laura Oleaga
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
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Abstract
OPINION STATEMENT Dysplasia and early laryngeal cancer lie on a spectrum of cellular changes. These start with early changes to the cells including epithelial hyperplasia and expand to dysplasia, squamous cell carcinoma in situ and finally developing in to invasive cancer. Dysplasia can range from low to high grade, with each being treated in a different manner. Treatment options are typically determined by where the dysplasia/invasive cancer lie on this spectrum along with the site within the larynx. Hyperkeratosis, mild dysplasia and moderate dysplasia typically involve primary endoscopic excision. Severe dysplasia and squamous cell carcinoma in situ involve primary endoscopic resection with the addition of possible laser resection and/or ablation. At this stage, surgery will be followed by close surveillance. Finally, early laryngeal cancer such as T1 and T2 lesions is typically more involved. Treatment depends on the site and degree of involvement of the structures, along with spread to surrounding structures. Typical treatment options of more involved early laryngeal cancer can range from radiation therapy, endoscopic transoral laser resection, endoscopic transoral robotic resection to open resection. Often times, my choice of treatment will be aimed at voice preservation but patient preference will also play a role in the decision making between treatment modalities. Chemotherapy and immunotherapy are typically not used in early stage laryngeal cancer.
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Chemoradiotherapy but Not Radiotherapy Alone for Larynx Preservation in T3. Considerations from a German Observational Cohort Study. Cancers (Basel) 2021; 13:cancers13143435. [PMID: 34298650 PMCID: PMC8306673 DOI: 10.3390/cancers13143435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary For advanced laryngeal carcinoma, primary radiotherapy with or without chemotherapy (pCRT or pRT) is used as an alternative to total laryngectomy (TL) to preserve a functional larynx. For advanced laryngeal cancer (T4), poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival in moderately advanced tumors (T3)? The outcomes after pRT, pCRT, or surgery were evaluated in 121 patients with T3 laryngeal cancers. pCRT and TL with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) yielded results without a significant survival difference. However, after pRT alone, survival was significantly poorer than after TL ± a(C)RT. Thus, according to our data and supported by the literature, pCRT instead of pRT alone is recommended for T3 laryngeal cancers. According to the literature, this recommendation also applies to bulky tumors (6–12 mm), vocal cord fixation, at least minimal cartilage infiltration, and advanced N stage. TL ± a(C)RT instead of larynx preservation should be considered if any of these factors is present and chemotherapy is prohibited; in cases with a tumor volume > 12 mm, severe forms of vocal cord fixation or cartilage infiltration; or when the patient needs a feeding tube or a tracheotomy before the onset of therapy. Abstract For advanced laryngeal cancers, after randomized prospective larynx preservation studies, nonsurgical therapy has been applied on a large scale as an alternative to laryngectomy. For T4 laryngeal cancer, poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival also in T3 tumors? The outcomes of 121 T3 cancers treated with pCRT, pRT alone, or surgery were evaluated in an observational cohort study in Germany. In a multivariate Cox regression of the T3 subgroup, no survival difference was noted between pCRT and total laryngectomy with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) (HR 1.20; 95%-CI: 0.57–2.53; p = 0.63). However, survival was significantly worse after pRT alone than after TL ± a(C)RT (HR 4.40; 95%-CI: 1.72–11.28, p = 0.002). A literature search shows that in cases of unfavorable prognostic markers (bulky tumors of 6–12 ccm, vocal cord fixation, minimal cartilage infiltration, or N2–3), pCRT instead of pRT is indicated. In cases of pretreatment dysphagia or aspiration requiring a feeding tube or tracheostomy, gross or multiple cartilage infiltration, or tumor volume > 12 ccm, outcomes after pCRT were significantly worse than those after TL. In these cases, and in cases where pCRT is indicated but the patient is not suitable for the addition of chemotherapy, upfront total laryngectomy with stage-appropriate aRT is recommended even in T3 laryngeal cancers.
