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Parvathaneni A, Patel SA, Houlton JJ, Pang J, Futran ND. Clarification of the margin status by the multidisciplinary tumor board following transoral robotic surgery for p16 positive oropharyngeal squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2023; 8:1500-1506. [PMID: 38130253 PMCID: PMC10731506 DOI: 10.1002/lio2.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/23/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Margin status interpretation following transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) is challenging. This study aims to assess the discrepancy between status of margins as reported by the pathologist versus as determined by multi-disciplinary team review (MDTB). Methods A retrospective study of 57 patients with OPSCC who underwent TORS from January 2010 to December 2016 was conducted. Our primary outcome measure was the discrepancy between the surgical specimen margins as described in the pathology report versus final margin status that was determined after the multi-disciplinary team discussion. Fisher's exact test was used. Results Based on the pathologist-report, 29 subjects (51%) had positive margins, compared to 2 (4%) after multi-disciplinary team discussion. Receipt of chemotherapy correlated with final margin status as determined by MDTB, not with initial main specimen margins (p = .02 and p = .08, respectively). With a median follow up of 28.4 months, two subjects (4%) had loco-regional recurrence. Conclusion Following TORS, there was a significant discrepancy between status of margins as reported by the pathologist versus as determined by MDTB review. Chemotherapy was avoided in 93.1% of cases that were originally reported as positive margins by the pathologist with an acceptably low recurrence rate. Level of evidence 4.
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Affiliation(s)
| | - Sapna A. Patel
- Department of Otolaryngology, The Southeast Permanente Medical GroupAtlantaGeorgiaUSA
| | - Jeffrey J. Houlton
- Head & Neck Specialists/Sarah Cannon Cancer InstituteCharlestonSouth CarolinaUSA
| | - John Pang
- Department of Otolaryngology—Head and Neck SurgeryOchsner LSU HealthShreveportLouisianaUSA
| | - Neal D. Futran
- Department of Otolaryngology—Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
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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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Miśkiewicz-Orczyk K, Ścierski W, Lisowska G, Majewski W, Golusiński P, Misiołek M. Salvage surgery in laryngeal cancer after radiotherapy and partial surgery - comparative results. J Cancer Res Ther 2023; 19:579-584. [PMID: 37470578 DOI: 10.4103/jcrt.jcrt_1548_21] [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: 07/21/2023]
Abstract
Objective The study is a retrospective comparison of the usefulness of salvage surgery between a group of previously radiotherapy-treated patients (RTPs) and a group of patients who previously underwent partial surgery with both local and ± nodal recurrence. Study Design Retrospective study. Setting Multi-center academic hospital. Materials and Methods The former group was comprised 30 previously RTPs, whereas the latter group consisted of 20 patients after partial laryngeal surgery with optional subsequent adjuvant radiotherapy (PSPs). Treatment efficacy was compared in both groups in relation to overall survival (OS) and the locoregional control rate (LCR). Local and ± nodal recurrence was considered primary treatment failure. All patients underwent total laryngectomy. Results The updated 5-year OS in the PSPs was 31%, while the percentage of the updated 5-year LCR was 42%. In the RTPs the updated 5-year OS was 21%, and the percentage of 5-year LCR was 38%. No statistically significant differences were found in terms of the comparison of OS or the comparison of LCR results in both groups (P = 0.427, P = 0.704, respectively). Conclusions Based on the analysis, it was found that irrespective of the initial treatment, salvage surgery was associated with decreased survival and cure rates (by 50%) compared to the group of patients with advanced laryngeal cancer who underwent primary total laryngectomy.
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Affiliation(s)
- Katarzyna Miśkiewicz-Orczyk
- Department of Otorhinolaryngology and Laryngological Oncology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Ścierski
- Department of Otorhinolaryngology and Laryngological Oncology, Medical University of Silesia, Zabrze, Poland
| | - Grażyna Lisowska
- Department of Otorhinolaryngology and Laryngological Oncology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Majewski
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Paweł Golusiński
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Góra, Zielona Góra, Poland
| | - Maciej Misiołek
- Department of Otorhinolaryngology and Laryngological Oncology, Medical University of Silesia, Zabrze, Poland
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Silver JA, Turkdogan S, Roy CF, Kost KM. Surgical Treatment of Early Glottic Cancer. Otolaryngol Clin North Am 2023; 56:259-273. [PMID: 37030939 DOI: 10.1016/j.otc.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality.
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Mariani C, Carta F, Bontempi M, Marrosu V, Tatti M, Pinto V, Gerosa C, Puxeddu R. Management and Oncologic Outcomes of Close and Positive Margins after Transoral CO 2 Laser Microsurgery for Early Glottic Carcinoma. Cancers (Basel) 2023; 15:cancers15051490. [PMID: 36900281 PMCID: PMC10000552 DOI: 10.3390/cancers15051490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic carcinoma. METHODS 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). RESULTS A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). CONCLUSIONS Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended.
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Affiliation(s)
- Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
- Correspondence:
| | - Mauro Bontempi
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Valeria Pinto
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Medical Sciences and Public Health, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
- ENT Department, King’s College Hospital London-Dubai, Dubai P.O. Box 340901, United Arab Emirates
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Kinberg E, Rapoport SK, Brown S, Woo P. Long-Term Voice Outcomes After Type I, Type II, or Type V Cordectomy. Ann Otol Rhinol Laryngol 2023; 132:133-137. [PMID: 35189725 DOI: 10.1177/00034894221081259] [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: 01/12/2023]
Abstract
INTRODUCTION We compare long-term voice outcomes in patients treated with European Laryngeal Society (ELS) classification Type I, Type II, or Type V cordectomy. The aim is to understand the impact of Type V cordectomy on voice outcomes in relation to Type I and Type II cordectomy. METHODS A retrospective review of patients treated with Type I, Type II, or Type V cordectomy by a single surgeon over a 20-year period was performed. Voice Handicap Index-10 (VHI-10) scores, Cepstral Spectral Index of Dysphonia (CSID) measures from CAPE-V sentences, and two-rater GRBAS scores were analyzed. RESULTS Sixty-two patients were identified with a mean follow-up of 52 months. Of these, there were 43 Type I and 19 Type II cordectomies, including 8 in each group with Type V resections. Significant differences in all parameters were noted between the Type I (VHI 5.7, CSID 20.6, Grade 1.3) and the Type II cohorts (VHI 12.6, CSID 36.3, Grade 1.8) who did not undergo Type V cordectomy. Patients undergoing Type V cordectomy demonstrated voice outcomes (VHI 9.4, CSID 35.6, Grade 1.7) which fell between those of Type I and Type II cordectomies. CONCLUSIONS Better long-term subjective, objective, and computer-analyzed voice outcomes are noted for patients undergoing Type I rather than Type II cordectomy. When Type V cordectomy is performed, voice outcomes are comparable to those of both Type I and Type II cordectomy, a surprising finding given the expectation of worsened dysphonia in longer resections. Further work is needed to explain this finding and define voice outcomes after Type V cordectomy.
