Transoral Laser Microsurgery in Early Glottic Lesions

Sjögren, E.V.

doi:10.1007/s40136-017-0148-2

Cited by 55 publications

(58 citation statements)

References 106 publications

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“…These rates are comparable with large series in literature, although the 5-year LC for T1 tumours is in the lower range [33]. A detailed analysis of our local control rates showed that the higher percentage of recurrence is related to a learning curve.…”

Section: Discussionsupporting

confidence: 88%

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Hendriksma

Montagne

Langeveld

et al. 2018

Eur Arch Otorhinolaryngol

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PurposeTo assess the impact of surgical margins status on local control in patients with primary early glottic (Tis-T2) squamous cell carcinoma after treatment with transoral CO2 laser microsurgery (TLM) and to assess the significance of additional wound bed biopsies.MethodsPatients with Tis-T2 tumours treated with TLM type I–III resections according to the European Laryngological Society classification between 2009 and 2013 were included in retrospective analysis. Recurrence rate was determined in patients with free versus non-free specimen margins and wound biopsies. Five-year survival rates were determined using the Kaplan–Meier method. Prognostic impact of pT-category, resection margin status, tumour differentiation, wound bed biopsy status, and number of biopsies on local control (LC) were tested with the log-rank test.ResultsEighty-four patients were included in the analysis. Positive margins were seen in 68 patients (81.0%). Margin status after TLM did not significantly influence LC (p = 0.489), however, additional wound bed biopsies were significantly associated with lower LC (p = 0.009). Five-year LC, disease-specific survival, overall survival and laryngeal preservation were 78.6, 78.0, 98.6 and 100%, respectively.ConclusionsAdditional wound bed biopsies can help predict local recurrence in patients treated with TLM for early glottic carcinoma. We propose that there is enough evidence to support a wait-and-see policy in patients with positive specimen margins and negative wound bed biopsies. For patients with positive wound bed biopsies, further treatment is warranted.

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Section: Discussionsupporting

confidence: 88%

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Hendriksma

Montagne

Langeveld

et al. 2018

Eur Arch Otorhinolaryngol

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In series with T1 midcord tumors the risk of local relapse is usually under 6%. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In series with T1 midcord tumors the risk of local relapse is usually under 6%.…”

Section: Discussionmentioning

confidence: 99%

“…2,11 For this reason, many authors have established the indications of TLM only for early carcinomas. 2,11 For this reason, many authors have established the indications of TLM only for early carcinomas.…”

Section: Local Extension Of the Tumormentioning

confidence: 99%

“…8 In his article, he expressed the difficulties to manage infiltrating tumors of the AC and suggested that development of transoral procedures should focus on complete transoral resection of the anterior part of the thyroid cartilage or at least thermal sterilization of that area. 2 However, other authors have expressed contrary opinions. 33 In the literature, special emphasis is taken to distinguish between those tumors that grow in the horizontal plane of the AC from those growing in the cranial-caudal plane, which require a more aggressive approach.…”

Section: Local Extension Of the Tumormentioning

confidence: 99%

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Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

et al. 2018

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Background Indications of transoral laser microsurgery (TLM) are conditioned by the risk of local relapse. Objective To evaluate prognostic factors of local relapse and local control with TLM (LC‐TLM). Methods Local relapse and LC‐TLM were evaluated in 1119 patients. Logistic regression and CHAID decision tree analysis were performed. Results Local relapse correlated to previous radiotherapy failure (8.45, CI 95%: 2.64‐27.03; P < .001), paraglottic involvement (2.42, CI: 1.41‐4.15; P = .001), anterior commissure involvement (2.12, CI: 1.43‐3.14; P < .001), grade of differentiation (1.74, CI: 1.18‐2.57; P = .005), and alcohol consumption (1.4, CI: 0.99‐1.98; P = .057). Local relapse tended to inversely correlate with experience (0.73, CI: 0.51‐1.03; P = .078). The most important factors for local relapse were previous radiotherapy failure and anterior commissure involvement. LC‐TLM inversely correlated with previous radiotherapy failure (0.09, CI: 0.03‐0.28; P < .001), paraglottic involvement (0.25, CI: 0.14‐0.43; P < .001), anterior commissure involvement (0.49, CI: 0.32‐0.77; P = .007), margins (0.56, CI: 0.30‐1.04; P = .068), and differentiation (0.68, CI: 0.44‐1.05; P = .087). LC‐TLM correlated with experience (1.71, CI: 1.13‐2.55; P = .010). The most important factors for LC‐TLM were previous radiotherapy failure and paraglottic involvement. Conclusion Previous radiotherapy failure is the most important factor for local relapse and LC‐TLM. In primary treatments, anterior commissure involvement and paraglottic involvement are the most important factors for local relapse and LC‐TLM, respectively.

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“…Moreover, when the tumor extends to the anterior commissure (AC), poorer voice outcome is seen, regardless of the treatment modality . When treated with TLM, the best voice results are achieved when the AC can be left intact along with part of the vocal fold muscle …”

Section: Introductionmentioning

confidence: 99%

Voice outcome after unilateral ELS type III or bilateral type II resections for T1‐T2 glottic carcinoma: Results after 1 year

et al. 2019

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Background Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification. Methods Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure. Results The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5. Conclusion Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.

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Transoral Laser Microsurgery in Early Glottic Lesions

Cited by 55 publications

References 106 publications

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

Voice outcome after unilateral ELS type III or bilateral type II resections for T1‐T2 glottic carcinoma: Results after 1 year

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