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27
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Evaluation of a curved surgical prototype in a human larynx. Eur Arch Otorhinolaryngol 2021; 278:2927-2935. [PMID: 33885971 PMCID: PMC8266771 DOI: 10.1007/s00405-021-06791-9] [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: 02/14/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
Purpose It is not always possible to create linear access to the larynx using a rigid operating laryngoscope for microlaryngoscopy. In this study, we evaluate the usability of a novel curved surgical prototype with flexible instruments for the larynx (sMAC) in a simulation dummy and human body donor. Methods In a user study (n = 6), head and neck surgeons as well as medical students tested the system for visualization quality and accessibility of laryngeal landmarks on an intubation dummy and human cadaver. A biopsy of the epiglottis was taken from the body donor. Photographic and time documentation was carried out. Results The sMAC system demonstrated general feasibility for laryngeal surgery. Unlike conventional microlaryngoscopy, all landmarks could be visualized and manipulated in both setups. Biopsy removal was possible. Visibility of the surgical field remained largely unobstructed even with an endotracheal tube in place. Overall handling of the sMAC prototype was satisfactorily feasible at all times. Conclusion The sMAC system could offer an alternative for patients, where microlaryngoscopy is not applicable. A clinical trial has to clarify if the system benefits in clinical routine.
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28
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Kozhanov LG, Kozhanov AL, Romanova ES. [Neoplasms of the upper respiratory tract and ear]. Vestn Otorinolaringol 2021; 86:96-102. [PMID: 33720660 DOI: 10.17116/otorino20218601196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.
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Affiliation(s)
- L G Kozhanov
- City Clinical Oncological Hospital No. 1, Moscow, Russia
| | - A L Kozhanov
- City Clinical Oncological Hospital No. 1, Moscow, Russia
| | - E S Romanova
- Central Clinical Hospital No. 2 named after N.N. Semashko, Moscow, Russia
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29
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Current indications for adjuvant treatment following transoral laser microsurgery of early and intermediate laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2021; 29:79-85. [PMID: 33664193 DOI: 10.1097/moo.0000000000000702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the information in the literature on the indications for adjuvant therapy after transoral laser microsurgery (TLM) for early/intermediate stage laryngeal cancer. RECENT FINDINGS A high rate of 'nonevaluable' margins after TLM significantly complicates decision-making concerning adjuvant therapy. However, consensus grows that second-look TLM in patients with multiple superficial and deep positive margins is more sensible than sending these patients systematically for adjuvant radiotherapy (RT). SUMMARY The classical adagium: 'Failure to achieve negative margins indicates need for adjuvant RT' does not translate automatically to patients with glottic cancer treated by TLM. Rather, specifically patients with multiple superficial positive margins and positive deep margins after TLM need careful judging what constitutes the best additional adjuvant treatment. Second-look resection is nowadays regarded as the preferred adjuvant treatment for many of these patients whereas RT is reserved for those in whom a second look TLM is judged unlikely to result in 'true negative margins.' Additionally, when the pathology of the re-resection reveals multiple foci of residual disease or suggests again a resection with positive margins, adjuvant postoperative RT is likely to result in a better local control. If this strict selection of patients for adjuvant RT is adhered to carefully, oncological and functional results will be optimal.
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30
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Lucioni M, Lionello M, Guida F, Sovran F, Canal F, Rizzotto G, Bertolin A. The thyro-cricoarytenoid space (TCAS): clinical and prognostic implications in laryngeal cancer. ACTA ACUST UNITED AC 2021; 40:106-112. [PMID: 32469004 PMCID: PMC7256911 DOI: 10.14639/0392-100x-n0373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022]
Abstract
The recent literature on laryngeal surgical oncology has increasingly focused on the negative prognostic impact of neoplastic involvement of the posterior portion of the inferior paraglottic space, which we refer to as the “thyro-cricoarytenoid space” (TCAS). We retrospectively considered the prognostic significance of TCAS involvement in a cohort of 84 patients treated with open partial horizontal laryngectomy for glottic squamous cell carcinoma. Univariate analysis was conducted on the prognostic value of several clinical and pathological parameters. Cases with TCAS involvement experienced a higher recurrence rate and shorter disease-free survival. Neoplasms involving the TCAS should be considered and treated as extralaryngeal malignancies. Posterior glottic tumours with TCAS invasion have worse prognosis when managed with conservative surgery. Total laryngectomy should be considered in cases of locally-advanced glottic carcinoma with TCAS involvement.