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Affiliation(s)
- Eliezer Kinberg
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Sarah K Rapoport
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Sarah Brown
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Peak Woo
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
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7
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Carreras A, Martínez-Torre MI, Zabaleta M, Sanchez-del-Rey A, Santaolalla F, Diaz-de-Cerio P. Prognosis and Outcomes in Early Stage Glottic Carcinoma Involving the Anterior Commissure Treated with Laser CO 2 Surgery: A Retrospective Observational Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:6048-6053. [PMID: 36742721 PMCID: PMC9895331 DOI: 10.1007/s12070-021-02698-3] [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: 05/08/2021] [Accepted: 06/20/2021] [Indexed: 02/07/2023] Open
Abstract
The anterior commissure (AC) is the area where the vocal cords attach to the thyroid cartilage through Broyles' ligament. Many authors argue that involvement of the anterior commissure in early stage glottic carcinoma (I, II) constitutes a risk factor for local recurrence. The objective of this study is to evaluate whether anterior commissure involvement in early stage glottis cancer is an independent risk factor for recurrence and mortality. The study included all those patients diagnosed with glottis carcinoma in stages I and II of the AJCC treated by transoral laser surgery at the Hospital San Pedro (Logroño, Spain) between 2005 and 2015. Patients were divided into two groups according to the presence (AC1) or absence (AC0) of involvement of the commissure. Of 29 patients treated, 44.8% were AC1. Patients with anterior commissure involvement had more local recurrence (p = 0.2701); higher mortality rate (p = 0.2256); lower disease-free survival (p = 0.0881) and a lower overall survival (p = 0.0331). The 5-year survival rate was 24.5% lower in patients with invasion of the anterior commissure. The involvement of the anterior commissure is an independent risk factor that should be considered in the prognosis of laryngeal cancer.
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Affiliation(s)
- A. Carreras
- Department of Otorhinolaryngology, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert 5, 08221 Terrassa, Barcelona Spain
| | - M. I. Martínez-Torre
- Department of Otorhinolaryngology Head and Neck Surgery, Hospital San Pedro, Logroño, La Rioja Spain
| | - M. Zabaleta
- Department of Otorhinolaryngology Head and Neck Surgery, Hospital San Pedro, Logroño, La Rioja Spain
| | - A. Sanchez-del-Rey
- Department of Dermatology, Ophthalmology and Otorhinolaryngology, College of Medicine, University of the Basque Country, Leioa, Bizkaia Spain
| | - F. Santaolalla
- Department of Dermatology, Ophthalmology and Otorhinolaryngology, College of Medicine, University of the Basque Country, Leioa, Bizkaia Spain
| | - P. Diaz-de-Cerio
- Department of Otorhinolaryngology Head and Neck Surgery, Hospital San Pedro, Logroño, La Rioja Spain
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8
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Korkmaz MH, Bayır Ö, Hatipoğlu EB, Tatar EÇ, Han Ü, Öcal B, Keseroğlu K, Karahan S, Saylam G. Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience. Eur Surg Res 2021; 63:132-144. [PMID: 34818662 DOI: 10.1159/000519718] [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: 06/27/2021] [Accepted: 09/16/2021] [Indexed: 12/09/2022]
Abstract
Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study. METHODS Patients with early-stage (Tis-1-2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. RESULTS One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of "wait and see" modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001). CONCLUSION The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.
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Affiliation(s)
- Mehmet Hakan Korkmaz
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey.,Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ömer Bayır
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey,
| | | | - Emel Çadalli Tatar
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ünsal Han
- Department of Pathology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bülent Öcal
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Holcomb AJ, Herberg M, Strohl M, Ochoa E, Feng AL, Abt NB, Mokhtari TE, Suresh K, McHugh CI, Parikh AS, Sadow P, Faquin W, Faden D, Deschler DG, Varvares MA, Lin DT, Fakhry C, Ryan WR, Richmon JD. Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:2434-2444. [PMID: 33856083 DOI: 10.1002/hed.26708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. METHODS Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan-Meier method. RESULTS Ninety-nine patients were included (median follow-up 21 months, range 6-121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. CONCLUSIONS Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.
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Affiliation(s)
- Andrew J Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Herberg
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Edgar Ochoa
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas B Abt
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tara E Mokhtari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher I McHugh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Sadow
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William Faquin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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10
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Shrinkage of specimens after CO 2 laser cordectomy: an objective intraoperative evaluation. Eur Arch Otorhinolaryngol 2021; 278:1515-1521. [PMID: 33515084 DOI: 10.1007/s00405-021-06625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The margin status after CO2 laser cordectomy for glottic carcinoma may influence prognosis. There are no studies assessing the possible bias due to anatomic changes of the specimens for shrinkage. The authors evaluated the intraoperative shrinkage of specimens immediately after transoral CO2 laser microsurgery (CO2 TOLMS) to improve the understanding and the interpretation of surgical margins. METHODS This is a prospective study involving a consecutive cohort of 23 patients (19 males, 4 females, mean age 69.9 years, range 42-83 years) with early glottic carcinoma treated by CO2 TOLMS from February 2017 to April 2019. The anteroposterior shrinkage of the specimen, of the tumor, and of the anterior and posterior margins was measured intraoperatively with a cross table reticle glass micrometer ruler, inserted into the eyepiece of the surgical microscope. RESULTS The mean shrinkage of the mucosal specimen from intralaryngeal measurement to post-resection measurement was 3.8 ± 0.3 mm, resulting in an average loss of 29% of the anteroposterior length (p < 0.01). The anteroposterior length of both the tumor and the margins after resection significantly decreased, but the shrinkage of the anterior and posterior margins was significantly greater than the shrinkage of the tumor (49% versus 20% and 45% versus 20%, p < 0.01). CONCLUSION The present study demonstrates significant shrinkage of specimens after CO2 TOLMS, especially in the anteroposterior length of the vocal cords, and justifies the good oncological results for specimens with close and single positive superficial margins. Follow-up versus a second surgical look policy could be safely suggested in cases of close superficial and single positive superficial margins.
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11
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Crary MA. Dysphagia and Head and Neck Cancer. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Saraniti C, Montana F, Chianetta E, Greco G, Verro B. Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients. Braz J Otorhinolaryngol 2020; 88:669-674. [PMID: 33272837 PMCID: PMC9483927 DOI: 10.1016/j.bjorl.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: “free” if macroscopic margin-tumor distance was at least 2 mm, as “close” if it was less than 2 mm and “positive” if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO2 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4–8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated. Results Five-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients. Conclusion This study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO2 laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.
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Affiliation(s)
- Carmelo Saraniti
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy.
| | - Francesca Montana
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
| | - Enzo Chianetta
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
| | - Giuseppe Greco
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
| | - Barbara Verro
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
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Verro B, Greco G, Chianetta E, Saraniti C. Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature. Int Arch Otorhinolaryngol 2020; 25:e301-e308. [PMID: 33968237 PMCID: PMC8096502 DOI: 10.1055/s-0040-1713922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction
Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO
2
laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult.
