Oncological results of endoscopic resections of Tis and T1 glottic carcinomas by carbon dioxide laser

A cohort of 88 patients with glottic cancer (13 Tis, 75 T1) who underwent endoscopic CO2 laser excision between January 1995 and June 1997 was prospectively studied. The mean follow-up was 43 months (range, 30 to 60 months). The depth and extent of the excision (graded according to the European Laryngological Society Classification, which includes 5 types of resection) were based on the results of a preoperative and intraoperative diagnostic test battery. Five patients died of other diseases, and none of glottic cancer. Of the 12 patients who developed a local recurrence, 5 underwent a second endoscopic procedure, 5 a total laryngectomy, and 1 a supracricoid laryngectomy, and 1 was treated with radiotherapy. The 5-year local control rate with endoscopic surgery alone, according to the Kaplan-Meier method, was 91%. None of the variables (8 related to the tumor and 2 to the treatment) tested in a univariate analysis by the log-rank test was found to have a significant impact on disease-free survival rates. The present study confirmed that endoscopic partial cordectomy for Tis and T1 glottic cancers can be regarded as a valid alternative to radiotherapy in terms of oncological results.     

Early-stage glottic cancer: oncological results and margins in laser cordectomy

OBJECTIVES: To assess local control of early-stage glottic cancer by laser cordectomy in comparison with previously published external partial laryngectomy series and to determine the relevance of histological margins in glottic cancers excised with laser cordectomy. DESIGN: Retrospective review of laser cordectomy for carcinoma in situ (Tis) and stage T1 glottic cancer from January 1991 to January 2004. SETTING: University hospital. PATIENTS: Fifty-two patients with Tis or T1 glottic cancer. INTERVENTION: Endoscopic laser cordectomy, classified using the system proposed by the European Laryngeal Society Working Committee. MAIN OUTCOME MEASURES: Local control after initial surgery and after salvage compared with a published historical control group, according to the type of cordectomy performed and the histological margins of the removed specimen. RESULTS: Sixteen patients with Tis, 30 with T1a tumors, and 6 with T1b tumors were followed up for an average of 38 months. Type I cordectomy was the most common procedure used to treat Tis, and type II and type III were the most common for treating T1a and T1b tumors. Of 6 recurrences, 4 were treated with laser cordectomy and 2 were treated with external partial laryngectomy. The rate of laryngeal preservation was 100%. There were 3 recurrences despite histologically clear margins. Three (17%) of 18 patients with suspicious margins developed recurrences. The rate of local control with single intervention (46 [89%] of 52) was lower than with partial external laryngectomy. However, 46 (89%) of 52 patients ultimately had less tissue removed by laser than would have been removed by external partial laryngectomy. CONCLUSIONS: Laser cordectomy provides excellent local control and laryngeal preservation. Close follow-up of patients with positive or suspicious margins is an alternative to further routine treatment.     

CO2激光声带切除术后复发相关因素分析

目的 探讨早期声门癌经CO2激光手术后,其复发相关因素对患者预后的影响。方法 回顾经CO2激光治疗声门癌患者76例病历资料,所有新鲜标本标记切缘,肉眼切缘2mm,甲醛液中固定。石蜡包埋,HE染色,光镜观察。Kaplan–Meier法计算生存率和无瘤生存率,单因素分析应用log rank test方法。结果 局部复发11例(14.5%),5年生存率92.0%,5年无瘤生存率81.9%,喉保存率96.1%。单因素分析显示,前联合受侵和甲杓肌受侵导致5年无瘤生存率降低(P=0.002,P=0.001),而病理切缘阳性并不影响5年无瘤生存率(P=0.065)。结论 前联合受侵和甲杓肌受侵将增加CO2激光治疗早期声门癌术后复发风险,切缘阳性并不影响5年无瘤生存率,对术后切缘阳性患者采取密切随访观察,避免过度治疗。     

