Transoral laser microsurgery for advanced laryngeal cancer

OBJECTIVE: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer. DESIGN: Prospective case series study. SETTING: Multi-institution (academic, tertiary referral centers). PATIENTS: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. INTERVENTIONS: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. MAIN OUTCOME MEASURES: End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. RESULTS: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. CONCLUSIONS: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.     

Transoral laser microsurgery in previously irradiated patients with laryngeal cancer

Purpose

Early laryngeal cancer is successfully managed with transoral laser microsurgery. Previously radiated patients may experience more post-operative complications. We investigate disease-free survival and secondarily prolonged pain and chondronecrosis.

Materials and methods

Retrospective review of 52 patients undergoing transoral laser microsurgery after previous radiation.

Results

Mean disease-free survival was 36.7 months. Overall disease-free survival was 57.6% at 3-year and 48.4% at 5-year follow-up, with no significant difference between surgery within as opposed to after 60 months of radiation or within as opposed to after 12 months of radiation. Thirteen patients, all with surgery within 60 months of radiation, experienced prolonged pain. Twelve experienced chondronecrosis, all within 12 months of surgery.

Conclusion

Transoral laser microsurgery for early laryngeal cancer is an adequate therapeutic option in patients with history of radiation with comparable disease-free survival to other reports. Patients undergoing transoral laser microsurgery within 60 months of radiation treatment are more likely to experience prolonged pain.     

喉显微外科激光技术治疗喉癌

激光(light amplification by stimulated emission ofmdiation,Laser)是上世纪60年代以来发展异常迅速的新兴科学技术.世界上第一台激光器是1960年Maiman制造的红宝石激光器,几十年来经过不断改进和发展,已有CO2、掺钕钇铝石榴石(Nd-YAG)、磷酸钛氧钾(KTP)、染料、半导体等多种激光应用于医学临床.     

Long-term results of treatment in T1, T2 laryngeal cancer with CO2 laser microsurgery

The aim of this study was estimation the long term results of CO2 laser therapy in laryngeal cancer. 36 patients with early glottic cancer-T1 and T2 were treated with CO2 laser microsurgery in 1990-1992. The control laryngological, phoniatric and laryngovideostroboscopic examinations were conducted from six to thirty months after the operation. The next controls were done within three years and then after eight to ten years from microsurgery. The local recurrence was observed only during the first control in seven cases--19%. Four patients underwent total laryngectomy after several laser microsurgery, two were treated only with CO2 laser and one had CO-therapy. The better quality of voice was observed during following control examinations. A scar with smooth surface and marge in 29 persons and a tendency to phonatory vibration of scar in 9 patients were noticed in laryngovideostroboscopy examination during the first control. Following examinations showed a progressive improvement of voice parameters.     

支撑喉镜下CO2激光喉肿瘤手术的并发症分析

目的 分析支撑喉镜下CO2激光喉肿瘤手术的并发症.方法对520例喉肿瘤患者支撑喉镜下行CO2激光手术,术后进行并发症分析.结果CO2激光引起的并发症61例,占11.73%;支撑喉镜造成的并发症71例,占13.65%.结论CO2激光喉手术须经支撑喉镜进行,故并发症可分为激光损伤造成的并发症和支撑喉镜造成的并发症.     

Treatment of laryngeal carcinomas by laser endoscopic microsurgery

OBJECTIVES: To determine if laser endoscopic microsurgery is a reliable and appropriate approach in the treatment of laryngeal cancers. STUDY DESIGN: Retrospective study of 160 patients treated from 1988 to 1996 at Liège. Analysis of indication, technique, and oncologic results. METHODS: Glottic tumors were treated with either type I, type II, or type III cordectomy, with or without conservation of an inferior muscular band, and extended if necessary to all or part of the contralateral cord. For supraglottic cancers, an excision limited to a part of the vestibule, a trans-preepiglottic resection, or a radical supraglottic resection was carried out. RESULTS: Our corrected actuarial survival at 5 years was 97% for the 98 infiltrative glottic tumors and 100% for the 18 infiltrative supraglottic and 27 in situ carcinomas. No local recurrences were noted, in either the group of 118 infiltrating cancers (in whom two precancerous lesions were treated with a further laser excision), or in the 27 in situ carcinomas. Local control was thus 100%. One patient died of his cancer, with lung metastases after neck recurrence. CONCLUSIONS: Like Steiner and Rudert, this series demonstrates the oncologic validity of this surgical approach to the treatment of unadvanced glottic tumors. Unlike these authors' study, however, strict case selection, as in cases with significant involvement of the anterior commissure, has allowed us to avoid local recurrences and consequently to avoid salvage total laryngectomies. Our experience with supraglottic cancers is too small to confirm the oncologic validity of this type of surgery but seems promising.     

