Complications of laser surgery for recurrent respiratory papillomatosis

During an 8-year period, 66 patients with recurrent respiratory papillomatosis underwent 890 laser microlaryngoscopy procedures. A retrospective analysis of immediate and delayed complications occurring with laser microlaryngoscopy in the treatment of these patients revealed that complications secondary to anesthetic technique and laser methodology were remarkably low (0.3%). Delayed complications of tissue injury (36% of pediatric patients and 17% of adult patients) were more frequent and included anterior glottic webbing, interarytenoid scarring and arytenoid fixation, vocal fold fibrosis, and generalized endolaryngeal glottic stenosis. All patients were evaluated by direct visualization and recording at the time of the operative procedure, as well as by review of intraoperative photographs. A smaller group of patients underwent analysis of voice recordings and laryngeal stroboscopy. The frequency and severity of tissue injury was higher in the patients with more severe disease who underwent multiple operative procedures.     

Complications of treatment of recurrent laryngeal papillomatosis with the carbon dioxide laser in children.

A retrospective study of the complications of treatment with the carbon dioxide (CO2) laser of 17 patients diagnosed to be suffering from recurrent laryngeal papillomatosis is presented. No immediate complications occurred except one case of laryngospasm and failure to intubate during anaesthesia leading to hypoxic encephalopathy. Three patients were completely free from disease and complications. Another patient was free from laryngeal lesions but developed a papilloma in the right tonsillar pillar. Five other patients showed one or more multiple sites of involvement in addition to the larynx. Laryngeal scarring developed in ten patients. Six patients (35.29 per cent) developed scarring as anterior glottic webs while in two scarring (11.7 per cent) occurred as posterior glottic webs. One developed scarring in the supraglottic region. The remaining one had scarring in both the glottic and supraglottic regions. One patient developed tracheal scarring necessitating laryngo-tracheal separation. Two patients were psychologically disturbed during treatment requiring psychiatric consultation and therapy.     

显微支撑喉镜下CO2激光手术或联合干扰素治疗复发性小儿喉乳头状瘤疗效对比

目的 探讨白细胞干扰素联合显微支撑喉镜下CO2激光手术治疗复发性小儿喉乳头状瘤的临床疗效。方法 回顾性分析61例复发性小儿喉乳头状瘤的临床治疗资料,运用解剖划分法,评估单纯显微支撑喉镜下CO2激光治疗(A组)、或联合干扰素共同治疗(B组)复发性小儿喉乳头状瘤这两种方案的临床效果。结果 两组乳头状瘤范围,① 术前均为1～8个解剖亚区,平均值A组为(3.45±1.86)个、B组为(3.53±1.67)个解剖亚区;② 术后A组1～4个、平均(2.09±0.87)个解剖亚区,B组1～3个、平均(1.47±0.63)个解剖亚区(P<0.05)。结论 单纯显微支撑喉镜下CO2激光手术与联合干扰素治疗复发性小儿喉乳头状瘤均能延缓肿瘤复发,联合治疗组较单纯手术组复发范围小。     

Safety of paediatric day-stay laryngeal surgery for recurrent respiratory papillomatosis

ObjectivesSafety assessment of day-stay laryngeal surgery in a cohort of children with recurrent respiratory papillomatosis (RRP). Recurrent respiratory papillomatosis is a chronic debilitating disease which usually requires multiple recurrent interventions under general anaesthesia. Day-stay surgery is an attractive option as it allows avoiding the inconvenience and costs of routine overnight admissions while recovering in the safe environment of the family home. This is the first study to assess the safety of day-stay laryngeal surgery in this cohort of patients.MethodsRetrospective cohort study of all consecutive RRP procedures performed between December 1998 and May 2015 in a single paediatric tertiary-level hospital.ResultsA total of 465 surgical procedures were performed in 20 patients. Average age on diagnosis was 4.5 years. 415 (89.25%) of the procedures were done as day cases without overnight admission. Average number of procedures per patient was 20 and 25 for Children positive to HPV6 and HPV11, respectively. Only one patient after one single procedure (presenting 0.21% of total procedures, 0.24% of day-stay procedures) represented after discharge.ConclusionsDay-stay surgery for children with RRP has a favourable safety profile in selected cases.     

Treatment of laryngeal papillomatosis with photodynamic laser therapy]

Laryngeal papillomas represent a disease of the head and neck that can be treated only symptomatically by surgical means. Twelve Patients (six adults and six children) with recurrent laryngeal papillomas were admitted to a pilot study for photodynamic laser treatment (Fig. 2). Forty-eight hours after intravenous application of hematoporphyrin derivative, PDT was performed by means of a specially developed laser light applicator (Fig. 1) under general anaesthesia. The laser light was generated by an argon-pumped dye laser system operating at a wavelength of 630 nm. On endoscopic evaluation the papilloma showed a whitish livid colour 24 hours after PDT. During the following 3-5 days the papilloma tissue was sloughed and the true and false vocal cords were covered by fibrin. Some 3-4 weeks after PDT the endolaryngeal mucosa had reepithelized in all patients with no signs of residual disease (Fig. 3). Despite the initial multifocal nature of the papilloma, even beyond the anterior commissure, no synechia developed.     