Objective
To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy.
Data Synthesis
We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up.
Conclusions
Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins.
Key Points
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Affiliation(s)
- Barbara Verro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, ENT Clinic, University of Palermo, Palermo, Italy
| | - Giuseppe Greco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, ENT Clinic, University of Palermo, Palermo, Italy
| | - Enzo Chianetta
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, ENT Clinic, University of Palermo, Palermo, Italy
| | - Carmelo Saraniti
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, ENT Clinic, University of Palermo, Palermo, Italy
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Chiesa-Estomba CM, Suarez JAS, Ninchritz-Becerra E, Soriano-Reixach M, González-García JA, Larruscain E, Altuna X. Transoral Carbon Dioxide Microsurgery of the Larynx as a Day-Case Outpatient Procedure: An Observational, Retrospective, Single-Center Study. EAR, NOSE & THROAT JOURNAL 2020; 100:100S-104S. [PMID: 32804574 DOI: 10.1177/0145561320951049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Despite good results of transoral laser CO2 microsurgery (CO2TOLMS) of the larynx, a lack of data related to the safety of this technique as a day-case procedure across the literature is evident. MATERIALS AND METHODS An observational, retrospective, non-randomized study. RESULTS One hundred four (62.6%) patients met the inclusion criteria, 96 (92.3%) patients were male, and 8 (7.7%) patients were female. The mean age of the study group was 66 ± 11 years (min: 34/max: 90). All the patients underwent CO2TOLMS were treated as an outpatient procedure. The glottis was the most common location affecting 97 (93.3%) patients, regarding the need of readmission, just 4 (3.8%) patients needed to be readmitted after surgery due to dyspnea secondary to laryngeal edema in 2 cases by laryngeal bleeding, and cervical emphysema in one case, respectively. Being just necessary to reintubate 1 patient (<1%) to control the bleeding. We didn't find any statistical correlation between variables and the need for readmission of reintubation. CONCLUSION According to our results, CO2TOLMS of the larynx can be safely performed as an outpatient procedure. To establish a proper protocol and to perform a careful preoperative assessment are essential to increase our success rate and to prevent any potential complication.
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Affiliation(s)
- Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Jon A Sistiaga Suarez
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Elisabeth Ninchritz-Becerra
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Maria Soriano-Reixach
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Jose A González-García
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Ekhiñe Larruscain
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Xabier Altuna
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
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An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions. Curr Oncol Rep 2020; 22:82. [PMID: 32601821 DOI: 10.1007/s11912-020-00942-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Failure to achieve tumor-free margins is the single largest cause of death for head neck cancer patients. At the same time, it is the only factor that is in complete control of the surgeon. This review summarizes evidence for the definition, clinical implications, and methods to achieve optimal margins. RECENT FINDINGS The previous universally followed definition of adequate margin (5 mm in final histopathology) has been disputed. Various biological, optical, and imaging adjuncts can aid in achieving optimal margins. Extent of resection and margins in human papilloma virus (HPV)-positive oropharyngeal cancers and following induction chemotherapy remain controversial. Though practiced widely, frozen section-guided margin revision has not conclusively shown improved local control rates. The role of molecular assessment of margins is promising but not established. The definition of adequate margin differs according to the site in the head neck region. Currently, the 5-mm margin at final histopathology is the most commonly accepted definition of an "adequate" margin.
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Hans S, Crevier-Buchman L, Circiu M, Idrissi YC, Distinguin L, de Mones E, Brasnu D, Lechien JR. Oncological and Surgical Outcomes of Patients Treated by Transoral CO 2 Laser Cordectomy for Early-Stage Glottic Squamous Cell Carcinoma: A Retrospective Chart Review. EAR, NOSE & THROAT JOURNAL 2020; 100:33S-37S. [PMID: 32204623 DOI: 10.1177/0145561320911486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To investigate the feasibility and the outcomes of transoral laser CO2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure. METHODS Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS). RESULTS A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs (P = .01). Different procedure tips were described for improving the laryngeal exposition. The 5-year laryngeal preservation rate, DSS, and DFS were significantly better in patients without SCC involvement of the anterior commissure, and did not vary according to the margin status. The laryngeal exposure difficulties did not impact the margin status. CONCLUSION The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.
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Affiliation(s)
- Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta Circiu
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younes Chekkoury Idrissi
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Léa Distinguin
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Erwan de Mones
- Department of Otolaryngology-Head and Neck Surgery, Bordeaux University, France
| | - Daniel Brasnu
- Department of Otolaryngology-Head and Neck Surgery, 55659Fondation A. Rothschild, Paris, France
| | - Jérôme R Lechien
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Laryngology Study Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
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Outcomes of definitive radiotherapy for early laryngeal cancer in terms of survival and patterns of failure. The Journal of Laryngology & Otology 2019; 133:1087-1091. [DOI: 10.1017/s0022215119002433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundEarly laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.MethodFrom January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.ResultsAll patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.ConclusionIn summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.
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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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Abstract
Successful management of laryngeal cancer depends on careful pretreatment evaluation of patient and disease factors to arrive at accurate staging, leading to appropriate treatment selection for patients with this highly impacting disease. Surgical modalities, including transoral laser microsurgery, open partial laryngectomy, and total laryngectomy, offer options, alone or in combination with radiation and chemotherapy. Treatment strategy for laryngeal cancer should strive for cure while maintaining the best quality of life possible for the patient. Achieving the goals of initial and salvage treatment for laryngeal cancer depends on executing a plan of care determined by the expertise of the multidisciplinary team.
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Lazio MS, Vallin A, Giannini C, Taverna C, Maggiore G, Saraceno MS, Gallo O. Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure? Ann Otol Rhinol Laryngol 2018; 128:277-285. [PMID: 30547680 DOI: 10.1177/0003489418819544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. METHODS: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. RESULTS: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). CONCLUSION: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.
