1
|
Crosetti E, Fantini M, Bertotto I, Bertolin A, Arrigoni G, Lorenzi A, Succo G. Current Status of Partial Laryngeal Surgery for Advanced Laryngeal Cancer: When and Why? Curr Oncol Rep 2024:10.1007/s11912-024-01516-7. [PMID: 38647994 DOI: 10.1007/s11912-024-01516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This paper aims to evaluate the evolution and current status of partial laryngeal surgery in the treatment of advanced laryngeal cancer (LC). Specifically, recent progress in the selection of both patients and tumors, together with surgical and rehabilitation innovations, have contributed to balancing oncological control with the maintenance of quality of life in naïve and radiorecurrent patients. The main aspect is represented by the recognized role of open partial horizontal laryngectomies (OPHLs) in this new era of laryngeal cancer treatment. RECENT FINDINGS Recent advancements highlight OPHLs' efficacy for conservative management of intermediate to advanced stages of LC. Innovations such as supratracheal partial laryngectomy have expanded surgical options, offering a modular approach to complex cases. Improved understanding of tumor biology, enhanced imaging techniques, and more precise preoperative planning have led to better patient outcomes, emphasizing the importance of a conservative function-preserving surgical treatment. These advancements reflect a broader trend towards individualized treatment plans that prioritize both survival and quality of life. OPHLs play an important role in current management of intermediate/advanced LC, effectively balancing oncological control with the preservation of laryngeal functions. Critical factors include meticulous patient and tumor selection, the impact of surgical and technological refinements on functional outcomes, and the necessity of a multidisciplinary approach in treatment planning. Current evidence justifies the use of these interventions in many intermediate T-stage laryngeal tumors, even at risk of upstaging on pathological examination. The oncological results, the preservation of laryngeal function and the laryngectomy-free survival achieved with OPHLs appear to be highly competitive with those of non surgical organ-preservation protocols, aiming to introduce a new standard in the LC treatment.
Collapse
Affiliation(s)
- Erika Crosetti
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Marco Fantini
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Department, Candiolo Cancer Institute - IRCCS, Candiolo, TO, Italy
| | - Andy Bertolin
- ENT Department, Vittorio Veneto Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giulia Arrigoni
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Lorenzi
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy.
- Department of Oncology, University of Turin, Turin, Italy.
| |
Collapse
|
2
|
Baguant A, Aboussouan MP, Castellanos PF, Atallah I. Decannulation of Tracheostomy-Dependent Patients: Results and Review of Techniques of Reconstructive Transoral Laser Microsurgery. Ann Otol Rhinol Laryngol 2023; 132:361-370. [PMID: 35686520 DOI: 10.1177/00034894221097183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to demonstrate the benefit of reconstructive transoral laser microsurgery (R-TLM) in decannulation of tracheostomy-dependent patients with airway obstruction. METHODS A consecutive series of tracheostomy-dependent patients who underwent R-TLM using multiple techniques described in our previous works, were reviewed for outcomes especially for decannulation. Full airway examination was essential to determine the anatomical and functional sites of obstruction to establish the surgical plan including R-TLM techniques needed to improve airway prior to permanent decannulation. RESULTS Twenty-two patients were treated. Eighteen subjects were successfully decannulated. Single or multiple R-TLM surgical technique(s) was/were performed during the same surgery to treat upper airway stenosis at the level of the hypopharynx, larynx, and trachea. The mean number of surgeries per patient was 2.1. Patients were followed up for at least 12 months. CONCLUSION R-TLM combines different surgical techniques which can be used individually or combined in a stepwise surgical plan for permanent decannulation of tracheostomy-dependent patients with a previous history of decannulation failure secondary to airway obstruction. Accurate preoperative examination gives valuable information about airway and allows establishing a stepwise surgical plan that may need multiple surgeries for full permanent decannulation of these patients.
Collapse
Affiliation(s)
- Ashley Baguant
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie-Pierre Aboussouan
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Ihab Atallah
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France.,School of Medicine, Grenoble Alpes University, Domaine de la Merci, Grenoble, France
| |
Collapse
|
3
|
Bertolin A, Lionello M, Ghizzo M, Barbero E, Crosetti E, Rizzotto G, Succo G. Modular approach in OPHL: are there preoperative predictors? ACTA ACUST UNITED AC 2021; 40:352-359. [PMID: 33299225 PMCID: PMC7726649 DOI: 10.14639/0392-100x-n0782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
Abstract
Objective Open partial horizontal laryngectomies (OPHLs) nowadays represent the first line surgical choice for the conservative treatment of locally intermediate and selected advanced stage laryngeal cancers. Among the peculiarities of OPHLs, there is the possibility of intraoperatively modulating the procedure. It would be useful for the surgeon to recognise preoperative endoscopic and radiological factors that can predict the possibility to modulate the laryngectomy. Methods The present study retrospectively reviewed a cohort of 72 patients who underwent OPHL for glottic LSCC, in order to identify preoperative (endoscopic and radiological) parameters that are able to predict modulation surgery. Results The hypoglottic extension of the glottic tumour was the preoperative finding that was most informative in predicting OPHL modulation. However, it had no significant impact on oncological outcomes. Conclusions Patients affected by tumours with hypoglottic extension and eligible for OPHL type II should be preoperatively informed about the possibility of an intraoperative switch towards OPHL type III.
