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     

Endoscopic laser surgery of laryngeal cancer

The paper reviews the experience in application of YAG laser radiation for the treatment of early (T1 and T2) laryngeal cancer. In 1984-1999 the laser treatment was given to 248 patients with laryngeal cancer. The technique of the procedure, indications and contraindications are described. Good results in T1 and T2 were achieved while further studies are required in T3.     

支撑喉镜下CO2激光手术治疗喉乳头状瘤

目的　观察支撑喉镜下CO2激光治疗喉乳头状瘤患者,分析其治愈率、复发率、复发时间及相关并发症,分析该技术的优缺点。方法　回顾性分析2012年2月～2014年6月经CO2激光治疗的喉乳头状瘤39例,均采用经口显微镜支撑喉镜下CO2激光治疗,全麻后支撑喉镜暴露喉乳头状瘤并固定,显微镜下CO2激光切除喉乳头状瘤。结果 随访1个月～2年,总体有效率约53.85%,复发率约42.56%,平均手术次数3.14次,平均复发时间约为7.6个月。结论 CO2激光出血少、手术时间短、术后恢复快且并发症较少见,值得临床推广。     

Endoscopic laser surgery. An alternative in laryngeal cancer treatment

Thirty-three patients with newly diagnosed laryngeal carcinoma underwent endoscopic treatment with the carbon dioxide laser under microscopic control and venturi jet ventilation. Ten of these patients underwent emergency tumor debulking to relieve airway obstruction and to avoid emergency tracheotomy for airway control, and 23 had definitive treatment of superficial or frankly invasive carcinoma. Among the first group, all had an adequate airway after tumor debulking and could be treated with elective laryngectomy with or without radical neck dissection once their metabolic conditions had improved and they had been appropriately evaluated. Among the second group, two died of lung carcinoma but were free of laryngeal disease and two were lost to follow-up at one year. With a minimal three-year follow-up, six of the remaining 19 patients underwent additional laser procedures. None have required external laryngeal surgery or radiation therapy. Endoscopic laser therapy appears preferable to a more radical approach for carcinoma in situ, microinvasive carcinoma, or superficially invasive carcinoma of the larynx.     

支撑喉镜下CO2激光并环后推进黏膜瓣治疗声门狭窄

声门狭窄特别是声门后部瘢痕狭窄是临床上一个较为棘手的疾病,常常伴有呼吸困难,有时可以见到声带活动受限.Bogdasarian和Olson[1]将其分为4级:1级为杓间区瘢痕,但是后连合正常;2级为杓间区和后连合均粘连瘢痕;3级为后连合瘢痕导致一侧环杓关节固定;4级为后连合瘢痕导敏双侧环杓关节固定.本文介绍了4例患者使用支撑喉镜下CO2激光切除喉狭窄并使用环后前移黏膜瓣修复后嗓音有不同程度提高或保持原样,均拔管.     

Localized laryngeal amyloidosis: A systematic review

ObjectiveThe larynx is the most common site of localized head and neck amyloidosis. Our study aimed to review the clinical features, treatments, and outcomes associated with localized laryngeal amyloidosis (LA). We also compared these features between two different time periods to evaluate the evolution of LA management.MethodsA literature search using PubMed, CINAHL, Embase, and Cochrane Library identified cases of LA published between 1891 and 2021. Biopsy-proven cases of localized LA were included. Non-English studies, animal studies, and reviews were excluded.Results282 patients (1891–1999: 142 patients, 2000–2021: 140 patients) from 129 studies were included. Results are reported as 1891–2000 vs. 2000–2021: Mean age was 48.5 years (range, 8–90 years) vs. 46.0 years (range, 9–84 years). The most common presenting symptoms were dysphonia (n = 30, 95 % vs. n = 127, 96 %) and difficulty breathing (n = 37, 27 % vs. n = 35, 27 %). A total of 62 (44 %) vs. 46 (33 %) lesions were found in the true vocal folds and 35 (25 %) vs. 59 (42 %) were found in the false vocal folds. 133 (94 %) vs. 137 (98 %) patients underwent surgical interventions to investigate and/or treat LA. Recurrent LA was reported in 27 (19 %) vs. 33 (24 %) patients with a mean time to recurrence of 25.4 months (range, 0.3–132 months) vs. 34.5 months (range, 0.8–144 months). Of cases reporting survival rate, 104 (97 %) vs. 107 (99 %) were alive at source study endpoints.ConclusionLA typically exhibits an indolent course; therefore, early intervention may address longstanding symptoms. Recurrent disease poses a clinical challenge in patients with LA.     

Results of supraglottic laryngeal cancer treatment with endoscopic surgery using CO2 laser

A group of 253 patients with laryngeal carcinoma was treated by endoscopic laser-CO2 surgery, 50 of them presented a supraglottic localization. The follow up period ranged from 1 to 10 years. From the analysis of different parameters (age, site, stage, histopathology, etc) it could be concluded that survival and free-symptoms-time rates in patients treated with laser endoscopy were similar to those obtained in patients treated with conventional external surgery. However, the endoscopic laser-CO2 surgery reported several advantages such as: no pharyngostoma, less complications, shorter stay in hospital and, consequently, lower health costs. In addition, tracheotomy was almost never necessary. Recurrencies can be also treated endoscopically, but, when total laryngectomy is needed following recurrency, this is considered to be a bad prognostic factor.     