CO2激光手术治疗喉癌的并发症分析

目的 总结CO2激光手术治疗喉癌的并发症发生情况,分析影响并发症发生的相关因素,并提出相应的预防措施.方法 总结分析北京同仁医院耳鼻咽喉头颈外科1992年8月至2008年12月激光手术治疗的912例喉癌患者临床资料.声门上型喉癌35例,声门型喉癌877例,声门型喉癌中原位癌(Tis)53例,T1 659例,T2 158例,T3 7例.术后随访2～18年,中位随访时间9.3年.结果 912例患者中,824例存活,失访29例(按死亡计算),死亡59例.直接法统计总的局部复发率为9.4%(86/912),3年生存率95.6%(775/811),5年生存率87.9%(518/589).83例(9.1%)出现手术相关并发症,其中声门上型喉癌中并发症发生率17.1%(6/35),声门型喉癌8.8%(77/877),两组差异无统计学意义(χ2=2.85,P＞0.05).声门型喉癌中,原位癌并发症发生率为5.7%(3/53),T1为7.8%(51/659),T2为13.3%(21/158),T3为28.6%(2/7),组间差异有统计学意义(χ2=8.97,P＜0.05＝.病变侵犯前联合的并发症发生率为12.8%(31/242),未侵犯前联合为7.2%(46/635),组间差异有统计学意义(χ2=6.78,P＜0.05＝.Ⅱ型手术患者并发症发生率为3.8%(4/105),Ⅲ型为7.0%(20/287),Ⅳ型为9.7%(22/226),Ⅴ型为12.0%(31/259),组间差异有统计学意义(χ2=7.96,P＜0.05＝.结论 全麻下显微喉镜激光手术治疗喉癌在术中、术后存在潜在风险和并发症,并发症的发生与原发肿瘤的部位范围和手术切除的范围和深度有关,需要采取积极的预防措施.

Abstract：

Objective To evaluate the complications of CO2 laser surgery in the treatment of laryngeal carcinoma,to analyze related factors and to propose preventive measures.Methods Retrospective analysis of 912 cases of laryngeal carcinoma(35 cases of supraglottic cancer and 877 cases of glottic cancer)treated only with laser surgery in Tongren Hospital was carried out.Among the glottic cancer,carcinoma in situ (Tis),T1,T2 and T3 were 53,659,158 and 7 cases.The follow-up period ranged from 2 to 18 years,with a median follow-up time of 9.3 years.Results Of 912 cases,824 cases were still alive,29 cases failed to be followed-up(taken into dead number),and 59 cases were dead.The recurrent rate was 9.4%(86/912).Three year survival rate was 95.6% (775/811)and five year survival rate was 87.9%(518/589).The incidence of surgery complications was 9.1% (83/912).Incidence of complications in supraglottic carcinoma and glottic carcinoma were 17.1% (6/35) and 8.8% (77/877),respectively,with no difference between the two groups (χ2 = 2.85,P ＞ 0.05).Incidence of complications of Tis,T1,T2 and T3 cases of glottic cancer were 5.7% (3/53),7.8% (51/659),13.3% (21/158) and 28.6% (2/7)respectively,with significant difference (χ2 = 8.97,P ＜ 0.05).Incidence of complications of glottic carcinoma with and without anterior commissure indision were 12.8% (31/242) and 7.2% (46/635)respectively,with significant difference between the two groups (χ2 = 6.78,P ＜ 0.05) .Incidence of complications in the patients underwent type Ⅱ ,Ⅲ,Ⅳ,Ⅴ cordectomy were 3.8% (4/105),7.0%(20/287),9.7% (22/226) and 12.0% (31/259) respectively,with significant difference (χ2 =7.96,P ＜0.05).Conclusions There are some potential risks and complications intra- and post-operatively,according to the sites and extent of the primary tumors and the range and depth of removed tissues.It needs to take active preventive measures to reduce the incidence of complications.     

Complications after CO2 laser surgery of laryngeal cancer in the elderly

Conclusion. Cancer of the larynx in elderly patients should be treated with curative intention, if the extension of the primary tumour allows safe resection. Transoral CO₂ laser microsurgery is associated with a low rate of major complications and can be regarded as suitable even for elderly patients. Age itself should never be the sole factor in deciding which therapy should be undertaken. Objectives. In the industrialized nations the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. Nowadays laryngeal cancer is often treated by transoral CO₂ laser microsurgery. Because of a variety of comorbidities, the incidence of perioperative complications in the group of elderly patients is of increasing interest. To date, no references in the literature have discussed complications after transoral CO₂ laser microsurgery in this age group. Patients and methods. Twenty-four patients over the age of 75 suffering from squamous cell carcinoma of the larynx and treated by transoral CO₂ laser microsurgery since 1998 were analysed for intraoperative and postoperative complications. Results. There was no evidence of surgery-related complications at all. Postoperatively, 6 of 24 patients complained about dysphagia. Due to intraoperative placement of nasogastric feeding tubes in these six cases further complications such as pneumonia resulting from aspiration could have been avoided.     

