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Reconstructive frontal anterior laryngectomy (RFAL) is a partial laryngeal surgery technique for resecting early-stage (T1-T2) glottic squamous cell carcinoma. Indications comprise a lesion of the anterior commissure of the larynx that cannot be adequately exposed by endoscopy, and cases in which radiotherapy is refused or contraindicated. The initial RFAL technique included epiglottoplasty. Here we propose a technique without epiglottoplasty, with the advantage of avoiding need for tracheotomy in most cases. After the first stage of surgical excision, reconstruction consists in placing a vertical brace transepiglottically and below the cricoid. The epiglottis is thus left at its original height and secured in place to prevent flapping in the pharyngolaryngeal lumen. Transverse bracing is then performed through the thyroid wings: one of the key points of this surgery is to control tension to avoid risk of stenosis. The subhyoid muscles are sutured together to achieve satisfactory sealing. This technique offers satisfying functional results and oncological control. The most frequent complications are (1) secondary tracheotomy, which can be avoided by selecting patients who require a primary tracheotomy and optimizing the seal, and (2) stenosis, which can be limited by not bringing the cartilaginous structures too close together during bracing.
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BACKGROUND: Dysphagia is a prevalent complication following partial laryngectomy. We aimed to introduce a novel bedside evaluation tool, the modified Gugging Swallowing Screen (GUSS), and evaluate its reliability and validity in patients with open partial laryngectomy before oral feeding. METHODS: We conducted a retrospective analysis of 120 patients with laryngeal cancer, including 40 hospitalized patients who underwent open partial laryngectomy. On the same day before oral feeding, we performed the modified GUSS, videofluoroscopic swallowing study (VFSS), and fiberoptic endoscopic evaluation of swallowing (FEES) to evaluate swallowing function. Two independent trained nurses assessed all patients for interrater reliability of modified GUSS. We compared the results of the modified GUSS with VFSS for predictive validity, and VFSS results for solid, semisolid, and liquid intake for content validity. RESULTS: The results of VFSS and FEES showed a strong correlation and consistency (rs = 0.952, p < 0.01; κ = 0.800 to 1.000, p < 0.01). The modified GUSS exhibited substantial to excellent interrater reliability across all classification categories (rs = 0.961, p < 0.01; κ = 0.600 to 1.000, p < 0.01) and demonstrated excellent consistency and predictive validity compared to VFSS (rs = -0.931, p < 0.01; κ = 0.800 to 1.000, p < 0.01). Content validity revealed that the risk of aspiration during solid intake was lower than that during semisolid intake (p < 0.01), and the risk of aspiration during semisolid intake was lower than that during liquid intake (p < 0.01), therefore confirming the subtest sequence of the modified GUSS. CONCLUSIONS: We successfully modified GUSS for patients with open partial laryngectomy. Moreover, the new bedside screening tool was validated as an effective tool for evaluating swallowing function and the risk of aspiration in patients with open partial laryngectomy before oral feeding.
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Trastornos de Deglución , Deglución , Humanos , Estudios Retrospectivos , Laringectomía/efectos adversos , Laringectomía/métodos , Reproducibilidad de los Resultados , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiologíaRESUMEN
BACKGROUND: For recurrent laryngeal cancer, the feasibility of salvage transoral laser microsurgery (TLM) remains controversial. This study compared the efficacy of TLM and open partial laryngectomy (OPL) for treatment of early local recurrence of glottic squamous cell cancer (GSCC) and confirm the effectiveness of salvage TLM as a treatment option. METHODS: This retrospective study involved 55 patients with early local recurrent GSCC treated with TLM, and the oncologic outcomes, functional outcomes, hospitalization time and complications were compared with a group of 40 recurrent GSCC patients matched for clinical variables of TLM group, treated by OPL by the same team of surgeons. RESULTS: The 5-year overall survival and disease-specific survival rates were 65.8% and 91.5%, respectively, for 55 patients with rTis-rT2 stage treated by TLM and 77.1% and 94.7%, respectively, for 40 patients with rTis-rT2 stage treated by OPL (OPL group). In the TLM and OPL groups, the local control rates after 5 years were 77.5% and 79.3%, respectively, and the laryngeal preservation rates were 94.4% and 83.6%, respectively (p > 0.05). Compared with the OPL group, the complication rate (1.82%) and hospitalization duration (5.42 ± 2.26 days) were significantly lower in the TLM group (p < 0.05). Compared with the OPL group, postsurgical health-related quality of life and quality of voice were significantly better in the TLM group (p < 0.001). CONCLUSION: Salvage TLM can be used as an effective treatment option for suitable patients after a full, comprehensive, and careful assessment of the characteristics of early locally recurrent glottic carcinoma.