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Affiliation(s)
- Maria Silvia Lazio
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Alberto Vallin
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Costanza Giannini
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Cecilia Taverna
- 2 Section of Anatomic Pathology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Giandomenico Maggiore
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Massimo Squadrelli Saraceno
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
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Nouraei SAR, Dorman EB, Macann A, Vokes DE. Outcomes of Treating Early Glottic Neoplasms With a Potassium Titanyl Phosphate Laser. Ann Otol Rhinol Laryngol 2018; 128:85-95. [DOI: 10.1177/0003489418806914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The aim of this study was to assess the outcome of treating glottic dysplasia and early squamous cell carcinoma (SCC) with potassium titanyl phosphate (KTP) photoangiolytic laser ablation. Methods: Patient demographics, comorbidities, and tumor characteristics were recorded. Perceptual, patient-reported, and objective voice outcomes were assessed. Use of treatment modalities in addition to the KTP laser, development of locoregional or metastatic SCC, and overall survival were recorded. Results: There were 23 patients with glottic dysplasia and 18 patients with glottic SCC. Mean age at treatment was 69 years. Most patients (95%) were male. Posttreatment fundamental frequency fell from 132 ± 35 to 116 ± 24 Hz ( P = .03). Overall, 61% of patients achieved a normal voice. There was a learning-curve, and most treatment failures occurred in the first half of the series. Five-year KTP-only disease-control rates were 87.1% and 53.5% for dysplasia and malignancy, respectively. Five-year overall survival was 56%, with no laryngectomies or deaths due to SCC. Conclusions: Ablating dysplasia and early glottic cancer using a KTP laser is a viable treatment option. It has a learning curve and a failure rate but, in this series, no ultimate loss of oncologic control. Its introduction into clinical practice should be managed carefully in the context of multidisciplinary cancer care. Level of Evidence: 4.
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Nature and role of surgical margins in transoral laser microsurgery for early and intermediate glottic cancer. Curr Opin Otolaryngol Head Neck Surg 2018; 26:78-83. [PMID: 29373328 DOI: 10.1097/moo.0000000000000446] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Summarize recent findings regarding the impact of margin status on oncologic outcomes and organ preservation, as well as evaluate possible management policies of close and positive margins after transoral laser microsurgery (TLM) for Tis-T2 glottic carcinomas. RECENT FINDINGS Impact of margin status on survival rates remains controversial, whereas some authors found close and positive margins to be independent risk factors for recurrence and poorer survival rates, others did not find any significant variations compared with negative ones. A common trend can be observed in performing a watchful waiting policy or second look TLM in patients with close-superficial and positive single-superficial margins. Further treatment seems preferable in case of deep and positive multiple superficial margins. SUMMARY Positive margins are present in up to 50% of patients treated by TLM, even though a high rate of false positivity, reaching 80%, has been described. Close and positive single superficial margins seem to be linked to higher recurrence rates compared with negative margins, even though watchful wait and see policy, especially when performed by adjunctive visual aids like Narrow Band Imaging, maintains good final oncological and organ preservation outcomes. Further treatments are required in case of deep margin positivity.
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Hendriksma M, Montagne MW, Langeveld TPM, Veselic M, van Benthem PPG, Sjögren EV. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO 2 laser microsurgery, on local control. Eur Arch Otorhinolaryngol 2018; 275:2333-2340. [PMID: 30027440 PMCID: PMC6096566 DOI: 10.1007/s00405-018-5070-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/18/2018] [Indexed: 12/03/2022]
Abstract
Purpose To assess the impact of surgical margins status on local control in patients with primary early glottic (Tis-T2) squamous cell carcinoma after treatment with transoral CO2 laser microsurgery (TLM) and to assess the significance of additional wound bed biopsies. Methods Patients with Tis-T2 tumours treated with TLM type I–III resections according to the European Laryngological Society classification between 2009 and 2013 were included in retrospective analysis. Recurrence rate was determined in patients with free versus non-free specimen margins and wound biopsies. Five-year survival rates were determined using the Kaplan–Meier method. Prognostic impact of pT-category, resection margin status, tumour differentiation, wound bed biopsy status, and number of biopsies on local control (LC) were tested with the log-rank test. Results Eighty-four patients were included in the analysis. Positive margins were seen in 68 patients (81.0%). Margin status after TLM did not significantly influence LC (p = 0.489), however, additional wound bed biopsies were significantly associated with lower LC (p = 0.009). Five-year LC, disease-specific survival, overall survival and laryngeal preservation were 78.6, 78.0, 98.6 and 100%, respectively. Conclusions Additional wound bed biopsies can help predict local recurrence in patients treated with TLM for early glottic carcinoma. We propose that there is enough evidence to support a wait-and-see policy in patients with positive specimen margins and negative wound bed biopsies. For patients with positive wound bed biopsies, further treatment is warranted.
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Affiliation(s)
- Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Marc W Montagne
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton P M Langeveld
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Maud Veselic
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Demir UL, Çevik T, Kasapoğlu F. Is There a Change in the Treatment of T1 Glottic Cancer After CO 2 Laser? A Comparative Study with Cold Steel. Turk Arch Otorhinolaryngol 2018; 56:64-69. [PMID: 30197801 DOI: 10.5152/tao.2018.3053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Carbon dioxide (CO2) laser provides high local control and disease-specific survival rates with minor morbidity and good quality of life in transoral cordectomy. We aimed to compare the oncological outcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer. Methods In this retrospective study, the participants were divided into two groups. The first group comprised patients who were operated upon between 2001 and 2007 using cold steel (group 1, n=38), and the second group comprised patients who were operated upon between 2008 and 2016 using CO2 laser (group 2, n=88). Both groups were compared regarding age, gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease-free survival (DFS). Results The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and 100% vs. 98.9%, respectively), and no association was found between surgical margin positivity and local recurrence. However, a significant association between the presence of anterior commissure involvement and recurrence was found in all 126 patients (p=0.016). Local recurrence was significantly higher in the group 2 (p=0.024), but it did not affect overall survival and DFS in these patients (100% vs. 94.1%). Conclusion Although CO2 laser excision is considered to be superior to cold steel regarding surgical time and bleeding control, the local recurrence rates were found to be higher with the laser than the cold steel. Thus, we argue that cases should be selected more carefully concerning the anterior commissure, depth of tumor invasion lateral to vocal muscle, difficulty at endoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections.
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Affiliation(s)
- Uygar Levent Demir
- Department of Otorhinolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Turgut Çevik
- Department of Otorhinolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Fikret Kasapoğlu
- Department of Otorhinolaryngology, Uludağ University School of Medicine, Bursa, Turkey
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Oncological Outcomes Following Transoral CO 2 Laser Microsurgery for T1 Glottic Cancer. Indian J Otolaryngol Head Neck Surg 2018; 71:542-547. [PMID: 31742018 DOI: 10.1007/s12070-018-1394-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022] Open
Abstract
The objective of this study is to analyze oncological outcomes for treatment of Tis and T1 glottic squamous cell carcinoma after transoral laser microsurgery. This study is retrospective analysis of previously untreated, suspected lesion of glottis, staged cT1a and cT1b squamous cell carcinoma in a tertiary care hospital and 53 patients were included in the study. End points for analysis were local control, overall and disease specific survival rates. The local control, ultimate local control with laser alone, 3-year overall survival, 3-year disease specific survival and organ preservation rates were 86.7, 90.5, 92.4, 98.1 and 98.1% respectively. The involvement of anterior commissure did not show any significant impact on local control or survival. TLM is safe and effective treatment of early glottis cancer, associated with less morbidity and a high percentage of local control, survival and organ preservation rates.