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Affiliation(s)
- Marco Lucioni
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | | | - Francesco Guida
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste University Hospital - ASUITS, Trieste, Italy
| | | | - Fabio Canal
- Pathology Unit, Vittorio Veneto - Conegliano Hospital, Italy
| | | | - Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
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31
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Chien PJ, Hung LT, Wang LW, Yang MH, Chu PY. Oncologic results and quality of life in patients with T3 glottic cancer after transoral laser microsurgery. Eur Arch Otorhinolaryngol 2021; 278:2983-2992. [PMID: 33403435 DOI: 10.1007/s00405-020-06445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE CO2 transoral laser microsurgery (CO2 TOLMS) is an alternative approach to non-surgical organ preservation in selected T3 glottic squamous cell carcinoma (SCC). This study aimed to assess the oncologic results and quality of life (QOL) of patients with T3 glottic SCC after CO2 TOLMS. METHODS Of the 44 patients who underwent CO2 TOLMS, 38 underwent QOL evaluations. QOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and head and neck module, Voice Handicap Index-30, and M. D. Anderson Dysphagia Inventory at least 6 months postoperatively. RESULTS The patients were predominantly male (98%), with a median age of 61 years. Cordectomy type included 1 type III, 4 type IV, 31 type V, and 8 type VI according to European Laryngological Society classification. Two patients (5%) had cervical lymph node metastasis and 21 patients (48%) underwent postoperative radiotherapy. With a mean follow-up of 65 months for all patients, 10 (23%) had tumor recurrence (9 local, 1 distant). After salvage surgery, four patients lived without disease, and the larynx was preserved in two. The 5-year local control and overall and disease-specific survival rates were 78%, 75%, and 84%, respectively. The overall laryngeal preservation rate was 82% (36/44). Most patients had satisfactory QOL. CONCLUSIONS In selected T3 glottic SCC cases, CO2 TOLMS can achieve favorable oncologic results and a satisfactory QOL.
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Affiliation(s)
- Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Ling-Wei Wang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Muh-Hwa Yang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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32
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Transoral laser microsurgery: feasibility of a new exoscopic HD-3D system coupled with free beam or fiber laser. Lasers Med Sci 2021; 36:1865-1872. [PMID: 33389311 DOI: 10.1007/s10103-020-03221-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/10/2020] [Indexed: 01/20/2023]
Abstract
In the last decades, new technological devices and instruments have been developed to overcome the technical limits of transoral laser microsurgery. The recent introduction of 3D endoscopy seems to be a promising tool in the field of diagnostic and operative laryngology as an alternative to the traditional microlaryngoscopy. Our work aims to present a novel transoral microsurgical setting that expands the use of exoscopic systems (in this case the VITOM® 3D-HD) as an alternative to the standard operating microscope. A customized support arm and an adaptor to firmly connect the VITOM® 3D-HD camera to the laser micromanipulator were specially designed. This setup was used as an alternative to the standard operating microscope in a cohort of 17 patients affected by suspicious early to intermediate pharyngo-laryngeal neoplasms. A historical cohort of patients treated with the traditional setting and matching the same inclusion criteria was used as a reference for the duration of surgical procedures. The surgical procedures comprised 7 cordectomies, 2 endoscopic partial supraglottic laryngectomies, 4 tongue base resections, and 4 lateral oropharyngectomies or hypopharyngectomies. In 6 cases (35%), a simultaneous neck dissection was performed. The low rate of positive deep (6%) or superficial (12%) margins reinforced the safety of this platform, and the results obtained in terms of operating time were comparable to the control group (p > 0.05), which confirms the feasibility of the system. Our surgical setting setup is a convincing alternative to traditional transoral laser microsurgery for early to intermediate pharyngo-laryngeal neoplasms. The main advantages of this system are comfortable ergonomics for the first surgeon and a potential benefit in terms of teaching if applied in university hospitals, since the entire surgical team can view the same surgical 3D-HD view of the first operator. Further work is still needed to objectively compare the traditional and new technique, and to validate our preliminary clinical findings.