Glottische Larynxkarzinome

BACKGROUND: Endoscopic laser resection is one treatment modality for early glottic carcinoma. Benefits are the preservation of laryngeal structure without tracheotomy, the short duration of treatment, low traumatisation and good functional results. METHODS: From 1989 to 1999, 143 patients with an isolated and previously untreated glottic squamous cell carcinoma were treated by CO2 endoscopic laser resection. The tumors were classified as carcinoma in situ (Tis) in seven cases, T1 tumor (T1N0M0) in 91 patients and T2 tumor (T2N0M0) in 45 cases. Median follow-up was 5 years. RESULTS: For the group of Tis and T1 carcinomas, 86 of 98 patients were free of recurrences. The 12 recurrences (12.2%) were treated by repeated laser surgery and laryngectomy (four patients). None of these patients died of tumor related causes. For patients with T2 carcinomas, the overall recurrence rate was 28.9% (13 patients). In six patients, a total laryngectomy had to be performed and one patient died because of tumor recurrence. The relapse free survival estimate using the Kaplan-Meier method was 87% for Tis and T1 carcinomas and 70% for T2 carcinomas. The overall laryngeal preservation rate was 95% for Tis and T1 carcinomas and 85% for T2 tumors. All recurrences occurred within 4 years of primary surgery. CONCLUSION: The results suggest that the oncological outcome after endoscopic laser surgery is comparable to conventional open partial resections.     

CO2激光喉显微手术治疗早期声门型喉癌疗效观察及相关因素分析

目的探讨CO2激光喉显微手术治疗早期声门型喉癌的疗效和安全性,对手术注意事项进行探讨。方法在显微支撑喉镜下,对27例早期声门型喉癌患者采用CO2激光手术治疗,其中Tis6例,T1a8例,T1b7例,T26例。累及前联合者3例,未累及前联合者24例。结果全部患者CO2激光手术均成功,术后无一例患者出现呼吸困难、出血等严重并发症。随访3年以上,存活率100％。2例患者复发,其中1例行CO2激光喉显微手术再切除,1例行喉垂直部分切除并术后放疗,随访2年均未再复发。结论CO2激光喉显微手术是治疗早期声门型喉癌的有效方法,通过选择合适的患者及注意术中操作,可减少甚至避免显微喉镜激光手术引起的声带粘连。     

Diode laser microsurgery for treatment of Tis and T1 glottic carcinomas

PURPOSE: The aim of the study was to demonstrate the oncologic safety of diode laser surgery in the treatment of early glottic carcinoma. MATERIALS AND METHODS: The study included 45 patients affected by Tis and T1 glottic squamous cell carcinomas and treated endoscopically by diode laser (60 W, 810 nm). The endoscopic resections were graded according to the European Laryngological Society Classification including 5 types of cordectomy. These cases were classified according to the 2002 American Joint Committee on Cancer-International Union Against Cancer (AJCC-UICC) TNM system and included 9 Tis (20%), 31 T1a (68.9%), and 5 T1b (11.1%) glottic carcinomas. The length of follow-up ranged from 24 to 86 months, with an average follow-up period of 36 months. The case study included 39 males (86.7%) and 6 females (13.3%), aged 35 to 81 years, with a mean age of 51 years. RESULTS: There were 5 recurrences (11.1%): 4 local (8.9%), in which 3 were salvaged, and 1 (2.2%) regional. Three patients (6.7%) developed second primary cancers on the controlateral cord after a mean of 18 months. All local recurrences occurred in patients with T1b lesions. Forty patients (88.9%) were alive and disease-free at a median follow-up of 36 months. The overall larynx preservation was 97.6%. The actuarial recurrence-free survival analysis by the Kaplan-Meier method showed a survival of 92.3% at 2 years, 89.2 at 5 years, and 85.6 at 7 years. CONCLUSIONS: Diode laser microsurgery is an oncologically safe, function-preserving modality for the treatment of Tis and T1 glottic carcinomas. This surgical technique provides excellent local control of disease and laryngeal preservation.     

CO2激光治疗声门型喉癌远期疗效分析

目的 探讨显微支撑喉镜下CO₂激光治疗声门型喉癌的远期治疗效果。 方法 对声门型喉癌患者106例,采用显微支撑喉镜下CO₂激光治疗,回顾性分析病历资料。其中T_isN₀M₀ 4例、T_1aN₀M₀ 62例、T_1bN₀M₀ 16例、T₂N₀M₀ 22例、T₃N₀M₀ 2例。 结果 106例患者手术顺利,无严重并发症发生。术后死于复发或颈部转移4例,死于意外4例,死于远处转移2例,失访4例,术后局部复发者再次手术后至今良好2例。目前92例仍存活,无肿瘤复发,生活质量良好。3年、5年和10年生存率分别为98.7%、95.2%和89.0%,总局部复发率为5.7%。 结论 显微支撑喉镜下CO₂激光手术是治疗T_is、T_1a声门型喉癌的首选方法,手术创伤小,术后恢复快,喉功能保全好,远期生存率高;该手术对于经过精心选择的声门型T_1b和T₂、T₃喉癌也有较好的临床疗效。     