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Neoplasias de Cabeza y Cuello , Neoplasias Laríngeas , Terapia por Láser , Neoplasias de Células Escamosas , Humanos , Estudios Retrospectivos , Microcirugia , Calidad de Vida , Recurrencia Local de Neoplasia/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Resultado del Tratamiento , Neoplasias Laríngeas/patología , Glotis/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Células Escamosas/patología , Neoplasias de Células Escamosas/cirugía , Rayos Láser , Estadificación de NeoplasiasRESUMEN
OBJECTIVE: To evaluate the effect of surgical procedures (transoral laser microsurgery (TLM) and open partial laryngectomy (OPL)) on the prognosis of patients with early laryngeal cancer. METHODS: A total of 760 patients diagnosed with early laryngeal cancer (T1-2N0M0) and treated with TLM (n = 416) or OPL (n = 344) between 2004 and 2015 were abstracted from the SEER database. Propensity score matching (PSM) and stabilized inverse probability of treatment weighting (SIPTW) were performed to obtain comparable cohorts. The survival rates were estimated by the Kaplan-Meier method, and compared using the log-rank test. Univariate and multivariate Cox regression analyses with a false discovery rate (FDR) correction were applied to contrast the association between two surgical approaches and overall survival (OS) and disease-specific survival (DSS). RESULTS: The 5-year OS for the TLM group was 79.5% versus 77.7% for the OPL group (P = 0.619). Similar results were revealed for the comparison of 5-year DSS rates (91.1% versus 91.5%, P = 0.891). After PSM and SIPTW balance the confounding factors, no significant difference was observed in the OS and DSS of patients treated with TLM compared to patients treated with OPL. The consistent results were still yielded (all P > 0.05), when stratified by gender, age, year of diagnosis, residence, household income, tumor site, T stage, differentiation, and adjuvant therapy. CONCLUSION: This study provides strong evidence that there is no significant difference in the prognosis of early laryngeal carcinoma between the treatment of TLM and OPL, which may be helpful to guide the clinical decision-making of these patients.
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Carcinoma , Neoplasias Laríngeas , Terapia por Láser , Humanos , Neoplasias Laríngeas/patología , Microcirugia/métodos , Laringectomía/métodos , Puntaje de Propensión , Estudios Retrospectivos , Pronóstico , Terapia por Láser/métodos , Carcinoma/patología , Rayos Láser , Estadificación de Neoplasias , Glotis/cirugíaRESUMEN
The first aim was to define the oncologic outcomes of open partial laryngectomy (OPL) in naïve pT3 laryngeal cancer. The second aim was to analyze the outcomes after OPL versus total laryngectomy (TL). A literature search was conducted in three databases (MEDLINE, EMBASE, and Cochrane Library) until January 2022. In 805 patients treated with OPL, 5-year OS, DSS, DFS and LFS were 80.5% (95% CI 70.6-87.6), 83.4% (95% CI 75.7-89), 77.4% (95% CI 66.3-85.7) and 77.9% (95% CI 68.7-85), respectively. Three articles compared TL versus OLP: 5-year OS, DSS and DFS risk difference were 0.100 (95% CI -0.092 to 0.291), 0.067 (95% CI -0.085 to 0.220) and 0.018 (95% CI -0.164 to 0.201) respectively. OPL for selected pT3 laryngeal cancer is able to guarantee a high percentage of oncological success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery.