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。     

Combined therapy with Isoprinosine and CO2 laser microsurgery for the treatment of laryngeal papillomatosis

Summary Recurrent laryngeal papillomas and their potential malignant degenerations in adult patients have been known clinically for about 100 years. An early effective treatment has great importance in preventing possible obstruction of the airway or malignant change. The use of endoscopic microsurgery with the CO₂ laser has resulted in a significant improvement in the eradication of papillomatous nodules. The advantages of laser surgery are: better visualization of the larynx to allow more precise and deeper resection of papillomas, limited bleeding, and a reduced possibility of seeding uninvolved mucosa. Although laser surgery is the current method of choice for treating laryngeal papillomatosis, it has not solved completely the problems of recurrences. To make treatment more effective, we have developed a therapeutic regimen that combines laser microsurgery with the immunostimulant methisoprinol (Isoprinosine). Our observations in 18 patients have shown that this combined management was more successful than using a single modility with either the laser or Isoprinosine alone. The combined approach was also effective in recurrent cases, with the timing of the combination influencing the results of the treatment given.     

Combined therapy with isoprinosine and CO2 laser microsurgery for the treatment of laryngeal papillomatosis

Recurrent laryngeal papillomas and their potential malignant degenerations in adult patients have been known clinically for about 100 years. An early effective treatment has great importance in preventing possible obstruction of the airway or malignant change. The use of endoscopic microsurgery with the CO2 laser has resulted in a significant improvement in the eradication of papillomatous nodules. The advantages of laser surgery are: better visualization of the larynx to allow more precise and deeper resection of papillomas, limited bleeding, and a reduced possibility of seeding uninvolved mucosa. Although laser surgery is the current method of choice for treating laryngeal papillomatosis, it has not solved completely the problems of recurrences. To make treatment more effective, we have developed a therapeutic regimen that combines laser microsurgery with the immunostimulant methisoprinol (Isoprinosine). Our observations in 18 patients have shown that this combined management was more successful than using a single modility with either the laser or Isoprinosine alone. The combined approach was also effective in recurrent cases, with the timing of the combination influencing the results of the treatment given.     

Application of laser surgery to the treatment of laryngeal cancer

The authors utilized CO2 laser to treat laryngeal cancer in 28 patients. The operative methods were the following: Method I. Glottic T1 tumor was completely vaporized by laser irradiation alone. This method was employed in cases without involvement of the anterior commissure and cartilagenous portion. Method II. Radiotherapy was carried out after removal of major lesion by laser surgery. The purpose of this method was to improve the success rate of radiotherapy. Method III. After radiotherapy laser surgery was done to remove residual tumor as far as possible in patients who could not undergo radical surgery due to poor general condition. Method I, or complete tumor resection by laser surgery alone, seemed profitable because of short admission period. It is, however, indispensable to select patients suitable for this treatment. Method II permitted improving the success rate of radiotherapy. Even after vaporizing major lesion by laser irradiation, 60Gy irradiation was required. Method III, or laser surgery on postradiation residual tumor was often useful to treat the patients with poor general condition or who refused more radical surgery.     

Laser transoral microsurgery in treatment of early laryngeal carcinoma

European Archives of Oto-Rhino-Laryngology - Laser transoral laryngeal microsurgery has become widely accepted treatment method because of its organ and function preservation and shorter period of...     

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.     

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer

IntroductionTrans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer.ObjectiveThe authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins.MethodsForty-four consecutive T1–T2 glottic cancers treated with trans-oral laser microsurgery Type I–VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section.ResultsOur study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively.ConclusionThe intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.