Collapse
Affiliation(s)
- Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | | | - Marco Ghizzo
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | - Emanuela Barbero
- Otorhinolaryngology Service, University of Eastern Piedmont, Novara, Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | | | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
| |
Collapse
|
4
|
Basterra J, Oishi N, López I, Otero M, Sánchez A, Zapater E. Use of monopolar microelectrodes and radiofrequency in the treatment of arytenoid edema after partial horizontal laryngectomy and radiotherapy. Head Neck 2021; 43:3245-3248. [PMID: 34309107 DOI: 10.1002/hed.26823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022] Open
Abstract
We evaluated the tissue reduction effects using monopolar microelectrodes (MME) coupled to a radiofrequency (RF) generator in arytenoid edema caused by postoperative radiotherapy in larynx. This is a retrospective transversal study, which included 15 patients with supraglottic laryngeal carcinoma. All the patients had undergone a partial horizontal laryngectomy and bilateral neck dissection followed by postoperative radiotherapy. The studied group of patients presented laryngeal stenosis defined by arytenoid edema as a complication, requiring permanent tracheostomy for mean of 12 months. The surgical procedure for treating the edema was the transoral approach of the larynx by microlaryngoscopy under general anesthesia; using 180° MME coupled to a 4-MHz RF generator delivering 15 W using coagulation mode. A total of 11 (73%) patients were decannulated. The median time for decannulation was 10 weeks. No complications were reported. After 2 years of follow-ups, no case of re-stenosis was found. MME coupled to RF is a very efficient method to treat arytenoid edema after adjuvant radiotherapy.
Collapse
Affiliation(s)
- Jorge Basterra
- Valencia Medical School, University General Hospital of Valencia, Valencia, Spain
| | - Natsuki Oishi
- ENT Department, University General Hospital of Valencia, Valencia, Spain
| | - Isabel López
- ENT Department, University General Hospital of Valencia, Valencia, Spain
| | - María Otero
- Department of Anesthesia, University General Hospital of Valencia, Valencia, Spain
| | - Alvaro Sánchez
- ENT Department, University General Hospital of Valencia, Valencia, Spain
| | - Enrique Zapater
- Valencia Medical School, University General Hospital of Valencia, Valencia, Spain.,ENT Department, University General Hospital of Valencia, Valencia, Spain
| |
Collapse
|
5
|
Yu L, Zheng M, Ren J, Hu J, Lu D, Yang H. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for patients with laryngeal cicatricial stenosis: Safety and efficacy. Head Neck 2021; 43:2634-2643. [PMID: 33942931 DOI: 10.1002/hed.26734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We assessed the safety and efficacy of supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in patients with laryngeal cicatricial stenosis. METHODS Sixteen patients receiving SCL-CHEP for severe laryngeal cicatricial stenosis between 2017 and 2018 were reviewed. Decannulation rate and tracheostomy closure time were used to evaluate efficacy. The Voice Handicap Index-10 (VHI-10), Voice-related Quality of Life (V-RQOL) scale and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale were used to assess vocal function. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed and the Penetration-Aspiration Scale (PAS), Eating Assessment Tool-10 (EAT-10), and Swallow Quality of Life Questionnaire (SWAL-QOL) were used to assess swallowing function. RESULTS Thirteen patients (81.25%) were decannulated successfully. The average tracheostomy closure time was 45.15 days. There was no observed postoperative complications or recurrence of stenosis. VHI-10 and V-RQOL scores showed significantly improved V-RQOL (p < 0.05). FEES-PAS, EAT-10, and SWAL-QOL showed no swallowing function damage. CONCLUSIONS SCL-CHEP is effective and safe for patients with severe laryngeal cicatricial stenosis. Accurate pre-procedure evaluation is especially important for patient selection and surgical success.
Collapse
Affiliation(s)
- Lingyu Yu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Meijun Zheng
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Ren
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juanjuan Hu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Lu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Yang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Atallah I, Castellanos PF. Transoral closure of the supraglottic larynx for intractable aspiration. Head Neck 2020; 43:1370-1375. [PMID: 33368866 DOI: 10.1002/hed.26599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this paper is to describe a novel, safe, and effective surgical technique to eliminate aspiration, that is performed entirely by reconstructive transoral laser microsurgery (R-TLM). Eleven tracheostomy-dependent patients with recurrent pneumonia secondary to intractable aspiration treated with transoral laryngeal closure were included in our study. In all cases, the supraglottic mucosa is incised in a circumferential manner. The distal tissues are sutured side-to-side longitudinally, and the superficial tissues are sutured back-to-front transversally. All patients successfully underwent transoral laryngeal closure without significant perioperative complication. Four patients resumed oral feeding for effective nutrition and two patients for pleasure. One patient developed a small fistula with a leak that warranted secondary closure by a follow-up R-TLM procedure and subsequently held to protect his airway. Complete supraglottic laryngeal closure can be performed safely and effectively using R-TLM techniques. They provide a natural-orifice alternative to open surgery in patients with intractable aspiration.
Collapse
Affiliation(s)
- Ihab Atallah
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France.,School of Medicine, Grenoble Alpes University, Grenoble, France
| | | |
Collapse
|
7
|
Lateral pharyngotomy approach in the treatment of oropharyngeal carcinoma. Eur Arch Otorhinolaryngol 2017; 274:2573-2580. [DOI: 10.1007/s00405-017-4538-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
|