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33
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Schild LR, Böhm F, Boos M, Kahrs LA, Coburger J, Greve J, Dürselen L, Hoffmann TK, Schuler PJ. Adding Flexible Instrumentation to a Curved Videolaryngoscope: A Novel Tool for Laryngeal Surgery. Laryngoscope 2020; 131:E561-E568. [PMID: 32585046 DOI: 10.1002/lary.28868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Transoral surgery of the larynx with rigid instruments is not always possible. This may result in insufficient therapy or in an increased need for open surgery. For these patients, alternative surgical systems are needed. Here, we demonstrate a curved prototype for laryngeal surgery equipped with flexible instruments. STUDY DESIGN Pre-clinical user study in an ex vivo porcine laryngeal model. METHODS The prototype was built from established medical devices, namely a hyperangulated videolaryngoscope and modified flexible instruments as well as three-dimensional printed parts. Feasibility of laryngeal manipulation was evaluated in a user study (n = 19) with a porcine ex vivo laryngeal model. Using three different visualization technologies, the participants performed various fine motor skills tasks and rated the usability of the system on a 5-point Likert scale. RESULTS Exposure, accessibility, and manipulation of important laryngeal structures were always possible using the new prototype. The participants needed considerably less time (mean, 96.4 seconds ± 6.4 seconds vs. 111.5 seconds ± 4.5 seconds, P = .18), reported significantly better general impression (mean score 3.0 vs. 3.8, P = .041) and significantly lower user head and neck strain (2.6 vs. 1.7, P = .022) using a 40-inch television screen as compared to a standard videolaryngoscope monitor. CONCLUSION The results indicate that our curved prototype and large monitor visualization may provide a cost-effective minimally invasive alternative for difficult laryngeal exposure. Its special advantages include avoiding the need for a straight line of sight and a simple and cost-effective construction. The system could be further improved through advances in camera chip technology and smaller instruments. Laryngoscope, 131:E561-E568, 2021.
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Affiliation(s)
- Leon R Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany
| | - Marco Boos
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Lüder A Kahrs
- Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Jan Coburger
- Department of Neurosurgery, Ulm University Medical Centre, Guenzburg, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
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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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35
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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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36
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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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37
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Current role of computed tomography imaging in the evaluation of cartilage invasion by laryngeal carcinoma. Radiol Med 2020; 125:1301-1310. [PMID: 32415474 DOI: 10.1007/s11547-020-01213-y] [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: 01/17/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate thyroid, arytenoid, and cricoid cartilage invasion on computed tomography (CT) imaging in patients undergoing total laryngectomy for both primary and recurrent laryngeal carcinoma. Secondary endpoint was to compare laryngeal cartilage invasion between primary and recurrent tumours. METHODS Pre-treatment CT of 40 patients who had undergone total laryngectomy was retrospectively evaluated and compared with histology. Focal erosions of thyroid cartilage were accounted for neoplastic invasion of the inner cortex. Full-thickness thyroid cartilage invasion was defined as a tumour-like tissue replacing thyroid cartilage or extended in extra-laryngeal soft tissues. Sclerosis and erosion of arytenoid and cricoid cartilages were assessed as signs of neoplastic invasion. RESULTS CT erosion showed perfect agreement for thyroid inner cortex and cricoid cartilage invasion and almost perfect agreement (87%) for arytenoid cartilage invasion. For tumours in contact with thyroid cartilages, the absence of CT erosion underestimated inner cortex infiltration. CT showed perfect agreement in predicting full-thickness thyroid cartilage invasion only in the case of extra-laryngeal neoplastic extension. Arytenoid sclerosis showed poor correlation with neoplastic invasion. For primary tumours, CT demonstrated good (inner cortex 75%; full-thickness 85%), substantial (67.5%), and perfect (100%) accuracy in thyroid, arytenoid, and cricoid cartilage invasion, respectively. No CT differences were observed between primary and recurrent laryngeal tumours. CONCLUSION Tumour-like tissue extension in the extra-laryngeal soft tissues was accurate in predicting thyroid cartilage full-thickness invasion. Erosions of arytenoid, cricoid, and thyroid cartilages' inner cortex on CT were highly indicative of neoplastic infiltration. No CT difference in cartilage infiltration between primary and recurrent tumours was observed.
