Complications of CO2 Laser Surgery for Laryngeal Cancer

Abstract

OBJECTIVE:Although PET-CT has been shown to have diagnostic and staging value for the head and neck carcinoma, it still has deficiencies to give an optimal level of sensitivity and specificity. High levels of false positivity continue to be the biggest clinical challenge. This study evaluates the impact of major clinicopathologic factors on PET-CT findings in the primary and lymph node metastatic head and neck carcinoma. METHOD: Retrospective chart review of a case series at Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute: 243 oral cavity (OC) and laryngopharyngeal carcinoma patients who underwent PET CT and neck dissections in the 3 consecutive years were included in the study. Major primary site was OC followed by oropharynx (OP), larynx and hypoharynx (HP) and carcinoma of unknown primary (CUP). RESULTS: Oral cavity and OP were the two major primary sites (70.3%, nϭ171), followed by larynx, CUP, and HP. 111 patients (45.6 %) were determined to be clinically Nϩ at the time of preoperative evaluation, while pathological Nϩ was detected in 36.2% of patients. Correlation of the PET CT SUV value and the clinicopathologic factors like the size of the largest lymph node, number of positive lymph nodes, extracapsular spread, tumor grade, primary site, size and depth of infiltration of the primary tumor, lymphatic and perineural invasion are all compared; correlation was found with the size and depth of infiltration of the tumor, and number of positive lymph node. Perineural (pϭ0.013) and lymphatic invasion (pϭ0.0093), and extracapsular spread (pϽ0.0001) was significantly altering the SUV value. CONCLUSION: Most of the adverse features of the current pathologic staging system are shown to have significant impact on the PET CT findings. Complication Rates in Stapled vs Suture Closure LaryngectomyLarry Myers, MD (presenter); Deborah Larrison, MD OBJECTIVE: Surgical technique, or fear of increased risk of complications including infection and fistula. The purpose of this study was to examine complication rates with the use of the linear stapling device compared with traditional suture techniques during laryngectomy in a matched cohort of patients. METHOD: This investigation was a retrospective, matched cohort design. The records of all patients undergoing total laryngectomy by the senior author were reviewed from 2002 to 2007. Criteria for inclusion in the study were as follows: Patients must have undergone total laryngectomy within the study period. Only patients with endolaryngeal disease or disease amenable to primary closure were included in the study cohort. This resulted in a total of 42 patients being included in the study. Of these, 26 patients underwent traditional suture closure of the pharynx and 16 patients underwent closure with the linear stapling device. Demographic data, clinical data, treatment data, and outcome data were retrospectively collected and stored in an Excel v12.2 database (Microsoft). Data were analyzed using SPSS v16.0 statistical softwa...

Complications after CO2 laser surgery for early glottic cancer: An institutional experience

“…We prescribe all patients proton pump inhibitor therapy immediately postoperatively for a minimum of 4 weeks. Vocal cord granuloma recurrence rates of up to 92% are reported despite careful microsurgical excision . An early second‐look operation enables a thorough examination of the larynx and facilitates simultaneous treatment for local recurrences, division of glottic web, and/or resection of granuloma …”

“…Vocal cord granuloma recurrence rates of up to 92% are reported despite careful microsurgical excision. 22 An early second-look operation enables a thorough examination of the larynx and facilitates simultaneous treatment for local recurrences, division of glottic web, and/or resection of granuloma. 10 Postoperative hemorrhage seems to be the most frequent complication and can be minor, major, or catastrophic.…”

Complications in CO2 Laser Transoral Microsurgery for Larynx Carcinomas

“…Finally, it is important to highlight that the complication rate for glottic, supraglottic, and hypopharyngeal tumors, at all stages, that have been operated on by experienced surgeons ranges between 3% and 19%. 3 12 16 17 This hypothesis may be confirmed by comparing tumor size, tumor location, and level of surgeon experience with the occurrence of complications. 3 Moreover, we must emphasize the limitations of our study.…”

“…As for associating TLM with neck dissection, some authors suggest ligation of the laryngeal branches of the external carotid artery. 12 Moreover, Ellies and Steiner, in a study that included 1,528 patients treated for TLM, showed 4.7% (72 patients) incidence of post-surgical bleeding. External carotid ligation was required on 7 of such cases.…”

“…In our series, no late bleedings were evident; however, we believe these complications should be considered, as they are even more dangerous because the patient is at home and, thus, the possibility of a fatal outcome is higher. 12 For this reason, some authors recommend performing prophylactic electrocoagulation of blood vessels in the laryngeal pedicle. As for associating TLM with neck dissection, some authors suggest ligation of the laryngeal branches of the external carotid artery.…”