Endoscopic CO(2) laser surgery for large internal laryngocele

The laryngocele is a benign air-filled dilatation of the saccule of the laryngeal ventricle. Its appearance may be related to increased intralaryngeal pressure due to chronic straining. The internal laryngocele is confined to the false vocal cord, and it does not pass through the thyrohyoid membrane. The most common symptoms for internal laryngocele are hoarseness and dysphagia. Large internal laryngoceles may also cause airway compromise, especially when complicated with infection. Endoscopic laser surgery is an acceptable mode of treatment even for large internal laryngoceles as in the present case.     

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。     

CO(2)-laser treatment of laryngeal amyloidosis

Four consecutive female patients (age: 14-47 years) with laryngeal amyloidosis, treated with endoscopic CO(2)-laser surgery, entered the study. All patients underwent periodic microlaryngoscopies following surgery to confirm the adequacy of the surgical resection. Recurrences or suspected lesions were resected and fibrin deposits were removed to prevent the formation of synechiae or healing adhesions. After two negative microlaryngoscopies, performed two months apart, the patients were followed-up approximately every six months over a period from six months to 18 years, with no evidence of recurrences. The endoscopic CO(2)-laser technique is highly effective in the treatment of localized laryngeal amyloidosis.     

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。     

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.     

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.     

Curative effect of cold micro forceps and CO2 laser in the treatment of laryngeal amyloidosis

Abstract

Background: Amyloidosis is a benign, slowly progressive disease. However, the treatment of laryngeal amyloidosis (LA) has not been studied systematically.

Objectives: To investigate the treatment results of cold micro forceps or carbon dioxide laser under microlaryngoscope in the treatment of LA.

Methods: A retrospective review was conducted for the cases collected from January 1990 to March 2016 at our department.

Results: One hundred and eighteen patients (44 males and 74 females, with an average age of 51.7 years) with LA were identified. The amyloidosis was not found in organs other than the larynges and tracheas. The patients most commonly presented with hoarseness and dyspnea. All patients underwent surgical removal of the amyloid deposits (via micro forceps or CO₂ laser). Twenty-nine patients developed recurrences requiring further treatments. The mean interval from treatments to recurrences in these patients was 16.5 months. Five patients were treated more than once. No significant difference was found between cold micro forceps and CO₂ laser methods in recurrences.

Conclusions: LA generally behaves as a benign disease. Resection of LA either via cold micro forceps or CO₂ laser under microlaryngoscope is both safe and effective methods. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence.     

支撑喉镜下CO2激光喉部分切除最大范围的实验研究

目的 通过实验动物激光手术,探索激光手术治疗声门型和声门型喉癌的安全性和手术切除范围。方法 选实验狗10只,模拟支撑喉镜下CO2激光手术,按标准的喉垂直部分或声门上水平部分切除术的切除范围,完成喉垂直部分切除7只,声门上水平部分切除3只。分别于术后立即(5只)和术后饲养40 d(5只)后麻醉状态下空气栓塞法处死。切除实验狗全喉,连续切片观察切除范围和手术后创面修复情况。结果 10只实验狗手术完成顺利,显微镜下观察满意,达到手术预期的切除范围,大体标本和连续切片观察1-5号狗喉标本,切除范围与手术一致,创面有激光烧灼后的黑色和黄褐色结痂。6-10号狗饲养40 d时处死,创面已修复。结论 动物支撑喉镜下CO2激光手术可完成经典的喉垂直部分切除术和声门上水平部分切除术的软组织切除范围,动物可存活,创面自行修复,提示扩大喉癌激光手术切除范围的可能性。     

Laser-assisted surgery addressing snoring long-term outcome comparing CO2 laser vs. CO2 laser combined with diode laser

Our study encompasses 61 patients (49 men--80.3%; 12 women--19.7%) treated from September 1998 through August 2001. Mean follow-up covers 25 months (range: 7-43 months). Our CO2-LAUP technique involves vaporizing the palatine mucosa along a rectangular surface from the palatal dimple to the base of the uvula; trimming the palatine arches under the velum; and resecting the uvula. For 22 patients, we employed intravelar diode laser coagulation in the expectation of reducing the postoperative pain whilst achieving the same therapeutic effectiveness. There is no pain difference between the CO2-LAUP technique versus that combining intravelar diode laser coagulation with CO2 laser uvula resection and trimming of the palatine arches. Mean maximal pain reaches 6.93 +/- 3.55 with CO2 laser and 6.95 +/- 3.64 with CO2 laser plus diode laser. Similarly, both techniques involve the same mean algesic period of 22 days with the day of maximal pain at 1 week after surgery. Associating base of tongue vaporization significantly increases the algesic period (p = 0.042). No long-term complications were observed in relation to intravelar coagulation or LAUP, whether combined or not with base of tongue vaporization. In terms of patients satisfaction, no significant difference exists between the various surgical techniques of the velum alone. The satisfaction rate reaches 5.26 +/- 3.92 with CO2 laser and 5.82 +/- 2.67 with the CO2 laser plus diode laser. Satisfaction is statistically identical when base of tongue vaporization is included in the procedure.     

CO2激光在喉癌治疗中的应用

1972年Strong和Jako首次用CO2激光治疗早期声门型喉癌获得了良好效果,自此CO2激光以其显著的优势和良好的治疗效果在喉癌治疗中得到广泛推广和应用。在过去的40年,激光手术已成为治疗喉癌的一种方式,并且CO2激光已成为治疗早期喉癌最主要的方式。近年来,一些学者开始应用CO2激光治疗晚期喉癌,且获得了良好的局部控制率、喉功能保留率等治疗效果。本文总结和分析了国内外CO2激光治疗喉癌的近期成果,并对此做一综述。