Treatment of early-stage glottic cancer by transoral laser resection

OBJECTIVES: We reviewed outcomes of treatment of early glottic carcinoma by transoral laser resection. METHODS: We performed a retrospective study of tumor stage, type of cordectomy (European Laryngological Society), resection margins, local control, and laryngeal preservation. RESULTS: Of 142 patients treated with curative intent, 79 (92% male; average age, 63 years) were retained for this study, on the basis of availability of information regarding resection margins, the absence of adjuvant radiotherapy, and followup of at least 2 years. The tumors were classified pTis (n = 21), pT1a (n = 51), or pT1b (n = 7) and were treated by cordectomy types I (23%), II (30%), III (27%), IV (6%), and V (14%). The average follow-up was 56 months (range, 24 to 150 months). The overall 5-year actuarial recurrence-free survival rate was 89%, and the 5-year actuarial disease-specific survival rate was 97.3%. There were 11 local recurrences (14%); 7 were treated by another laser resection, 1 by radiotherapy, 1 by supracricoid partial laryngectomy, and 2 by total laryngectomy. The overall rate of final local control with the laser alone was 100% for patients with initially positive margins, 95% for those with initially suspicious margins, and 94% for those with free margins. The overall rate of organ preservation was 100% for patients with positive or suspicious margins and 96% for those with free margins. Margin status (p = .39), cordectomy type (p = .67), and anterior commissure involvement (p = .16) were not statistically related to recurrence (Kaplan-Meier calculations with nonparametric univariate analysis). The recurrence rate was significantly higher for T1b tumors, however (p = .001). CONCLUSIONS: Laser microresection provides high rates of local control and organ preservation for early glottic cancer. Positive or suspicious margins were not related to recurrence, nor was anterior commissure involvement. This study implies that suspicious margins can be managed with a "watch-and-wait" attitude. Re-treatment with laser, external partial laryngectomy, and radiotherapy remain therapeutic options for recurrences.     

Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgery

Materials and methodsThe records of patients treated with TLM with previously untreated early stage glottic squamous cell carcinoma were reviewed.ResultsA total of 201 patients were enrolled: 191 men (95.0%) and 10 women (4.98%). The anterior commissure (AC) was involved in 94 (47.8%) patients. The 3- and 5-year overall survival rates of all patients were 94.5% and 90.9%. The local recurrence rates were 30.8% in the AC involvement (AC+) group and 16.0% in the group without AC involvement (AC–). The mortality rates were 18.1% and 3.7% in the AC+ and AC– groups. The 3- and 5-year disease-free survival rates were lower in the AC+ group (89.1%, 82.5%) than that in AC– group (99.0%, 96.5%). Local recurrence rates were 25%, 22.7%, 23.4%, and 22.1% for Tis, T1a, T1b, and T2 lesions. The mortality rates were 0.0%, 4.6%, 12.8%, and 15.3%. Three- and 5-year disease-free survival rates did not differ significantly between the tumor stage subgroups. The mortality for patients with local recurrence was 22.2%, which was higher than that for those without recurrence. The organ preservation rate was 98.5%.PurposeThis study was to assess the rates of oncological outcomes in patients with early stage glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM).ConclusionAC involvement was a predictor of local recurrence, and its presence was associated with a reduced survival rate and increased mortality after TLM. TLM got high survival rate and low recurrence rate. The staging and oncological outcomes did not differ between tumor stage subgroups.     

Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management, and outcome

Although transoral laser surgery (TLS) for the treatment of early stage glottic carcinoma is now widely used, the patterns of local recurrences, related re-treatment methods, and results have not been documented comprehensively. Two hundred fifty-two patients with glottic carcinoma stage I or II were treated for cure with TLS alone and followed up for 24 to 139 months (mean, 62 months). Their charts were retrospectively reviewed to identify local recurrence patterns. Thirty-five patients (13.9%) presented with local recurrences or second laryngeal primaries 4 to 84 months (mean, 23 months) after initial treatment. Of the 161 patients classified T1N0M0, 21 (13.0%) suffered local recurrences, and in the 91 classified T2N0M0, 14 (15.4%) tumors recurred. If tumors recurring more than 60 months after initial treatment are considered second primary tumors rather than recurrences, then only 18 (11.2%) of 161 patients classified T1N0M0 would have had a recurrence. However, the difference in local control between patients with stage I versus stage II disease would still not be significant (p = .41). Of the 35 patients with local recurrences, 16 (45%) were managed with total laryngectomy, 10 (28.6%) with further TLS, 4 (11.4%) with partial laryngectomy, and 2 (5.7%) with radiotherapy, and 3 (8.6%) had no curative treatment. Accordingly, 16 patients (45.7%) with local treatment failure could be treated with further organ-sparing treatment methods. The actuarial overall survival, disease-specific survival, and organ preservation rates 5 years after the diagnosis of recurrent disease were 43.6%, 74.6%, and 33.7%. Transoral laser surgery leads to local control rates that are comparable to those found after radiotherapy for lesions classified T1 and leads to slightly better control rates for lesions classified T2, but the results are inferior to those achieved with conventional partial laryngectomy. However, if local recurrence occurs, then more re-treatment options are available after TLS as compared to initial radiotherapy or open surgery.     

CO2 laser cordectomy for early-stage glottic carcinoma: a long-term follow-up of 156 cases

OBJECTIVES: To define when laser resection of early-stage glottic carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options. STUDY DESIGN: Retrospective study of 151 patients treated from April 1982 to June 1996 in the Department of Otorhinolaryngology at "La Sapienza" University. We provide analysis of indications, techniques, and oncologic results of this study. METHODS: Glottic tumors were treated with type III, type IV, and type Va cordectomies according to the classification of endoscopic cordectomies proposed by the European Laryngological Society in 2000. RESULTS: The results are summarized as follows: all patients with carcinoma in situ Tis are free of disease with local control rate at 3 years of 100%; 2 died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 83.2%. Of the 117 patients with stage T1a cancer, 110 are free of disease at 3 years with local control rate of 94%; 4 patients died of other causes without evidence of local recurrence with an overall survival rate of 96.5%. Of the 22 patients with stage T1b cancer, 20 are free of disease at 3 years with a local control rate of 91%; 1 patient died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 95.4%. CONCLUSIONS: According to our experience, we can conclude that endoscopic laser surgery is an efficacious and cost-effective treatment for early stage glottic cancer.     

Transoral laser surgery for early glottic carcinoma

This prospective study evaluates the oncological results of transoral laser surgery (TLS) for glottic carcinoma categorized Tis, T1 and T2 in a large, unselected group of 285 consecutive patients from a university-based referral center that uses transoral laser surgery as the standard approach to these tumors. Patients were treated between 1 January 1987 and 31 December 1996. Thirty-three patients had Tis disease, 174 T1 tumors and 113 T2. Main outcome measures were local control with initial therapy, ultimate local control, regional control, organ preservation, overall survival and cause-specific survival. The 5-year uncorrected actuarial survival for all 285 patients was 71.1%, and cause-specific actuarial survival was 98.7%. Local control with initial treatment was 85.9%, ultimate local control with salvage for local treatment failures 98.5%, and regional control 98.4%. In all, 94.3% had their larynges preserved after 5 years. Although favorable oncological results for early laryngeal carcinoma treated with laser surgery are supported this study, no definitive recommendations can be given for the best single treatment. Partial laryngectomies lead to the highest local control rates reported so far, radiotherapy is believed to preserve voice best and laser surgery is associated with time- and cost-effectiveness, low morbidity, fair local control rates and excellent re-treatment options in case of local failure. All specialists dealing with the treatment of early glottic carcinoma should be able to offer these different treatment modalities to their patients and to deal specifically with each patient’s individual needs and preferences. Received: 29 October 1998 / Accepted: 2 July 1999     

Results of surgical salvage after failure of definitive radiation therapy for early-stage squamous cell carcinoma of the glottic larynx