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Benazzo M, Sovardi F, Preda L, Mauramati S, Carnevale S, Bertino G, Berton F, Meroni M, Herman I, Trisolini G, Morbini P. Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers. Cancers (Basel) 2020; 12:cancers12051074. [PMID: 32357419 PMCID: PMC7281313 DOI: 10.3390/cancers12051074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Preoperative imaging impacts treatment planning and prognosis in laryngeal cancers. We investigated the accuracy of standard computed tomography (CT) in evaluating tumor invasions at critical glottic areas. Methods: CT scans of glottic cancers treated by partial or total laryngectomy between Jan 2015 and Aug 2019 were reviewed to assess levels of tumor invasion at critical glottic subsites. CT accuracy in the identification of tumor extensions was determined against the gold standard of histopathological analysis of surgical samples. Results: This study included 64 patients. In the anterior commissure, CT showed high rates of false positives at all levels (sensitivity 56.2–70%, specificity 87.8–92.3%); in the anterior vocal fold, it overestimated the deep invasion (19.5% specificity, 90.3% sensitivity), while it underestimated the extralaryngeal spread (63.6% sensitivity, 98.1% specificity). In the posterior paraglottic space (pPGS), false negative results were more frequent for superficial extensions (25% sensitivity, 95.8% specificity) and deep invasions (58.8% sensitivity, 82.3% specificity). Shorter disease-specific and disease-free survivals were associated with pStage IV (p: 0.045 and 0.008) and with the pathological involvement of pPGS (p: 0.045 and 0.015). Conclusions: Negative prognostic correlation of pPGS involvement was confirmed on histopathological data. CT staging did not provide a satisfactory prognostic stratification and should be complemented with magnetic resonance imaging.
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Affiliation(s)
- Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Fabio Sovardi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
- Correspondence: ; Tel.: +39-331-229-2171
| | - Lorenzo Preda
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Simone Mauramati
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Sergio Carnevale
- Section of Anatomic Pathology, Cerba Healthcare Italia, 20139 Milan, Italy;
| | - Giulia Bertino
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Francesca Berton
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Matteo Meroni
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Irene Herman
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Giuseppe Trisolini
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
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Imaging checklist for preoperative evaluation of laryngeal tumors to be treated by transoral microsurgery: guidelines from the European Laryngological Society. Eur Arch Otorhinolaryngol 2020; 277:1707-1714. [DOI: 10.1007/s00405-020-05869-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
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Advantages of Transoral Endoscopic Diode Laser Microsurgery for the Treatment of Early-Stage Glottic Laryngeal Cancers. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.97928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jumaily M, Faraji F, Osazuwa-Peters N, Walker RJ, Ward GM. Prognostic significance of surgical margins after transoral laser microsurgery for early-stage glottic squamous cell carcinoma. Oral Oncol 2019; 97:105-111. [DOI: 10.1016/j.oraloncology.2019.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 12/28/2022]
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Involvement of the Anterior Commissure in Early Glottic Cancer (Tis-T2): A Review of the Literature. Cancers (Basel) 2019; 11:cancers11091234. [PMID: 31450795 PMCID: PMC6769981 DOI: 10.3390/cancers11091234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The impact of the anterior commissure (AC) involvement on prognosis in laryngeal cancer remains a topic of discussion with inconsistent results in the literature. This review examines AC involvement as a prognostic factor in patients with early glottic cancer (Tis-T2) treated with radiotherapy or transoral laser microsurgery (TLM). Methods: A systematic literature search was performed. Due to the heterogeneity of the data, no meta-analysis was implemented. Weighted averages were calculated if the appropriate data were extractable. Results: Thirty-four studies on radiotherapy and 23 on TLM fit the inclusion criteria. The majority of studies for both radiotherapy (67.7%) and TLM (75.0%) did not report a significant impact on oncological outcomes. Weighted averages were slightly lower in patients with AC involvement. The two studies that applied a more detailed classification showed a significant impact on the amount of AC involvement. Conclusions: Binary variables (yes/no) for AC involvement lead to inconsistent results. Studies that use more detailed classifications of the AC show that there is a significant impact on the outcome. To further elucidate the role of the AC, detailed stratification of tumors involving the AC need to be investigated in further studies for both treatment modalities.