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Neoplasias Laríngeas , Humanos , Manejo de Datos , Neoplasias Laríngeas/cirugía , Laringectomía , Selección de Paciente , Estudios RetrospectivosRESUMEN
Objective·To compare the effects and complications of carbon dioxide laser laryngectomy and open partial laryngectomy in the treatment of laryngeal carcinoma.Methods·Clinical data of 101 patients with stage Ⅰ-Ⅲ laryngeal squamous cell carcinoma admitted to Renji Hospital,Shanghai Jiao Tong University School of Medicine from January 2013 to January 2018 were selected and divided into open surgery group and minimally invasive group according to different surgical methods.The open surgery group received open partial laryngectomy(57 cases),and the minimally invasive group received carbon dioxide laser laryngectomy(44 cases).Follow-up visits were made by telephone and outpatient visits,and the operation time,postoperative laryngeal mucosa edema time,length of stay,5-year survival rate,complication rate and recurrence rate of the two groups were compared in the different clinical stages(stage Ⅰ,stage Ⅱ,and stage Ⅲ)and tumor locations(glottic type and non-glottic type).Results·The operation time,postoperative laryngeal mucosa edema time and length of stay of the minimally invasive group were shorter than those of the open surgery group(P＜0.05).Comparison of the 5-year survival rates of patients with the same clinical stage and glottic type between the two groups showed no statistically significant difference(both P＞0.05);while comparison of the 5-year survival rates of patients with non-glottic type between the two groups(62.5％in the open surgery group vs 0 in the minimally invasive group)showed a statistically significant difference(P＜0.05).In the minimally invasive group,there were 3 cases of complications,including 1 case of fever and 2 cases of lung infection;in the open surgery group,there were 14 cases of complications,including 5 cases of fever,7 cases of lung infection and 2 cases of pharyngeal fistula.The complication rate of patients in the minimally invasive group(6.82％,3/44)was lower than that in the open surgery group(24.60％,14/57),and the difference was statistically significant(P＜0.05);the complication rate of patients with stage Ⅱ and glottic type in the minimally invasive group was significantly lower than that in the open surgery group(P＜0.05).Comparing the recurrence rate of patients in the two groups(10.53％in the open surgery group vs 2.27％in the minimally invasive group),the difference was not statistically significant(P＞0.05).Conclusion·Compared with open partial laryngectomy,carbon dioxide laser laryngectomy has faster postoperative recovery and lower complication rate in the treatment of early and middle laryngeal malignant tumors,so it is worth promoting.
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OBJECTIVE: The purpose of this study was to investigate the effects of hyaluronic acid injection on dysphagia, aspiration, and voice problems in patients with persistent functional problems despite appropriate rehabilitation after partial laryngectomy. METHODS: Seventeen patients who underwent hyaluronic acid injection due to persistent swallowing, aspiration, and voice problems after partial laryngectomy surgery were included in the study. The hyaluronic acid injection was performed after 2 years of follow-up after partial laryngectomy surgery. Evaluation of swallowing was performed through a fiberoptic endoscopic evaluation of swallowing and was quantified using two scales: a dysphagia score and a modified penetration-aspiration scale. Voice Handicap Index-10 was used for the determination of the psychosocial handicapping effects of the voice. Jitter percent, shimmer percent, fundamental frequency, harmonics-to-noise ratio, and maximum phonation time were evaluated for the acoustic analysis of the voice. All measurements were performed at preoperative day and postoperative months 1, 6, and 24. RESULTS: A statistically significant improvement was observed for all of the evaluated parameters except the harmonics-to-noise ratio for postoperative months 1 and 6 (P < 0.05). There was no statistically significant difference between the postoperative sixth month and the preoperative value of the harmonics-to-noise ratio. A statistically significant improvement was observed between the postoperative 24th month and preoperatively for jitter percent, shimmer percent, fundamental frequency, maximum phonation time, dysphagia, and penetration aspiration score (P < 0.05). CONCLUSION: Surgical rehabilitation should be considered along with conservative treatments to improve swallowing and voice function after partial laryngectomy. Hyaluronic acid injection may be an effective method both in the short and long term for the surgical rehabilitation of persisting functional problems that may occur following partial laryngectomies.