OBJECTIVE: To report the outcome of surgical salvage performed for early-stage squamous cell carcinoma of the glottic larynx that recurred or progressed after definitive radiotherapy. DESIGN: Retrospective outcome analysis. SETTING: Tertiary referral center specializing in head and neck cancer. PATIENTS: Forty-three patients who underwent salvage surgery after definitive radiation therapy for early-stage (T1-T2) glottic cancer were identified from a preexisting database of 662 patients with squamous cell carcinoma of the larynx treated at Memorial Sloan-Kettering Cancer Center between the years 1984 and 1998. The T stage at initial presentation was T1 in 20 (18%) and T2 in 23 (32%). Twenty-one patients (49%) were amenable to salvage partial laryngectomy (SPL), but 22 (51%) required salvage total laryngectomy (STL). Details on patient characteristics, tumor characteristics, postoperative complications, and survival outcome were extracted from the database. MAIN OUTCOME MEASURES: Overall survival, disease-specific survival, neck recurrence-free survival, and distant recurrence-free survival. RESULTS: No postoperative death occurred following salvage surgery. The overall incidence of complications was 21%, with no difference between the SPL and STL groups. Patients who required STL had poorer overall survival and disease-specific survival compared with patients who required SPL (overall survival, 50% vs 89%; P = .003; disease-specific survival, 51% vs 93%; P = .002). This difference in survival was associated with a poorer neck recurrence-free survival and distant recurrence-free survival in the STL group compared with the SPL group (neck recurrence-free survival, 80% vs 100%; P = .04; distant recurrence-free survival, 71% vs 93%; P = .06). Univariate analysis showed that age and clinical T stage at recurrence were predictors of overall survival, disease-specific survival, and distant recurrence-free survival. CONCLUSIONS: Careful selection of patients with early-stage glottic tumors that recur or progress after radiation allows patients to be successfully treated by partial laryngectomy with excellent survival outcome. However, despite an aggressive policy of performing partial laryngectomy when feasible, up to 50% of patients will require a total laryngectomy owing to progression of disease. These patients have poorer survival outcomes manifested by local, regional, and distant disease progression.     

喉垂直切除会厌下移喉重建术治疗早期声带癌的疗效观察

目的:评价喉垂直切除会厌下移喉重建术(Tucker技术)治疗早期声带癌(T1b,T2)的效果,明确Tucker技术的手术适应证。方法:回顾性分析139例接受Tucker技术治疗患者的临床资料,其中127例是首次接受治疗的患者(T1b48例,T279例),12例(Tr)是声带癌曾接受过放射治疗或声带切除后复发的患者。计算生存率和评估喉功能恢复情况。结果:T1期患者的5年生存率为91.0%,肿瘤局部控制率为100%;T2期患者的5年生存率为86%,肿瘤局部控制率为94.0%;Tr期患者的5年生存率为64.0%,肿瘤局部控制率为82%。喉功能保留方面:气管拔管率为100%,平均拔管时间10d。胃管拔除率为99.3%(138/139),6例因误咽施行了胃造漏术,1例因顽固性误咽导致吸入性肺炎施行了功能性全喉切除术;平均胃管拔管时间为15d。121例(87.1%)患者获得了好或较好的发声,18例患者的发声质量较差如同耳语声。结论:喉垂直切除会厌下移喉重建术(Tucker技术)是治疗T和T期声带癌的有效手术方法。     

CO2激光在声门型喉癌外科治疗中的应用

目的 分析CO2激光治疗声门型喉癌的适应证、手术要点和并发症的预防.方法 回顾性分析复旦大学附属眼耳鼻喉科医院2003年3月至2006年6月间应用CO2激光治疗的60例无转移的声门型喉癌(T1期52例和,12期8例)的疗效和手术并发症.结果 所有病例术后声音嘶哑都比较明显,随着患侧声带切除后的逐渐修复,发音逐渐响亮,1年左右接近正常发音或轻度嘶哑.术后无气管切开、误吸和呼吸困难患者,除2例双侧声带癌行双侧声带切除后发生前连合粘连外,无其他严重并发症.60例喉癌病例中,54例术后随访2～5年无瘤生存.术后复发4例,1例再次激光手术,随访至今2年无瘤生存;3例改为喉全切除术,其中1例随访2年无瘤生存,2例再次复发死亡.术后4年和5年各失访1例.以Kaplan-Maier法统计累积生存率,3年和5年生存率分别为100.0%和91.5%.结论 激光作为一种微创技术,在喉癌的外科治疗中具有广泛的应用前景.激光手术创伤小,出血少,恢复快,疗效好,且能保留较为满意的发音功能,是治疗T1、T2声门型喉癌的理想方法,值得推广.     