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Klimza H, Jackowska J, Piazza C, Banaszewski J, Wierzbicka M. The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer. Braz J Otorhinolaryngol 2018; 85:228-236. [PMID: 29550291 PMCID: PMC9452233 DOI: 10.1016/j.bjorl.2018.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. Objective The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. Methods Forty-four consecutive T1–T2 glottic cancers treated with trans-oral laser microsurgery Type I–VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. Results Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. Conclusion The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.
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Affiliation(s)
- Hanna Klimza
- Poznan University of Medical Sciences, Department of Otolaryngology, Head and Neck Surgery, Poznan, Poland
| | - Joanna Jackowska
- Poznan University of Medical Sciences, Department of Otolaryngology, Head and Neck Surgery, Poznan, Poland.
| | - Cesare Piazza
- Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Department of Otolaryngology, Head and Neck Surgery, Milan, Italy
| | - Jacek Banaszewski
- Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Department of Otolaryngology, Head and Neck Surgery, Milan, Italy
| | - Malgorzata Wierzbicka
- Poznan University of Medical Sciences, Department of Otolaryngology, Head and Neck Surgery, Poznan, Poland
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van Loon Y, Hendriksma M, Langeveld TPM, de Jong MA, Baatenburg de Jong RJ, Sjögren EV. Treatment Preferences in Patients With Early Glottic Cancer. Ann Otol Rhinol Laryngol 2017; 127:139-145. [PMID: 29291278 PMCID: PMC5815424 DOI: 10.1177/0003489417749253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: For early glottic carcinoma, the 2 main treatment modalities are radiotherapy (RT) and transoral CO2 laser microsurgery (TLM). The aim of this study was to investigate treatment preferences and considerations in patients with early glottic carcinoma (T1-T2) who were given a choice between TLM and RT. Subjects and Methods: Patients with early glottic cancer (suspected or confirmed extended T1 or limited T2) were counseled by an ENT-surgeon. A subset of 32 patients was also counseled by a radiotherapist. Treatment choice and considerations were recorded and analyzed. Results: Of 175 patients, 168 patients (96%) chose TLM, and 7 patients (4%) chose RT. The most common reason for choosing TLM was shorter treatment and more treatment options in case of recurrence. Subanalysis showed that additional counseling by the radiotherapist did not seem to affect our patients’ preferences for TLM in this group. Conclusions: The majority of patients in our study prefer TLM to RT when given a choice. Reasons given indicate that optimizing future treatment options and practical considerations seemed more important to our patients than primary functional outcome. Further research is needed to study patient-related and physician-related factors to gain more insight into this complicated process of shared decision making.
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Affiliation(s)
- Yda van Loon
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Martine Hendriksma
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Ton P M Langeveld
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin A de Jong
- 2 Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob J Baatenburg de Jong
- 3 Department of Otorhinolaryngology, Head & Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Elisabeth V Sjögren
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Winiarski P, Lewandowski A, Greczka G, Banaszewski J, Klimza H, Wierzbicka M. Primary and salvage laser surgery of 341 glottic cancers-Comparison of treatment outcomes between University Head Neck Tertiary Referral Center and Local Head Neck Department. Lasers Surg Med 2017; 50:311-318. [PMID: 29135033 DOI: 10.1002/lsm.22759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The main goal was to compare the clinical data of patients with T1 and T2 glottic cancer treated with CO2 transoral laser microlaryngoscopy (TLM) in the Tertiary Referral University Department of Otolaryngology, Head Neck Surgery, Poznan and the local Department of Otolaryngology, Oncology and Maxillofacial Surgery, Bydgoszcz. MATERIAL AND METHODS Unified databases for the 7-year period January 2005-December 2011 were created to compare these two cohorts. The database contained 341 patients: 231 from the tertiary center and 110 from the local department, of which 298 (87%) were men, and 43 (13%) were women. RESULTS Cordectomy type I-IV was performed in 250 (73%) patients, cordectomy type V-VI in 84 (25%) patients, and cordectomy enlarged to epiglottic petiole in 7 (2%) patients. Local recurrence was observed in 96 (28%) cases. Among these cases, 81 (87.5%) patients had salvage surgery: 43 re-cordectomy, 10 open partial laryngectomy, and 28 total laryngectomy. The outcomes for the whole cohort, Tertiary Referral Center and Local Department respectively were as follows: larynx preservation rate was 91.8%, 93.6%, and 88%; 3-year disease specific survival was 97.4%, 97.9%, and 93.3%; 3-year overall survival was 93.5%, 96.6%, and 85.5%; 5-year disease specific survival was 95.2%, 95.2%, and 96.3%; and 5-year overall survival was 84.5%, 88.7%, and 76%, respectively. CONCLUSION Comparison of the cohorts showed that outcomes of primary treatment were similar but there were noticeable differences in salvage treatment efficacy, favoring patients from the Tertiary Referral Center. Lasers Surg. Med. 50:311-318, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Piotr Winiarski
- Department of Otolaryngology, Otolaryngological Oncology and Maxillofacial Surgery, Jan Biziel Second University Hospital, Bydgoszcz, Poland
| | - Artur Lewandowski
- Department of Otolaryngology, Otolaryngological Oncology and Maxillofacial Surgery, Jan Biziel Second University Hospital, Bydgoszcz, Poland
| | - Grażyna Greczka
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Banaszewski
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Hanna Klimza
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
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Wolber P, Schwarz D, Stange T, Ortmann M, Balk M, Anagiotos A, Gostian AO. Surgical Treatment for Early Stage Glottic Carcinoma with Involvement of the Anterior Commissure. Otolaryngol Head Neck Surg 2017; 158:295-302. [DOI: 10.1177/0194599817728476] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Assessment of the value of transoral laser microsurgery (TLM) compared with open surgery (OS) for early stage squamous cell carcinoma of the glottic larynx with special regard to involvement of the anterior commissure (AC). Study Design Case series with chart review. Setting Tertiary care otolaryngology clinic. Subjects and Methods Review of clinicopathological data of all patients with previously untreated T1a, T1b, and T2 glottic squamous cell carcinoma of the larynx who were consecutively enrolled over a 10-year period (January 1, 1992, to December 31, 2002). Results Local recurrence rate was 20.4% (10 of 49) for TLM and 10.7% (3 of 28) for OS. Comparison of the TLM and OS groups regarding local recurrence rates revealed a significant difference only for tumors invading the AC ( P = .046). Within the TLM group, tumors with involvement of the AC showed a significantly higher recurrence rate (38.1%; 8 of 21) compared with tumors without involvement of the AC (7.1%; 2 of 28; P = .008). In the OS group, involvement of the AC revealed no significant difference ( P = .45). The overall survival in both groups was comparable in both groups (TLM, 93.9%; OS, 89.3%; P = .47). Conclusion TLM and OS are equally effective surgical treatments for early stage glottic cancer without involvement of the AC, with selection of treatment based on pretreatment endoscopy. However, TLM is associated with less morbidity. In case of invasion of the AC, OS yields lower recurrence rates.