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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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Liang F, Xiao Z, Chen R, Han P, Lin P, Huang Y, Huang X. Transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma. Oral Oncol 2019; 96:66-70. [PMID: 31422215 DOI: 10.1016/j.oraloncology.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/31/2019] [Accepted: 07/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the effective and safety of transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma by compared with CO2 laser surgery. MATERIALS AND METHODS From September 2015 to July 2018, 44 patients with early glottic carcinoma underwent transoral microsurgery were divided into 980-nm/1470-nm dual-wavelength fiber laser surgery (Dual-wavelength fiber laser group) and CO2 laser surgery (CO2 laser group). The operative time, number of other hemostatic devices used, postoperative blood loss, surgical complications and postoperative length of hospital stay The time of mucosal epithelialization and Voice Handicap Index-10(VHI-10) in pre-operation, 1-month postoperation and 6-month postoperation in both two groupswere retrospectively analyzed. RESULTS All the patients underwent successful operation and all the tumors received en-bloc resection with negative margins. The median operative time in Dual-wavelength laser group was faster than CO2 laser group (32.00 min vs 37.50 min, p = 0.014). There was no statistically significant difference between the two groups in the median postoperative hospital stay and the median time of mucosal epithelialization. No patient need feeding tubes place temporarily or permanently in both two groups. Tongue numbness, tear of the palatal arch, postoperative vocal cord adhesion, VHI-10 score in Pre-operation, 1-month postoperation and 6-month postoperation were similar in both two group. No recurrence was reported in both groups during follow-up. CONCLUSION Compared to the CO2 laser surgery, transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery is a safe and feasible procedure for early-stage glottic carcinoma. It can provide clearer surgical field without hemorrhage and make the operation simpler, smoother and faster.
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Affiliation(s)
- Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Zhiwen Xiao
- Department of Otorhinolaryngology-Head&Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, China
| | - Renhui Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Pin Han
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Yuzhang Huang
- Department of Otorhinolaryngology-Head&Neck Surgery, Beijing United Family Hospital, Beijing 100015, China.
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
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Chang BA, Lott DG, Nagel TH, Howard BE, Hayden RE, Hinni ML. Outcomes Following Transoral Laser Microsurgery With Resection of Cartilage for Laryngeal Cancer. Ann Otol Rhinol Laryngol 2019; 128:978-982. [DOI: 10.1177/0003489419851521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction:The ability to treat more advanced laryngeal cancers by transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety.Methods:We describe a retrospective review of patients undergoing resection of the thyroid cartilage during transoral laser microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included.Results:Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration.Conclusion:We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.