经口内镜下CO2激光切除Tis～T2期声门型喉癌复发相关因素分析

目的 探讨经口内镜下CQ激光手术治疗的Tis、T1、T2期声门型喉癌患者术后复发的相关因素.方法 回顾性分析在安徽省立医院接受经口内镜下CO2激光治疗的180例Tis～T2期声门型喉癌患者的临床资料,其中Tis 22例,T1a 90例,T1b 32例,T2 36例;以肿瘤复发为终点,运用单因素及多因素方法分析年龄、性别、肿瘤T分期、手术方式、病理分级、声带运动、前联合是否受累等因素对复发率的影响.结果 Tis患者的复发率为9.09％(2/22),T1a患者的复发率为13.33％(12/90),T1b患者的复发率为18.75％(6/32),T2患者的复发率为38.89％(14/36);Ⅰ型手术患者术后复发率为0,Ⅱ型手术患者术后复发率为3.57％(1/28),Ⅲ型手术患者术后复发率为15.0％(9/60),Ⅳ型手术患者术后复发率为19.60％(10/51),Ⅴ型手术患者术后复发率为36.84％(14/38).不同肿瘤T分期及不同手术方式患者复发率之间差异有显著统计学意义(P=0.006);单因素Logistics回归分析示T2期(OR=6.36,P＜0.05)及手术方式(OR=2.06,P＜0.05)与术后复发率显著相关,多因素Logistics回归分析手术方式(OR=1.71,P＜0.05)是术后复发率的独立影响因素.结论 声门型喉癌复发率与T分期及手术方式密切相关,随着T分期及手术等级的增高患者复发率随之升高,手术方式是术后复发的独立危险因素.     

The role of supracricoid laryngectomy for glottic carcinoma recurrence after radiotherapy failure: a critical review

CONCLUSIONS: In the near future salvage supracricoid laryngectomy (SCL) will be used more extensively for failures of radiotherapy for glottic carcinoma. OBJECTIVES: Primary radiotherapy has been used for patients with early glottic carcinomas in northern Europe and North America for more than half a century. Local recurrences after radiotherapy for glottic malignancies occur in 5-25% for T1 carcinomas and in 15-50% for T2 carcinomas. The classic choice as salvage surgery in cases of glottic squamous cell carcinoma recurrence after irradiation failure is total laryngectomy. The development of extended conservation procedures such as SCL has permitted an increasing number of successful partial laryngectomies that save laryngeal functions after radiotherapy failure. SCL allows the creation of a neo-larynx, permitting both swallowing and speech; in most cases the tracheostoma can be closed. METHODS: The electronic database Pubmed was searched without publication date limits. RESULTS: Considering available data (103 cases), 84.5% of the cases treated with salvage SCL for irradiation failure did not present a new local recurrence; laryngeal recurrences after salvage SCL (15.5%) were successfully treated with total laryngectomy in 66.7% of the cases. Tracheostoma closure was possible in all except two cases after a mean period ranging between 12 and 28 days. Swallowing results seemed good, with longer recovery time in irradiated than in non-irradiated patients who underwent SCL. Voice quality determined with psychoacoustic methods had acceptable intelligibility.     

T3N0M0声门型喉癌手术治疗预后因素分析

目的探讨T3N0M0声门型喉癌手术治疗预后影响因素。方法收集81例T3N0M0声门型喉癌手术治疗病例资料,其中部分喉切除47例,全喉切除34例;I5例术后放疗。采用X2检验单因素分析和Cox比例风险回归模型进行多因素分析。结果81例T3N0M0声门型喉癌患者5年疾病特异性生存率67．1％,5年整体生存率58．0％。单因素分析显示年龄、吸烟指数、前联合累及情况、分化程度、5年内局部复发情况和术后颈部转移情况不同组间生存分布的差异具有统计学意义（P〈0．05）;多因素分析显示局部复发、术后颈部转移、年龄、前联合累及情况和分化程度是影响本组患者生存的独立危险因素。结论局部复发、术后颈部转移、年龄、前联合累及情况和分化程度是影响患者生存率的主要因素,对T3N0M0声门型喉癌采取预防性颈部淋巴结清扫术,重视前联合病变处理是提高患者生存率的关键。     

Results of treatment of 584 laryngeal cancers at the Ear-Nose-Throat Clinic of Marburg University

The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.     

Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery

Objective

Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.