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

Abstract

Background: To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. Methods: Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. Results: The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1 .537-8.495]) and posterior ) PGS involvement were

Magnetic resonance imaging to assess cartilage invasion in recurrent laryngeal carcinoma after transoral laser microsurgery

“…In a retrospective series of 15 patients treated by salvage TL for recurrences after CO 2 TOLMS, Horwich et al 23 found a high prevalence of cartilage invasion (at the level of the thyroid and cricoid in 66% and 60% of patients, respectively), probably reflecting the three most frequent areas of failure of tumour control by transoral surgery, i.e. the anterior commissure (especially in the presence of transcommissural tumours), the subglottis, and the posterior paraglottic space 5 , 23 . In our series, the rate of invaded cartilages was much lower, presumably indicating that recurrences had been detected earlier, thanks to our proactive policy of systematic imaging follow-up in high-risk T2-T3 glottic cancers 11 .…”

“…Carbon dioxide transoral laser microsurgery (CO 2 TOLMS) as defined by the European Laryngological Society (ELS) 1 is a well-established treatment option for early (T1-T2) and selected T3 glottic tumours [2][3][4][5] . When compared to open surgery, assessment of tumour margins during and after CO 2 TOLMS is hampered by thermal damage and shrinkage of the small specimens, potentially reaching 29% in its anteroposterior length 6 .…”

The inside‐out surgical anatomy of the paraglottic space a video‐guided endoscopic dissection

“…The paraglottic space is of utmost importance regarding laryngeal cancer spread 7,8 . The local spread of laryngeal cancer depends primarily on its site of origin, which is predominantly the mucosa.…”

“…The paraglottic space is of utmost importance regarding laryngeal cancer spread. 7 , 8 The local spread of laryngeal cancer depends primarily on its site of origin, which is predominantly the mucosa. The route of invasion is highly determined by the anatomy of the adjacent tissues, especially their muscular content.…”

Kommentar zu „Glottiskarzinom: präoperative Diagnostik zur Einschätzung der Tumorausbreitung“

“…des Ary kontraindiziert sein kann und andere Möglichkeiten der chirurgischen Tumor Entfernung diskutiert werden müssen, wie eine horizontale supraglottische Teilresektion, eine totale Laryngektomie oder auch ein nichtoperatives Vorgehen mittels Radiochemotherapie [3,4]. In multivariaten Analysen sind die Fixation des Arytenoidgelenks durch eine Tumorinfiltration und die Infiltration des posterioren und inferioren PGR unabhängige Variablen für die lokale Tumorkontrolle [5]. Daher kommt der präthera-…”