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Affiliation(s)
- Brent A. Chang
- Department of Otolaryngology/Head & Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - David G. Lott
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Thomas H. Nagel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Brittany E. Howard
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Richard E. Hayden
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Michael L. Hinni
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Marchi F, Filauro M, Missale F, Parrinello G, Incandela F, Bacigalupo A, Vecchio S, Piazza C, Peretti G. A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases. Cancers (Basel) 2019; 11:E717. [PMID: 31137671 PMCID: PMC6562846 DOI: 10.3390/cancers11050717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Almalina Bacigalupo
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Radiation Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Stefania Vecchio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
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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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Tirelli G, Gardenal N, Gatto A, Bonini P, Tofanelli M, Fernández-Fernández MM. Is there a role for ultrasonic surgery in transoral laryngeal cancer resections? Expert Rev Med Devices 2019; 16:275-279. [DOI: 10.1080/17434440.2019.1596795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
| | - Pierluigi Bonini
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
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Del Bon F, Piazza C, Lancini D, Paderno A, Bosio P, Taboni S, Morello R, Montalto N, Missale F, Incandela F, Marchi F, Filauro M, Deganello A, Peretti G, Nicolai P. Open Partial Horizontal Laryngectomies for T3⁻T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization. Cancers (Basel) 2019; 11:cancers11030289. [PMID: 30832209 PMCID: PMC6468624 DOI: 10.3390/cancers11030289] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 01/16/2023] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate–advanced laryngeal cancers (LC). T–N categories are well-known prognosticators: herein we tested if “anterior” vs. “posterior” tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor. We analyzed a retrospective cohort of 85 T3–4a glottic LCs, treated by Type II or III OPHL (according to the European Laryngological Society classification) from 2005 to 2017 at two academic institutions. Five-year overall survival (OS), disease-specific survivals (DSS), and recurrence-free survivals (RFS) were compared according to tumor location and pT category. Anterior and posterior tumors were 43.5% and 56.5%, respectively, 78.8% of lesions were T3 and 21.2% were T4a. Five-year OS, DSS, and RFS for T3 were 74.1%, 80.5%, and 63.4%, respectively, and for T4a 71.8%, 71.8%, and 43%, respectively (p not significant). In relation to tumor location, the survival outcomes were 91%, 94.1%, and 72.6%, respectively, for anterior tumors, and 60.3%, 66.3%, and 49.1%, respectively, for posterior lesions (statistically significant differences). These data provide evidence that laryngeal compartmentalization is a valid prognosticator, even more powerful than the pT category.
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Affiliation(s)
- Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Bosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Taboni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Riccardo Morello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Nausica Montalto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Francesco Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Marta Filauro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Prediction of Posterior Paraglottic Space and Cricoarytenoid Unit Involvement in Endoscopically T3 Glottic Cancer with Arytenoid Fixation by Magnetic Resonance with Surface Coils. Cancers (Basel) 2019; 11:cancers11010067. [PMID: 30634566 PMCID: PMC6356606 DOI: 10.3390/cancers11010067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
Discrimination of the etiology of arytenoid fixation in cT3 laryngeal squamous cell carcinoma (SCC) is crucial for treatment planning. The aim of this retrospective study was to differentiate among possible causes of arytenoid fixation (edema, inflammation, mass effect, or tumor invasion) by analyzing related signal patterns of magnetic resonance (MR) in the posterior laryngeal compartment (PLC) and crico-arytenoid unit (CAU). Seventeen patients affected by cT3 glottic SCC with arytenoid fixation were preoperatively studied by state-of-the-art MR with surface coils. Different signal patterns were assessed in PLC subsites. Three MR signal patterns were identified: A, normal; B, T2 hyperintensity and absence of restriction on diffusion-weighted imaging (DWI); and C, intermediate T2 signal and restriction on DWI. Signal patterns were correlated with the presence or absence of CAU and PLC neoplastic invasion. Patients were submitted to open partial horizontal or total laryngectomy and surgical specimens were analyzed. Pattern A and B did not correlate with neoplastic invasion, while Pattern C strongly did (Spearman’s coefficient = 0.779, p < 0.0001; sensitivity: 100%; specificity: 78%). In conclusion, MR with surface coils is able to assess PLC/CAU involvement with satisfactory accuracy. In absence of Pattern C, arytenoid fixation is likely related to mass effect and/or inflammatory reaction and is not associated with neoplastic invasion.
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