CO2 Transoral Microsurgery for Supraglottic Squamous Cell Carcinoma

Abstract

The present study analyzed the results of the endoscopic approach to T1, T2 and selected T3 supraglottic carcinoma with the aim of reviewing functional and oncologic outcomes after different types of endoscopic supraglottic laryngectomies. This is a retrospective clinical study of 42 consecutive patients (mean age of 61.8 years, 33 males, 9 females) treated by the senior author for supraglottic squamous cell carcinoma with a transoral CO2 laser approach and reviewed from November 2010 to September 2017. Surgical procedures were classified according to the European Laryngological Society. In addition to the standardized transoral supraglottic laryngectomies, we introduced a modified type IVb by sparing the inferior third of the arytenoid if not directly involved in the tumor. Swallowing was evaluated with the Swallowing Performance Status Scale reported by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. Survival probabilities were estimated using Kaplan-Meier curves. Two type I, 2 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 3 type modified IVb, and 5 type IVb supraglottic laryngectomies were performed. Twenty-one patients (50%) underwent primary neck dissection. The pathologic TNM classification according to the 8th edition of the American Joint Committee on Cancer system was as follows: 9 pT1cN0, 2 pT1N0, 1 pT1N1, 7 pT2cN0, 1 rypT2cN0, 9 pT2N0, 4 pT2N1, 2 ypT2N1, 2 pT3cN0, 2 rypT3cN0, 1 pT3N1, and 2 pT3N2b. Mean follow-up was 3.4 years (range of 9 months to 6 years). According to the Kaplan–Meier analysis, 5-year disease-specific survival, local-relapse-free survival, nodal-relapse-free survival, overall laryngeal preservation and overall survival of patients without previous head and neck radiotherapy/open surgery were 100%, 95.2%, 87.8%, 100%, and 64.6%, respectively. Patients who underwent type I, IIa, and IIb resections (n = 6) started oral feeding the day after surgery, patients who underwent type III-IVb modified resections (n = 31) started oral feeding 3–4 days after surgery, and patients who underwent standard type 4b resections (n = 5) started oral feeding 7 days after surgery. Three months after surgery, patients without a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed significantly better swallowing compared to patients who underwent standard type IVb resection: grade 4–6 impairment of swallowing in 8 and 66.7% of cases, respectively (p = 0.006072); patients with a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed not statistically significant better swallowing compared to patients who underwent standard type IVb resection: grade 4–6 impairment of swallowing at 3 months in 16.7% and 50% of cases, respectively (p = 0.23568). Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to traditional open neck surgery and chemo-radiotherapy. Recovery o...

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

“…Consequently, if the approximation of false vocal folds and arytenoids to epiglottic petiole is restored, airway protection may still be guaranteed [ 29 ]. However, to ensure maintenance of sphincteric mechanisms, it is of crucial importance to preserve at least the postero-lateral part of the arytenoid to allow the anatomical integrity of the hypopharyngo-laryngeal wall, thereby minimizing the risk of swallowing disorders [ 36 , 37 ].…”

Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments

“…Other experienced surgeons agree that the best candidates are T3 laryngeal tumors located in the anterior compartments of the larynx. 8,[17][18][19] T4a tumors are generally excluded from transoral approach except for very selected cases, and those diagnosed mainly intraoperatively. On the contrary, controversy exists in the literature regarding the indications of tumors with invasion of the vertical plane of the anterior commissure where, if feasible, supracricoid laryngectomy has demonstrated better local control than TOLMS.…”

Laser Microsurgery Versus Radiotherapy Versus Open Partial Laryngectomy for T2 Laryngeal Carcinoma: A Systematic Review of Oncological Outcomes

“…However, Hoffmann et al (96 patients) and Carta et al (105 patients), in large sample-sized studies, revealed a significantly increased risk for local recurrences in patients with extensive infiltration of the AC. 59,63,80…”

“…However, Hoffmann et al (96 patients) and Carta et al (105 patients), in large sample-sized studies, revealed a significantly increased risk for local recurrences in patients with extensive infiltration of the AC. 59,63,80 The vertical plane of the AC has been identified as a laryngeal subsite at risk for local treatment failures. [81][82][83][84] In the ventral compartment, cancer can easily diffuse superficially along the ventral mucosa containing blood vessels and glands; this diffusion usually follows a cranial-to-caudal direction.…”

“…Laccourreye et al 79 found that among 416 patients with T1 or T2 laryngeal cancers undergoing vertical partial laryngectomies, the failure rate was 23% if the AC was involved; higher than at other anatomic subsites. Studies on CO 2 TOLMS [52][53][54]58,59,63 and studies on RT 20,21,24,25,76 analyzed the involvement of the AC and concluded that its involvement did not result in a significantly lower overall survival rate. However, Hoffmann et al (96 patients) and Carta et al (105 patients), in large sample-sized studies, revealed a significantly increased risk for local recurrences in patients with extensive infiltration of the AC.…”