Is There a Change in the Treatment of T1 Glottic Cancer After CO2 Laser? A Comparative Study with Cold Steel

CO2 LASER versus Blade Scalpel Surgery in the Management of Nasopharyngeal Masses in Dogs

We aimed to compare surgical time, bleeding level, patient pain level, healing period, scar tissue, relapse of the initial process and complications in patients with nasopharyngeal oncological masses undergoing surgery using a scalpel blade versus a CO2 surgical laser. This is a clinical prospective study comprising surgical work in the nasopharynx area. A sample of 12 inpatients dogs (N = 12) of both genders underwent a surgical excision of nasopharyngeal masses with a scalpel blade (GS n = 6) and CO2 surgical laser (GL n = 6). An Aesculigth CO2 surgical laser-Vetscalpel® model with a superpulse mode, 12 W of power, and a multi-focus pen was used. Statistically significant differences were registered for a p-value of < 0.05. Variations were noted between both groups (GS and GL) concerning surgery time (p = 0.038), first meal time (p = 0.013), pain level (p = 0.003), and healing time (p = 0.014), with the GL group presenting lower values. GL exhibited only one relapse case, with the elapsed time being more than double that of the GS group. Surgical and healing times were shorter in the GL group, and pain levels were lower, with the GL group also demonstrating less scar tissue than the GS group, along with a lower relapse rate. Nasopharynx surgical exposure with precision via the soft palate using the CO2 laser has facilitated successful treatment of regional masses without discomfort and complications, compared to conventional blade scalpel procedures.

A Retrospective Study to Assess the Accuracy of Frozen Sections in Laser Laryngeal Surgery

OBJECTIVE

The basis of good vocal outcomes following Transoral Laser Microlaryngeal Cordectomy (TLMC) is the narrow margin that is oncologically accepted for the glottis. Our objective is to evaluate the reliability of frozen section (FS) compared to paraffin section (PS) during TLMC and during laser laryngeal surgery when an incisonal or excisional biopsy is being performed.

METHODS

Retrospectively, records of 159 sequential patients who underwent CO₂ laser laryngeal surgery with intraoperative FS were reviewed along with the final PS. Group A patients were TLMC patients where FS was utilized for free margin confirmation (42 specimens) and Group B patients were those in whom FS was performed for primary diagnosis (122 specimens).

RESULTS

A total of 164 samples were included where specimens submitted for FS were also processed for PS. Concordance was observed in 156 samples, discordance in 8, with 4 cases belonging to each group. FS was reported as false negative in 5 and false positive in 3 cases. In Group A where FS was utilized for free margin confirmation, the sensitivity was found to be 60%, specificity and positive predictive value (PPV) 100%, and negative predictive value (NPV) 88.9%. In Group B where FS was performed for primary diagnosis, the sensitivity was found to be 98.4%, specificity 95.1%, PPV 95.2%, and NPV 98.3%.

CONCLUSION

A 100% PPV of FS in group A suggests that positive FS margins during TLMC may be safely relied upon in making decisions to upgrade the type of cordectomy being performed. A NPV of 88.9% in group A suggests that despite a clear frozen margin report during TLMC, 11.1% of patients would need further treatment. A PPV of 95.2% in group B suggests that although FS analysis is important for guiding further management, decisions regarding major laryngeal surgery should not be undertaken based solely on FS.

Prognosis and Outcomes in Early Stage Glottic Carcinoma Involving the Anterior Commissure Treated with Laser CO2 Surgery: A Retrospective Observational Analysis

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.

Prognostic comparison of transoral laser microsurgery for early glottic cancer with or without anterior commissure involvement: A meta-analysis

OBJECTIVES

Transoral laser microsurgery (TLM) has gradually gained approval in the treatment of early glottic cancer. However, the oncological outcomes of TLM for glottic cancer with anterior commissure (AC) involvement are still a controversial topic. We aimed to systematically review the literature on glottic cancer (Tis-T2) with patients who received TLM as first choice therapy and to evaluate several prognostic outcomes in patients with or without AC involvement.

METHODS

A systematic literature retrieval was conducted in PubMed, Medline (Ovid) and Web of Science. Risk ratio (RR) between AC involvement (AC+) or without AC involvement (AC-) was assessed and 95% confidence interval(95%CI) was calculated, which was performed on RevMan 5.3.

RESULTS

A total of 20 literatures were included when comparing the local recurrence (LR) rate of patients with or without AC involvement, and the results suggested LR matters in group AC+ over group AC- (RR = 2.39, 95%CI = 1.99-2.86, p < 0.00001). The 5-year overall survival(5yOS) rate included 10 studies, and there was no significant difference between AC+ and AC- (RR = 0.98, 95%CI = 0.93-1.02, p = 0.35). The laryngeal preservation rate (LPR) of AC+ was lower than that of AC- (RR = 0.97, 95%CI = 0.94-1.00, p = 0.04).

CONCLUSION

The results indicate that the prognosis of early glottic cancer with AC involvement is more likely to have higher local recurrence and lower LPR but no statistical difference in 5yOS rate.

Oncological and Surgical Outcomes of Patients Treated by Transoral CO2 Laser Cordectomy for Early-Stage Glottic Squamous Cell Carcinoma: A Retrospective Chart Review

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.