Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure?

Abstract

Objectives: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. Methods: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. Results: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). Conclusion: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.

Chirurgische Rekonstruktionen beim Larynxkarzinom

“…Narben können durch ein primär rekonstruktives Vorgehen kompensiert oder in ihrem Ausmaß positiv beeinflusst werden. [8,23].…”

The Same–Up–Down Staging System for Recurrent Early Glottic Cancer

“…Exclusive radiotherapy (RT) or surgery, mostly in the form of transoral laser microsurgery (TLM), are the two main primary treatment options, with comparable results in terms of survival even in the most recent series [1,5]. With the ultimate aim of optimizing the functional outcomes, TLM is performed in the most conservative way, because tumor-free margins of one millimeter are usually sufficient and lead to the voice recovering faster [6,7]. On the other hand, new RT techniques are being investigated, such as single vocal cord irradiation (with apparently good results) [8] or the use of stereotactic RT, which is still in its preliminary phase [9,10].…”