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Affiliation(s)
- Philipp Wolber
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - David Schwarz
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | | | - Magdalene Ortmann
- Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Cologne, Germany
| | - Matthias Balk
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Andreas Anagiotos
- ENT Department, Nicosia General Hospital & Larnaca General Hospital, Nicosia, Cyprus
| | - Antoniu-Oreste Gostian
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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Galli A, Giordano L, Sarandria D, Di Santo D, Bussi M. Oncological and complication assessment of CO2 laser-assisted endoscopic surgery for T1-T2 glottic tumours: clinical experience. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:167-73. [PMID: 27214828 PMCID: PMC4977004 DOI: 10.14639/0392-100x-643] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 01/10/2016] [Indexed: 01/22/2023]
Abstract
Several therapeutic options are used for treatment of early stage glottic carcinoma (Tis/T1/T2): open partial laryngectomy (OPL), radiotherapy and CO2 laser-assisted endoscopic surgery. Laser surgery has gradually gained approval in the management of laryngeal cancer. We present our experience in endoscopic laser surgery for early stage glottic carcinomas. This was a retrospective analysis of 72 patients with T1-T2 glottic cancer treated with laser cordectomy between 2006 and 2012. All patients had at least a 36-month follow-up period. Percentages for disease-specific survival, disease-free survival (DFS) and laryngeal preservation rates were 98.6%, 84.7% and 97.2% respectively. Considering neoplastic features that could predict long-term oncological outcome, tumoural involvement of anterior commissure and pathological staging (pT) significantly correlate with local recurrence (p = 0.021 and p = 0.035) and with a lowered DFS (p = 0.017 and p = 0.023). Other variables such as clinical staging, type of cordectomy, involvement of other structures and surgical margin status showed no significant impact on oncological endpoints. CO2 laser surgery is a reliable technique for T1-T2 glottic cancer considering oncological outcomes. The recurrence rate seems to be affected by involvement of anterior commissure and pT stage.
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Affiliation(s)
- A Galli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - L Giordano
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - D Sarandria
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - D Di Santo
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - M Bussi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
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Aluffi Valletti P, Taranto F, Chiesa A, Pia F, Valente G. Impact of resection margin status on oncological outcomes after CO2 laser cordectomy. ACTA ACUST UNITED AC 2017; 38:24-30. [PMID: 28530251 DOI: 10.14639/0392-100x-870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 12/17/2016] [Indexed: 11/23/2022]
Abstract
The management of positive resection margins in micro-endoscopic glottic laser surgery remains a controversial and critical point. This study aims to assess the impact of margin status after transoral laser surgery on local control, survival and organ preservation rates; the decision-making process and treatment options in cases with positive margins are also discussed. We retrospectively reviewed the clinical and histological records of 308 consecutive patients with primary early glottic carcinoma (T1a, T1b, selected T2) and treated with endoscopic laser cordectomy. Recurrence rates and survival related to margin status were analysed using the Kaplan-Meier method. Local relapses and disease-free-survival rates were significantly related to excision margin status (p < 0.001). In the T1a category (n = 228) no significant differences were observed in disease-free-survival (p = 0.889) and overall survival (p = 0.426) between patients submitted to further treatment (revision endoscopic surgery or radiotherapy) for positive excision margins and patients who were left untreated. In 20 of 24 (83%) patients with positive margins that were surgically re-excised, no residual carcinoma was detected. Margin status (mainly multifocal and deep positive margins) at first surgery was significantly related to the final organ preservation rate (p < 0.001). Margin status during laser cordectomy in early glottic cancer has a prognostic impact on local control of disease without compromising survival. Patients with multifocal and deep positive borders should be surgically retreated and strictly monitored to increase the organ preservation rates. Careful preparation and mapping of the surgical specimen enhances the accuracy of pathological examination by reducing the risk of overestimate positive margins.
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Affiliation(s)
- P Aluffi Valletti
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - F Taranto
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - A Chiesa
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - F Pia
- Dipartimento di Scienze della Salute, Otorhinolaryngology and Head and Neck Surgery Unit
| | - G Valente
- Dipartimento di Medicina Traslazionale, Laboratory of Pathology, Università del Piemonte Orientale, Novara, Italy
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Relationship of medial versus superior vocal-cord location of T1 squamous cell carcinoma with tumor recurrence. Am J Otolaryngol 2017; 38:316-320. [PMID: 28169008 DOI: 10.1016/j.amjoto.2017.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if the clinical behavior of T1 glottic squamous cell carcinoma varies by its location on the medial free edge or upper aspect of the vocal cords. STUDY DESIGN Retrospective cohort. SETTING Single tertiary university-affiliated medical center. SUBJECTS AND METHODS Clinical, treatment, and outcome data were collected for 104 patients with T1N0M0 glottic squamous cell carcinoma who were treated and followed at our center in 1995-2013. Findings were compared between those with a tumor on the medial (n=60, 57.7%) or superior (n=44, 42.3%) aspect of the cords. RESULTS Mean follow-up time was 4.15years. No between-group differences were found in demographic or risk factors. There was a significant association of anterior commissure involvement with disease recurrence (P=0.0012) and of superior (vs medial) location with higher rates of anterior commissure involvement (P<0.001) and recurrence (P=0.01) and shorter time to recurrence (P<0.001). CONCLUSIONS T1 squamous cell carcinomas on the superior aspect of the vocal cords have a poorer prognosis than medial tumors and should be closely monitored for recurrence.
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Gallet P, Rumeau C, Nguyen DT, Teixeira PA, Baumann C, Toussaint B. "Watchful observation" follow-up scheme after endoscopic CO 2 laser treatment for small glottic carcinomas: A retrospective study of 93 cases. Clin Otolaryngol 2017; 42:1193-1199. [PMID: 28296244 DOI: 10.1111/coa.12863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Evaluate the clinical outcome of patients treated with CO2 laser surgery for early-stage glottic carcinomas followed up with 3-month laryngoscopy regardless of tumor grade and margins. DESIGN Case series. SETTING Retrospective review of the clinical records of patients treated at the ENT department of a tertiary university hospital. PARTICIPANTS AND METHOD Clinical records from patients with early-stage glottic carcinomas (Tis/T2) treated with curative intent by CO2 laser surgery in a ten-year period were evaluated. Regardless of tumor margin status, patients underwent fiber endoscopy 6 weeks after surgery and a systematic second look by direct laryngoscopy under general anesthesia at 3 months. MAIN OUTCOME MEASURES Local control, laryngeal preservation rate. RESULTS Ninety-three patients were included. Disease control was obtained in 90/93 cases. Laryngeal preservation rate was 96.8%. Twenty patients had a local residual disease or recurrence after the first laser surgery, but 17 were salvaged (85%). Local residual disease and recurrence were more frequent in patients with advanced disease (T1b/T2), invasion of anterior commissure and "non-safe" margins. CONCLUSION The proposed follow-up scheme might be a valuable option, but with caution for positive or unevaluable margins as the latter is an independent risk factor for local recurrence. An early laser excision procedure (eg, within the first two months after surgery) or an alternative strategy may be discussed in this situation. "Watchful observation" should be reserved for compliant patients only so that the risk of missing potential recurrences is minimised.
