Treatment for T3 to T4a laryngeal cancer by open partial horizontal laryngectomies: Prognostic impact of different pathologic tumor subcategories

Succo, Giovanni; Crosetti, Erika; Bertolin, Andy; Piazza, Cesare; Molteni, Gabriele; Cirillo, Stefano; Petracchini, Massimo; Tascone, Martina; Sprio, Andrea Elio; Berta, Giovanni Nicolao; Peretti, Giorgio; Presutti, Livio; Rizzotto, Giuseppe

doi:10.1002/hed.25176

Cited by 48 publications

(74 citation statements)

References 25 publications

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“…The recent literature increasingly focuses on the prognostic meaning of glottic localization of the disease. Succo et al showed significantly better oncological outcomes for primary OPHL in patients with locally intermediate–advanced stage disease involving the anterior glottis, if compared with posterior localizations . It would be interesting to know if the distinction of anterior versus posterior localization of both primary and recurrent diseases could be informative to predict success after salvage surgery.…”

Section: Resultsmentioning

confidence: 99%

Salvage open partial horizontal laryngectomy after failed radiotherapy: A multicentric study

et al. 2019

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Objectives The primary aim of the present study was to report our multi‐institutional experience in surgical salvage with open partial horizontal laryngectomies (OPHL) after failed radiotherapy (RT) for laryngeal squamous cell carcinoma (LSCC). Secondary aims were to analyze the prognostic meaning of the main clinical and pathological parameters in relation to the oncologic outcome and to compare our results with the available literature. Study Design A retrospective multicenter analysis of surgical oncological outcomes. Methods We retrospectively review the clinical charts of 70 recurrent LSCC patients after primary RT failure undergone salvage OPHL. Results At last follow‐up, 46 patients (65%) were disease‐free; six (9%) were alive with disease; nine (12%) died because of the disease; and nine (12%) died without evidence of disease. The final local control, overall survival, disease‐specific survival, and laryngectomy‐free survival were 87%, 75%, 87%, and 91%, respectively. Twelve patients (17%) experienced postoperative complications, whereas 18 patients (25%) experienced late sequelae. In five patients (7%), decannulation was not possible because of postoperative laryngeal stenosis. Conclusion In selected patients, when proper selection criteria for conservation laryngeal surgery are adopted, OPHL can be considered for salvage after RT failure. Level of Evidence 4 Laryngoscope, 130:431–436, 2020

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Section: Resultsmentioning

confidence: 99%

Salvage open partial horizontal laryngectomy after failed radiotherapy: A multicentric study

et al. 2019

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“…In view of its excellent negative predictive value, MR may represent a useful tool for differentiating patients with arytenoid immobility due to neoplastic involvement (cT3/pT3) from those in which arytenoid fixation has inflammatory causes (cT3/pT2). Indeed, this can greatly influence treatment choice, favoring conservative approaches aimed at preserving laryngeal function, as well as requiring elective management of neck lymph nodes or predicting postoperative adjuvant treatments [4,13,14,15,16]. …”

Section: Discussionmentioning

confidence: 99%

“…Anatomical section representing the glottic plane on a transverse section: dashed line (“magic plane” according to Succo et al [4]) indicates the limit dividing the anterior (green) from the posterior (red) laryngeal compartments. Legend: Ac, arytenoid cartilage; tc, thyroid cartilage; vm, vocal muscle.…”

Section: Figurementioning

confidence: 99%

“…This leads to substantial diagnostic uncertainty, since these conditions have relevant and dissimilar clinical implications. For example, in a recently published multicentric study on T3 and T4 laryngeal SCC treated by open partial horizontal laryngectomies (OPHLs), pT3 tumors with posterior laryngeal compartment (PLC) invasion (i.e., the paraglottic space located posterior to a line drawn from the arytenoid vocal process perpendicularly to the thyroid cartilage, of which the CAU represents a key structure) demonstrated significantly worse prognosis than anteriorly located pT4 lesions [4]. For this reason, the theoretical plane dividing the anterior from the PLC was also called by the authors the “magic plane” (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Posterior Paraglottic Space and Cricoarytenoid Unit Involvement in Endoscopically T3 Glottic Cancer with Arytenoid Fixation by Magnetic Resonance with Surface Coils

Ravanelli

Paderno

Bon

et al. 2019

Cancers

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Discrimination of the etiology of arytenoid fixation in cT3 laryngeal squamous cell carcinoma (SCC) is crucial for treatment planning. The aim of this retrospective study was to differentiate among possible causes of arytenoid fixation (edema, inflammation, mass effect, or tumor invasion) by analyzing related signal patterns of magnetic resonance (MR) in the posterior laryngeal compartment (PLC) and crico-arytenoid unit (CAU). Seventeen patients affected by cT3 glottic SCC with arytenoid fixation were preoperatively studied by state-of-the-art MR with surface coils. Different signal patterns were assessed in PLC subsites. Three MR signal patterns were identified: A, normal; B, T2 hyperintensity and absence of restriction on diffusion-weighted imaging (DWI); and C, intermediate T2 signal and restriction on DWI. Signal patterns were correlated with the presence or absence of CAU and PLC neoplastic invasion. Patients were submitted to open partial horizontal or total laryngectomy and surgical specimens were analyzed. Pattern A and B did not correlate with neoplastic invasion, while Pattern C strongly did (Spearman’s coefficient = 0.779, p < 0.0001; sensitivity: 100%; specificity: 78%). In conclusion, MR with surface coils is able to assess PLC/CAU involvement with satisfactory accuracy. In absence of Pattern C, arytenoid fixation is likely related to mass effect and/or inflammatory reaction and is not associated with neoplastic invasion.

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“…As emphasized in recent work, surgical ability (as a matter of fact, the success of a procedure requires millimetric accuracy) and strict patient selection are mandatory for good results 7,8,9 . In good hands, and if applied to the proper patients and diseases, TLM and OPHL exhibit solid surgical and survival outcomes.…”

Section: Introductionmentioning

confidence: 99%

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Crosetti

Fantini

Lancini

et al. 2020

JoVE

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Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course "Lary-Gym". Further perspectives on robotic surgical training are described.

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Treatment for T3 to T4a laryngeal cancer by open partial horizontal laryngectomies: Prognostic impact of different pathologic tumor subcategories

Abstract: Anterior cT3 tumors are manageable by OPHL, and this approach could also be proposed in the treatment of early anterior cT4aN0. Despite promising results, OPHLs should be considered under investigation in posterior cT3 tumors due to clinical and biological behavior similar to cT4a tumors.

Cited by 48 publications

References 25 publications

Salvage open partial horizontal laryngectomy after failed radiotherapy: A multicentric study

Salvage open partial horizontal laryngectomy after failed radiotherapy: A multicentric study

Prediction of Posterior Paraglottic Space and Cricoarytenoid Unit Involvement in Endoscopically T3 Glottic Cancer with Arytenoid Fixation by Magnetic Resonance with Surface Coils

Learning Modern Laryngeal Surgery in a Dissection Laboratory

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