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Trastornos de Deglución , Neoplasias Laríngeas , Trastornos de la Voz , Deglución , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Humanos , Ácido Hialurónico/efectos adversos , Neoplasias Laríngeas/cirugía , Laringectomía/efectos adversos , Laringectomía/métodos , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiologíaRESUMEN
BACKGROUND: This study aims to investigate the clinical efficacy of transoral laser microsurgery and open partial laryngectomy (OPL) in treating T1-2 laryngeal cancer. METHODS: A retrospective analysis was conducted of 182 patients with T1-2 cancer with anterior vocal commissure (AVC) involvement. The local control (LC), disease-free survival (DFS) and overall survival (OS) rates at 5-year follow-up and the influencing factors were analyzed. RESULTS: No significant difference was observed in the LC or DFS rates between the two groups at 3- and 5-year follow-up. No significant difference was found between the two groups with T1-stage disease. The 5-year LC rates were significantly different from patients with grade 3 or 4 tumors on indirect laryngoscopy and patients with class III or IV tumors on the modified Mallampati test (MMT) (log-rank test: χ2=8.037, P=0.005). The 3-year LC rate of OPL in the depth of pathological infiltration (3-5 mm) group was found to be significantly higher than that of TLM. Significant differences in pathological infiltration depth (3-5 mm) existed between the two groups (log-rank test: χ2=5.786, P=0.016). CONCLUSIONS: T1 lesions are generally limited and superficial, and laser surgery can be well-controlled. For patients with difficult airway exposure, surgeons should have extensive surgical experience and skills. It is recommended that a variety of equipment should be ready so that surgeons can convert to open surgery at any time. For patients with a deep infiltration depth, surgeons should examine laryngoscopy imaging results before surgery.
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OBJECTIVES: To develop and validate an ex-vivo dissection model suitable for open laryngeal surgery (open partial laryngectomy and total laryngectomy) training. METHODS: A fresh ex-vivo 6-months old ovine model was tested by experienced laryngologists and validated during two international dissection courses on open laryngeal surgery held in December 2018 and 2019. Each participant completed a survey to subjectively evaluate the dissection experience. Likewise, four experienced laryngologists rated their experience. Statistical comparison of these ratings was performed. RESULTS: The suitability of the ex-vivo ovine model for open laryngeal surgery was assessed among 28 head and neck surgeons with a mean experience of 6.3 years and 4 expert laryngologists. The feedback from all the participants was excellent with a mean overall impression of 9.5 (± 0.7 SD) and a mean recommendation score of 9.6 (± 0.6 SD) for further use. No statistically significant differences were found comparing neither the overall grade (p= 0.63) nor the recommendation rating (p= 0.24), testifying that even for expert laryngologists this remains a viable model for open laryngeal surgery training. CONCLUSIONS: The complexity of open laryngeal surgery makes simulation an attractive option for developing skills that are transferrable to operating setting. Due to the anatomic resemblance with the human, the ex-vivo ovine model is herein proposed as a training model for open laryngeal surgery. Validation among beginners and expert laryngologists revealed its suitability as effective teaching means in laryngectomies.
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Laringectomía/educación , Laringe/cirugía , Animales , Actitud del Personal de Salud , Neoplasias Laríngeas/cirugía , Modelos Animales , Otolaringología/educación , Ovinos , Entrenamiento SimuladoRESUMEN
INTRODUCTION: The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO2 transoral laser microsurgery [CO2 TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL). METHODS: A systematic search was performed using the MEDLINE database, Scopus, and Google scholar. The inclusion criteria were studies of patients with T2N0 glottic tumor, treated with either primary CO2 TOLMS, definitive curative RT, or primary OPL, and with reported oncological outcome at 5 years calculated with a Kaplan-Meier or Cox regression method. RESULTS: The results of the current review show that local control (LC) is higher with OPL 94.4%, while there are no differences in LC at 5-year posttreatment for patients treated with RT, compared to those treated with CO2 TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO2 TOLMS results in higher laryngeal preservation than primary treatment with RT (respectively 95.8%, 86.9%, and 82.4%). CONCLUSION: First-line treatment with OPL and CO2 TOLMS should be encouraged in selected T2 patients, because it results in higher laryngeal preservation and similar LC compared to primary treatment with RT. The involvement of the anterior commissure in the craniocaudal plane and T2b impaired vocal cord mobility have a poorer prognosis and LC compared to patients with T2a tumors for both CO2 TOLMS and RT.