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Affiliation(s)
- P Gallet
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
| | - C Rumeau
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
| | - D T Nguyen
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
| | - P A Teixeira
- University of Lorraine, Nancy, France.,Guilloz Imaging Department, University Hospital, Nancy, France
| | - C Baumann
- University of Lorraine, Nancy, France.,Clinical Epidemiology and Evaluation, University Hospital, Nancy, France
| | - B Toussaint
- Department of ENT and head and neck surgery, University Hospital, Nancy, France.,University of Lorraine, Nancy, France
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Abstract
PURPOSE OF REVIEW To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature. RECENT FINDINGS The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future. SUMMARY TLM for early glottic carcinoma (Tis-T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.
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Affiliation(s)
- E V Sjögren
- Department of ENT and Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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37
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Day AT, Sinha P, Nussenbaum B, Kallogjeri D, Haughey BH. Management of primary T1-T4 glottic squamous cell carcinoma by transoral laser microsurgery. Laryngoscope 2016; 127:597-604. [PMID: 27578610 DOI: 10.1002/lary.26207] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the oncologic outcomes of patients with early and select advanced primary glottic squamous cell carcinoma (SCCa) managed by transoral laser microsurgery (TLM). STUDY DESIGN Retrospective cohort study. METHODS Ninety cases of TLM-managed primary glottic SCCa were identified retrospectively using a prospectively collected database. RESULTS Outcomes of patients with pTis-pT2a disease (n = 65) and pT2b-pT4a disease (n = 25) were, respectively: 5-year local control, 86.2% and 67.5%; 5-year disease-free survival, 64.9% and 44.9%; 5-year disease-specific survival, 96.4% and 59.0%; laryngeal preservation, 96.9% and 80%. Five of nine patients (56%) with supraglottic-glottic-subglottic tumors were local recurrence-free compared to the 70 of 81 (86%) patients with glottic, supraglottic-glottic, and glottic-subglottic tumors. Seven of 13 patients (54%) with positive or indeterminate margins were local recurrence-free compared to 68 of 77 (88%) patients with negative margins. CONCLUSIONS Given sample size considerations, this study highlights the satisfactory oncologic outcomes of TLM-treated glottic cancer and the potential importance of margin management and disease extension within the larynx. LEVEL OF EVIDENCE 4 Laryngoscope, 127:597-604, 2017.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Bruce H Haughey
- Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, U.S.A.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Saini AT, Parasher AK, Kass JI, Altman KW, Miles BA. Intraoral midline mandibulotomy improves laryngeal access for transoral resection of laryngeal cancer. Am J Otolaryngol 2016; 37:95-8. [PMID: 26954859 DOI: 10.1016/j.amjoto.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Intraoral midline mandibulotomy is a technique that can be used to increase exposure for transoral endoscopic laser microsurgery (TLS). We describe the case of a 51 year old male with persistent T1 glottic carcinoma. At initial diagnosis, he had been referred for curative radiotherapy as laryngeal access was not sufficient for TLS. For treatment of his recurrence, we describe the technique of performing a midline mandibular osteotomy to improve access to the larynx allowing for safe and effective transoral endoscopic laser microsurgery. Surgical access to the larynx was greatly improved, and we were able to perform TLS in a case that would have otherwise not been amenable to TLS. An intraoral midline mandibulotomy can improve access to the larynx and allow for successful transoral resection of laryngeal cancer in patients with otherwise inaccessible tumors.
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Shen L, Xu L, Wang Q, Fan GK. Healing process following laser cordectomy of early glottis carcinoma from endoscopic view. Lasers Surg Med 2016; 48:483-9. [PMID: 26900138 DOI: 10.1002/lsm.22492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Transoral laser surgery is useful for treating early glottic carcinoma. Wound areas after carbon dioxide (CO2 ) laser surgery are not covered by flaps, delaying healing. The healing process following laser cordectomy is not well understood. In this study, laryngoscopes were used to monitor the normal healing process after laser cordectomy and to determine if there was residual or recurrent disease. MATERIALS AND METHODS This prospective case study included 36 patients who underwent CO2 laser surgery for early glottis carcinoma between January 2011 and June 2014 at a university tertiary referral center. Postoperative complications, oncologic results, and mucosal stabilization time were analyzed. Vocal fold stabilization was defined as an absence of gross changes during two consecutive follow-up examinations. RESULTS The 3-year overall survival rate was 100% and the 3-year local control rate was 94%. Vocal cord stabilization was observed in 29 patients at a mean 88.1 days, with stabilization associated with the type of cordectomy (P < 0.05). During the wound-healing process, two patients experienced local recurrences. One had a persistent white patch for over 4 months and the other presented with a new mass in a non-operated area. Biopsies of both lesions showed recurrent disease. Postoperative complications included granulation in two patients and anterior commissure adhesion in one. CONCLUSION CO2 laser microsurgery is an effective treatment for early glottis carcinoma. Close attention should be paid to delays in healing process after laser surgery. Interventions should be considered for patients with abnormal laryngoscopic appearance or overly prolonged healing. Lasers Surg. Med. 48:483-489, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lei Shen
- Department of Otolaryngology, 2nd Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lin Xu
- Department of Otolaryngology, 2nd Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Wang
- Department of Otolaryngology, 2nd Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guo-Kang Fan
- Department of Otolaryngology, 2nd Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Chiesa Estomba CM, Reinoso FAB, Velasquez AO, Fernandez JLR, Conde JLF, Hidalgo CS. Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2. Int Arch Otorhinolaryngol 2016; 20:212-7. [PMID: 27413401 PMCID: PMC4942297 DOI: 10.1055/s-0036-1572430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/06/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction
Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected. Objective
The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM. Methods
Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate. Results
The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 ± 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%. Conclusion
TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation.
