Relationship between CO<sub>2</sub> laser–induced artifact and glottic cancer surgical margins at variable power doses

Buchanan, Malcolm A.; Coleman, Hedley; Daley, James M.; Digges, James; Sandler, Mark; Riffat, Faruque

doi:10.1002/hed.24076

Cited by 9 publications

(14 citation statements)

References 42 publications

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“…This is very likely due to the fact that, in nearly half of our cases, accurate histopathological assessment of surgical margins could not be carried out due to thermal damage of the tissue. This problem in laser surgery has been reported before . Positive tumor margins are a common finding in TLS for laryngeal cancer, because preserving laryngeal function is an important treatment goal besides complete tumor removal .…”

Section: Discussionmentioning

confidence: 53%

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Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

et al. 2017

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Section: Discussionmentioning

confidence: 53%

“…This problem in laser surgery has been reported before. 32 Positive tumor margins are a common finding in TLS for laryngeal cancer, because preserving laryngeal function is an important treatment goal besides complete tumor removal. 33 Small laryngeal cancers can be removed with minimal margins and still be oncologically safe.…”

Section: Surgical Marginsmentioning

confidence: 99%

Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

et al. 2017

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“…10,11 In a study evaluating the surgical margin after CO 2 laser surgery in T is , T1, and T2 glottic carcinoma, Buchanan et al even observed an inverse relationship between power and thermal tissue damage. 9 Remarkably, none of these studies considered laser duration. Buchanan et al proposed that this inverse correlation could be an indirect effect; using laser irradiation at higher power intensities led to an increase in cutting speed and therefore shorter procedural time, thereby leading to less thermal damage.…”

Section: Discussionmentioning

confidence: 99%

“…2 Few studies were published investigating thermal effects of CO 2 lasers, either using a fiber [5][6][7] or an articulated arm delivery system. 3,[8][9][10][11][12][13] However, none of these studies performed a systematic and complete analysis of the effects of individual CO 2 laser settings. Hence, the exact effect of adjusting laser settings on thermal energy produced by the laser, the depth of laser incision, and the thermal damage to surrounding tissue remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Settings for Office‐Based Endoscopic CO₂ Laser Surgery Using an Experimental Vocal Cord Model

et al. 2020

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Objectives/Hypothesis: To provide insight in the thermal effects of individual laser settings in target tissues to optimize flexible endoscopic CO 2 laser surgery treatment. Study Design: Experimental laboratory study. Methods: Thermal effects of the CO 2 laser using a fiber delivery system were visualized using the color Schlieren technique in combination with a polyacrylamide gel tissue model. Variable settings were used for emission mode, power, laser fiber distance, and laser duration, which were evaluated in every possible combination. Collateral thermal expansion and incision depth were measured. To validate the model, the results were compared to histology after CO 2 laser irradiation of ex vivo human vocal cords, and the intraclass correlation coefficient was calculated. Thermal damage and incision depth were measured by a blinded pathologist. Results: Of all parameters studied, duration of laser irradiation had the greatest effect on thermal expansion. Increased distance between laser tip and target tissue resulted in significantly reduced incision depth and increased thermal expansion. Pulsed emission modes led to increased incision depths. The intraclass correlation coefficient for consistency between the model setup and the ex vivo human vocal cords was classified as "fair." Conclusions: By using high-intensity pulsed lasers at minimal distance to the target tissue, exposure times and subsequent damage to surrounding tissue can be reduced. If an evaporation technique is used, lower power in continuous wave at a larger distance to the target tissue will lead to superficial but broader thermal effects. The model setup used in this study is a valid model to investigate laser-induced thermal effects in vocal cord tissue.

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“…In their study, Buchanan et al 29 pointed out that the CO 2 laser induces a thermal cytologic damage that could result in misinterpretation or difficult assessment of margin status. In particular, they report that the CO 2 laser at a higher power causes less tissue damage thanks to the greater speed of the beam and, consequently, reduced contact between it and the cell.…”

Section: Challenges In the Histological Assessment Of Resection Marginsmentioning

confidence: 99%

Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

Verro

Greco

Chianetta

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points

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Relationship between CO₂ laser–induced artifact and glottic cancer surgical margins at variable power doses

Cited by 9 publications

References 42 publications

Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

Optimizing Settings for Office‐Based Endoscopic CO₂ Laser Surgery Using an Experimental Vocal Cord Model

Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

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Relationship between CO2 laser–induced artifact and glottic cancer surgical margins at variable power doses

Cited by 9 publications

References 42 publications

Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

Optimizing Settings for Office‐Based Endoscopic CO2 Laser Surgery Using an Experimental Vocal Cord Model

Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

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Product

Resources

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Relationship between CO₂ laser–induced artifact and glottic cancer surgical margins at variable power doses

Optimizing Settings for Office‐Based Endoscopic CO₂ Laser Surgery Using an Experimental Vocal Cord Model