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Carcinoma/terapia , Neoplasias Laríngeas/terapia , Laringectomía/mortalidad , Terapia por Láser/mortalidad , Microcirugia/mortalidad , Radioterapia/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/mortalidad , Carcinoma/patología , Supervivencia sin Enfermedad , Femenino , Glotis/efectos de la radiación , Glotis/cirugía , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Laringectomía/métodos , Laringe/efectos de la radiación , Laringe/cirugía , Terapia por Láser/métodos , Láseres de Gas/uso terapéutico , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Radioterapia/métodos , Resultado del Tratamiento , Pliegues Vocales/efectos de la radiación , Pliegues Vocales/cirugíaRESUMEN
Conservation laryngectomy has gained considerable acceptance as a means of enhancing overall long-term function preservation in the management of glottic cancers. This study aims to evaluate the oncological and functional outcomes of conservation surgery for carcinoma of the glottis. Fifty consecutive conservation laryngectomies from January 2010 to December 2018 were studied. Glottic cancers of stages I to IVa were carefully selected both in the primary and salvage settings after a consensus from the multidisciplinary tumour board (MDT). Oncological outcomes in terms of overall survival and disease-free survival were measured, and the long-term functional outcomes of voice and swallowing were evaluated using the GRBAS vocal scale and SWAL-QOL questionnaire. The median follow-up period was 63.4 months. The overall 5-year survival probability was 98% (standard error 2.2%), while median disease-free survival was 23 months. The median GRBAS scores in the open and transoral laser microsurgery (TOLMS) group were 1.828 and 1.428, respectively. The median SWAL-QOL scores in majority of quality of life domains were in the mild or no disease impact zone (71-100). Conservative laryngeal surgery plays a crucial role in the treatment of glottic cancers in all stages. It is oncologically safe, and the functional outcomes are favourable.
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A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter- and intra-rater agreement was assessed using unweighted Cohen's kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter- and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.
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Endoscopía del Sistema Digestivo/estadística & datos numéricos , Tecnología de Fibra Óptica/estadística & datos numéricos , Complicaciones Posoperatorias/diagnóstico , Aspiración Respiratoria/diagnóstico , Evaluación de Síntomas/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Deglución , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Endoscopía del Sistema Digestivo/métodos , Femenino , Tecnología de Fibra Óptica/métodos , Humanos , Laringectomía/efectos adversos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Aspiración Respiratoria/etiología , Evaluación de Síntomas/métodosRESUMEN
BACKGROUND: The application of CO2 fiber laser technology to ENT surgery has led to new interesting scenarios, both in endoscopic and in open surgical approaches. METHODS: The current video shows three examples of open partial horizontal laryngectomies (OPHLs) performed using CO2 fiber laser for resection procedures. RESULTS: CO2 fiber laser helped the surgeon in improving the accuracy of resection and the quality of surgical margins on specimen. The low thermal damage on tissues resulted in minor postoperative edema and a fast recovery of laryngeal function. CONCLUSIONS: In our experience, the application of CO2 fiber laser showed some very useful features for performing OPHLs: a high cutting precision with very low tissue damage, the possibility of delivering energy without touching the organ, a modulable power for the various surgical steps, a very good maneuverability of the fine fiber holder during the procedure allowing the surgeon to "draw" the resection with a great accuracy.