Soft-tissue complications of laser surgery for recurrent respiratory papillomatosis

Twenty-two patients with recurrent respiratory papillomatosis underwent 105 carbon dioxide (CO2) laser microlaryngoscopic and tracheobronchoscopic operations from July 1986 through February 1990. All soft-tissue complications, whether intraoperative or delayed secondary to laser surgery, were retrospectively analyzed. The intraoperative laser-related soft-tissue complication rate was zero. Two of the 22 patients acquired slight unilateral true vocal cord scar tissue and 1 patient developed a small posterior laryngeal web. The delayed soft-tissue complication rate was 13.6%, which compares favorably with published reports of 28.7% and 45%. This low complication rate has resulted from the selection of appropriate CO2 laser emission parameters and the use of the microspot micromanipulator, which help minimize lateral and/or deep thermal damage at the site of laser impact.     

The etiology of laryngeal papillomatosis.

Sophisticated virological techniques are described for isolating whole virus, free viral DNA, or integrated viral DNA. Based upon preliminary results, it is suggested that the virus responsible for laryngeal papillomatosis is not the same as the virus responsible for cutaneous papillomatosis lesions and, for the most part, it exists in the integrated DNA form.     

Endoscopic laser surgery for laryngeal cancer

Endoscopic laser surgery is a novel treatment modality for laryngeal cancer. CO₂ laser combined with an operating microscope is the most frequently used instrumentation. In Finland we started large-scale laser surgery in 1994 in all five university hospitals, covering a population of about five million people. By 1998 we had operated on 140 patients, of whom 11 were females. Eighty-three per cent of the lesions were glottic. Because of the low number of stage III–IV patients, the recurrence and survival analyses included 132 patients with in situ, stage I or stage II tumours, numbering 8, 96 and 28 respectively. The mean follow-up time was 38 months. The 2-year recurrence frequencies were 5% for stage I, 31% for stage II, and 11% altogether. No patients developed recurrences after 2 years. Seven patients underwent a salvage laryngectomy and the adjusted cumulative survival rate was 95%. After laser surgery the quality of voice was good or excellent in 70% and only three patients suffered from severe aphonia. This study showed that the results of endoscopic laser surgery are comparable with those of radiation therapy, but this type of treatment is more convenient for the patients and much cheaper for society. Received: 20 June 2000 / Accepted: 10 April 2001     

Complications of laser surgery

It is only through meticulous attention to detail that complications in the use of lasers can be avoided. Lasers can be efficient, safe, and effective tools for the head and neck surgeon. However, it is imperative that the surgeon take all precautions so that the incidence of complications, uniquely attributable to laser energy, will be kept to a minimum. Inattention to detail may expose the patient to an unnecessary risk of complications.     

Juvenile laryngeal papillomatosis

From the records of 23 patients with juvenile laryngeal papillomatosis, various aspects of the aetiology, natural history and treatment of the condition have been presented. The lesions are thought to be viral in origin, they are notoriously unpredictable in their behaviour, and treatment can often be prolonged and frustrating. Tracheostomy should be avoided, if possible, owing to the risk of further dissemination down the trachea and bronchi. The CO2 laser now seems to be the surgical treatment of choice, and early reports of adjuvant interferon therapy are encouraging. However, the laser is only available in certain centres, and interferon supplies are limited at present.     

Complications after CO(2) laser surgery of laryngeal cancer in the elderly

CONCLUSION: Cancer of the larynx in elderly patients should be treated with curative intention, if the extension of the primary tumour allows safe resection. Transoral CO(2) laser microsurgery is associated with a low rate of major complications and can be regarded as suitable even for elderly patients. Age itself should never be the sole factor in deciding which therapy should be undertaken. OBJECTIVES: In the industrialized nations the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. Nowadays laryngeal cancer is often treated by transoral CO(2) laser microsurgery. Because of a variety of comorbidities, the incidence of perioperative complications in the group of elderly patients is of increasing interest. To date, no references in the literature have discussed complications after transoral CO(2) laser microsurgery in this age group. Patients and methods. Twenty-four patients over the age of 75 suffering from squamous cell carcinoma of the larynx and treated by transoral CO(2) laser microsurgery since 1998 were analysed for intraoperative and postoperative complications. RESULTS: There was no evidence of surgery-related complications at all. Postoperatively, 6 of 24 patients complained about dysphagia. Due to intraoperative placement of nasogastric feeding tubes in these six cases further complications such as pneumonia resulting from aspiration could have been avoided.     

Complications of laryngeal framework surgery (phonosurgery)

The rising popularity of surgery involving the laryngeal framework (surgical medialization of immobile vocal folds, vocal fold tightening, pitch variation, etc.) has resulted in increasing case experience. Little has appeared in the literature regarding complications or long-term results of this type of surgery. Several years' experience in a major referral center with various types of laryngeal framework surgery has led to a small number of complications. These have included late extrusion of the prosthesis and delayed hemorrhage. A review of these complications and recommendations for modification of technique to minimize them in the future are discussed.