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Affiliation(s)
| | | | - Alejandra Osorio Velasquez
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Vigo, Vigo, Pontevedra, Spain
| | | | - Jose Luis Fariña Conde
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Vigo, Vigo, Pontevedra, Spain
| | - Carmelo Santidrian Hidalgo
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Vigo, Vigo, Pontevedra, Spain
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Shoffel-Havakuk H, Lahav Y, Davidi ES, Haimovich Y, Hain M, Halperin D. The role of separate margins sampling in endoscopic laser surgery for early glottic cancer. Acta Otolaryngol 2016; 136:491-6. [PMID: 26817681 DOI: 10.3109/00016489.2015.1132843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Sampling surgical margins in trans-oral laser microsurgery for early glottic squamous cell carcinoma (SCC) may allow for increased local control rate, although with no difference in local control by endoscopic treatment alone. OBJECTIVE To further delineate the role of routinely sampling separate surgical margins, in patients with early glottic SCC undergoing endoscopic laser resection. METHODS A retrospective case control study. One hundres and two early glottic cancer patients staged Tis-T2 underwent endoscopic laser surgery with curative intent as the primary treatment. Separate margins from the surgical bed were sampled following complete tumor resection in 64 patients; in 38 patients no margins were sampled. RESULTS Margin sampling showed a tendency towards reduced risk for local recurrence, adjusted HR = 0.439 (p-value = 0.096). However, there was no difference in local control by endoscopic treatment alone. The patients with sampled margins were further divided based on margins' status: 39 (61%) had negative margins, and 25 (39%) had positive margins. Compared with negative margins, patients with positive margins showed increased risk for recurrence, adjusted HR = 8.492 (p = 0.008). When margins were not sampled the risk for local recurrence was increased compared to negative margins (adjusted HR = 7.875, p-value = 0.008), and relatively comparable to what was observed when sampled margins were positive (adjusted HR = 0.927, p-value = 0.88).
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Affiliation(s)
- Hagit Shoffel-Havakuk
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
- b The Hebrew University, Hadassah Medical School , Jerusalem , Israel
| | - Yonatan Lahav
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
- b The Hebrew University, Hadassah Medical School , Jerusalem , Israel
| | - Erez Shmuel Davidi
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
| | - Yaara Haimovich
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
| | - Moshe Hain
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
| | - Doron Halperin
- a The Department of Otolaryngology Head and Neck Surgery , Kaplan Medical Center , Rehovot , Israel
- b The Hebrew University, Hadassah Medical School , Jerusalem , Israel
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Dysphagia and Head and Neck Cancer. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D. Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy. Laryngoscope 2015; 126:1817-22. [DOI: 10.1002/lary.25757] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/16/2015] [Accepted: 10/02/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Babak Sadoughi
- The Sean Parker Institute for the Voice; Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
| | - Cécile Badoual
- Department of Pathology; Hôpital Européen Georges Pompidou; Paris France
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Longitudinal Voice Outcomes Following Advanced CO2 Laser Cordectomy for Glottic Cancer. J Voice 2015; 29:772-5. [DOI: 10.1016/j.jvoice.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
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Hoffmann C, Hans S, Sadoughi B, Brasnu D. Identifying outcome predictors of transoral laser cordectomy for early glottic cancer. Head Neck 2015; 38 Suppl 1:E406-11. [DOI: 10.1002/hed.24007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Caroline Hoffmann
- Department of Otolaryngology-Head and Neck Surgery; Hôpital Européen Georges Pompidou; Paris France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery; Hôpital Européen Georges Pompidou; Paris France
| | - Babak Sadoughi
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Beth Israel; New York NY
| | - Daniel Brasnu
- Department of Otolaryngology-Head and Neck Surgery; Hôpital Européen Georges Pompidou; Paris France
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Hartl DM, Brasnu DF. Contemporary Surgical Management of Early Glottic Cancer. Otolaryngol Clin North Am 2015; 48:611-25. [DOI: 10.1016/j.otc.2015.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Berania I, Dagenais C, Moubayed SP, Ayad T, Olivier MJ, Guertin L, Bissada E, Tabet JC, Christopoulos A. Voice and Functional Outcomes of Transoral Laser Microsurgery for Early Glottic Cancer: Ventricular Fold Resection as a Surrogate. J Clin Med Res 2015; 7:632-6. [PMID: 26124910 PMCID: PMC4471751 DOI: 10.14740/jocmr2216w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2015] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the study was to evaluate the oncological and functional outcomes with transoral laser microsurgery (TOLM) of patients with early glottic cancer. Methods We have prospectively evaluated patients treated with TOLM for Tis, T1 or T2 glottic squamous cell carcinoma. Evaluation of oncological outcomes, and voice and functional outcomes was assessed using voice-handicap index 10 (VHI-10) and performance status scale for head & neck cancer patients (PSS-H&N). Predictors of poor voice quality were evaluated using Student’s t-test. Results Thirty patients were included, with 17.7 months mean follow-up. There were no cases of locoregional recurrence. Twelve patients (40%) were considered as having a problematic voice outcome. Four subjects out of 30 (13.3%) had significant problems with understandability of speech. Significant differences (P < 0.05) in VHI-10 score were found with tumor stage and partial resection of the ventricular fold. Conclusions We report excellent oncological and functional outcomes in early glottic cancer treated with TOLM, with advanced tumors and partial resection of the ventricular fold as a surrogate predicting worse voice outcomes.
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Affiliation(s)
- Ilyes Berania
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Christophe Dagenais
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Tareck Ayad
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Marie-Jo Olivier
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Jean-Claude Tabet
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
| | - Apostolos Christopoulos
- Otolaryngology-Head and Neck Surgery Service, Universite de Montreal Hospital Center (CHUM), Montreal, Canada
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Mau T, Palaparthi A, Riede T, Titze IR. Effect of resection depth of early glottic cancer on vocal outcome: an optimized finite element simulation. Laryngoscope 2015; 125:1892-9. [PMID: 26010240 DOI: 10.1002/lary.25267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament. STUDY DESIGN Computer simulation. METHODS A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0 ) and sound pressure level (SPL). A more restricted F0 -SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing. RESULTS Subligamental cordectomy generated solutions covering an F0 -SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0 -SPL ranges, 57% and 19% of normal, respectively. CONCLUSION This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anil Palaparthi
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah
| | - Tobias Riede
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah.,Department of Physiology, Midwestern University, Glendale, Arizona
| | - Ingo R Titze
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa, U.S.A
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Clinical significance of granulation tissue after transoral laser microsurgery for glottic cancer. The Journal of Laryngology & Otology 2015; 129:377-82. [DOI: 10.1017/s0022215115000444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Granulation tissue after transoral laser microsurgery can make it difficult to distinguish between normal healing and tumour recurrence.Materials and methods:We carried out a retrospective analysis of 316 consecutive glottic carcinomas (Tis–T3). Presence of granulation tissue at one and six months was correlated with demographic and clinical data, tumour and surgical characteristics, and tumour relapse.Results:Granulation tissue appeared in 53.8 per cent of patients at month 1, resolving spontaneously in 41.8 per cent. Revision surgery was performed in 60.1 per cent and was effective in 41.1 per cent. At month 6, 14.9 per cent of patients presented with granulation tissue. In 74.5 per cent the tissue was surgically removed and was positive for malignancy in 62.9 per cent. Tumour relapse presented in 29.4 per cent with granulation tissue at month 1 and in 61.7 per cent at month 6 (p= 0.000). Granulation tissue at month 1 correlated with thyroid cartilage exposure and continued smoking. At month 6, granulation tissue correlated with thyroid cartilage exposure, the affected surgical margins and diabetes.Conclusion:Granulation tissue after transoral laser microsurgery is frequent. When it persists at six months, revision surgery is formally recommended.
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