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Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Laringe/cirugía , Láseres de Gas/uso terapéutico , Dióxido de Carbono , HumanosRESUMEN
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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Neoplasias Laríngeas/terapia , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/rehabilitación , Laringectomía , Terapia por Láser , Microcirugia , Disección del Cuello , Estadificación de Neoplasias , Selección de Paciente , Calidad de Vida , Terapia RecuperativaRESUMEN
PURPOSE: The objective of the current systematic review with meta-analysis was to report the pooled survival outcomes of supracricoid partial laryngectomy in the setting of radiorecurrent laryngeal cancer to investigate if and when an organ-sparing surgical treatment is adequate. METHODS: The search included all original papers from 1990 to December 2017. The search terms included the following: cricohyoepiglottopexy; cricohyoidopexy; cricohyopexy; horizontal laryngectomy; and partial, subtotal, supracricoid, and supraglottic laryngectomy. Inclusion criteria were as follows: (1) data clearly distinguish results of partial laryngeal procedures; (2) clear description of tumor stage and selection criteria; (3) clear description or derivability of local control and survival rates. RESULTS: Eleven out of 270 papers were analyzed, and a total of 251 cases were included. Two-year LC, 3-year DFS, and 5-year OS were 92, 80, and 79%, respectively. Heterogenicity evaluated with the I2 parameter was 14, 0, 0%, respectively. The larynx preservation rate was 85.2%, the decannulation rate was 92.1%, and swallowing recovery was 96.5% (PEG dependence and the aspiration pneumonia rate were 3.5 and 6.4%, respectively). CONCLUSIONS: SCPL is oncologically sound, guaranteeing a high percentage of success. The homogeneity of data should encourage the use of SCPL as salvage treatment for recurrent LSCC.
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Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Laringectomía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Cartílago Cricoides/patología , Cartílago Cricoides/cirugía , Humanos , Neoplasias Laríngeas/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Terapia Recuperativa , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Several studies have previously analyzed the relationship between QOL and signs of dysphagia in patients treated for head and neck cancer and have reported heterogeneous findings. To the best of our knowledge, no study has previously investigated this relationship among patients who underwent open partial horizontal laryngectomy (OPHL). The aim of the study is to determine if patient-reported swallowing-related QOL can discriminate between safe and unsafe swallowing in OPHL patients. METHODS: 92 type I, type II, and type III OPHL patients at least 6 months postoperatively were recruited. Fiberoptic endoscopic evaluation of swallowing (FEES) was conducted using liquids, semisolids, and solids. FEES recordings were assessed through the penetration-aspiration scale, the pooling score and the dysphagia outcome and severity scale. All patients completed the MD Anderson dysphagia inventory (MDADI). Kruskal-Wallis test and post-hoc Mann Whitney U test were performed to compare MDADI scores among different level of airway invasion, post-swallow pharyngeal residue's degree and overall dysphagia severity. ROC curves were generated to determine diagnostic accuracy of the MDADI. RESULTS: Statistically significant differences in MDADI scores were found between level of airway invasion with semisolids and solids, degree of pharyngeal residue with solids, and severity of dysphagia. MDADI showed significant diagnostic accuracy only in the detection of moderate/severe pharyngeal residue and severe dysphagia; however, sensitivity and specificity were low. CONCLUSIONS: Investigating patients' perception of swallowing impairment and swallowing-related QOL is not sufficient to discriminate safe and unsafe swallowing in OPHL patients.
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Trastornos de Deglución , Deglución/fisiología , Endoscopía/métodos , Laringectomía , Complicaciones Posoperatorias , Calidad de Vida , Adulto , Anciano , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Laringectomía/efectos adversos , Laringectomía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/psicología , Periodo Posoperatorio , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: The aim of the study was to estimate usability of the piezoelectric knife in larynx surgery. Prove that the piezoelectric staff can be used to do any different shape incision within the larynx cartilages. MATERIAL AND METHODS: 35 patients hospitalized in our Department in 2014-2016 were enrolled in our study. 24 patients went vertical partial laryngectomy and 1 patient went horizontal partial laryngectomy because of larynx cancer. 5 patients went partial laryngectomy because of low stage of piriformis recess cancer. Piezoelectric staff was used to do thyroidectomy and resection of thyroid cartilage suspected of carcinomatosis infiltration. The rest 4 patients had done widening of larynx lumen due to larynx stenosis or slenderness. The piezoelectric tool was used to do different incision or resection within the larynx cartilages in case of widening lumen of the larynx. RESULTS: The larynx cartilages, especially thyroid cartilage could be cut in different shapes using piezoelectric tools. The usage of this equipment causes the minimal loss and small destruction of local healthy tissues. CONCLUSIONS: The Piezoelectric instrument is useful instrument suit to operate within larynx cartilages. Exchangeable tip available in different shapes enables different resections of cartilages. Using the piezoelectric staff we can remove pathological tissue with minimal local destruction. Our observation shows that larynx operation with a usage of the piezoelectric knife is safe and effective. Current English literature does not describe usage piezoelectric tools in larynx surgery. It is essential to do more observation about that type of operations.
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Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Laringe/cirugía , Piezocirugía/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
T1a and T1b glottic squamous cell carcinoma (SCC) are often analyzed together by authors who investigate the oncologic outcomes achieved after different therapeutic options. Nevertheless, T1b definitely represents a more advanced tumor stage compared to T1a glottic SCC. The objective of this review was first to analyze the overall success rates in the treatment of patients affected by T1b glottic SCC. Moreover, a subgroup analysis was planned to specifically compare the outcomes obtained with radiotherapy (RT), transoral laser microsurgery (TLM) and open partial laryngectomies (OPL). An electronic library search of the relevant English literature was performed. Potentially eligible articles were reviewed. Qualified articles were selected and evaluated. Fifty-two studies comprising 2360 patients were included. The overall rate of disease-free survival (DFS) was 85% (95% CI 83-87). The overall rate of overall survival was 85% (95% CI 80-88) while the rate of disease-specific survival (DSS) was found to be 96% (95% CI 90-98). Statistical data concerning outcomes for each therapeutic modality showed an higher DFS rate for subjects treated with RT and OPL, respectively, 87% (95% CI 0.85-0.89) and 83% (95% CI 0.78-0.89), when compared to those who underwent TLM 77% (95% CI 0.69-0.83). In conclusion, our results showed a high level of overall DSS (96%) for patients affected by T1b glottic SCC. Regarding the specific therapeutic options, our subgroup analysis showed as patients treated with TLM present a higher rate of oncological recurrence in comparison to those who underwent RT or OPL. Nevertheless, on the basis of our data it was also noted that no significant differences subsist in terms of survival rates among the three different treatments. Moreover, the absence of a comparative analysis useful to confirm these conclusions must be considered.
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Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Glotis/cirugía , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Carcinoma de Células Escamosas/mortalidad , Supervivencia sin Enfermedad , Humanos , Neoplasias Laríngeas/mortalidad , Laringectomía/métodos , Terapia por Láser/métodos , Microcirugia/métodos , Estadificación de Neoplasias , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: The optimal treatment of patients with T3 laryngeal carcinoma is controversially challenged by open partial laryngectomies (OPL), transoral laser microsurgery (TLM) and radiation therapy alone (RT) or combined with chemotherapy (ChRT). Treatment guidelines, experts' opinions and clinical studies are highly contradictory. The aim of this study is to compare the primary outcomes of the available treatment methods and identify the sources of variance among studies. METHODS: A review of the literature published in the time period 2003-2015 was conducted via the PubMed database (www.pubmed.org) and Scopus database (www.scopus.com) with the search terms "T3 laryngeal squamous cell cancer treatment". Data from clinical studies involving patients with T3 laryngeal cancer (n > 10) subjected to TLM, OPL, ChRT or RT, were pooled. In the absence of controlled studies, prospective and retrospective clinical trials with minimum 5-year follow-up were acceptable, provided that they included a description of patient eligibility criteria, so as to exclude studies with serious selection bias. RESULTS: Literature lacks studies with homogenous populations regarding TNM staging, preoperative/postoperative treatment or anatomical subsite. This raises substantial controversies and prohibits the conduction of a meta-analysis. Data for qualitative analysis were pooled from 8 studies (n = 1226). OPL and TLM both offer patients high survival and organ preservation rates. Preoperative induction chemotherapy seems to significantly compromise overall survival. CONCLUSIONS: Multicenter studies referring to homogenous populations, at least regarding staging and anatomical subsite, are needed. No safe conclusions can be drawn given the heterogeneity in patient cohorts, study design and evaluation of results in the existing literature.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Antineoplásicos/uso terapéutico , Terapia Combinada , Humanos , Laringectomía , Terapia por Láser/métodos , Clasificación del Tumor , RadioterapiaRESUMEN
Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.