Systematic review and meta-analysis of transoral laser microsurgery in hypopharyngeal carcinoma

Safe Use of High-Flow Oxygenation During Transoral Laser Microsurgery Without Airway Fire: A Review of 369 Consecutive Cases

OBJECTIVE

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is often avoided during intraoral laser use due to the concern for an airway fire with the addition of high-flow oxygen. We aim to demonstrate that THRIVE can be safely used during transoral laser microsurgery (TLM) without causing an airway fire or other major complications.

STUDY DESIGN

Retrospective cohort study.

SETTING

Emory University Hospital Midtown between January 2020 and April 2024.

METHODS

A retrospective chart review of all patients who underwent TLM with the use of THRIVE was performed. A standardized laser safety protocol was followed, and either a carbon dioxide or potassium titanyl phosphate laser was used for all cases.

RESULTS

In total, 369 cases were examined, and no fire, ignition, flash, or major complication occurred. In total, 270 (73.2%) patients were Caucasian females and 271 (73.4%) patients had a primary diagnosis of idiopathic subglottic stenosis. A total of 110 (29.8%) cases were completed with the use of THRIVE alone, 238 (64.5%) required the addition of jet ventilation, and 21 (5.7%) required intubation for the completion of the case. Increased body mass index was positively associated with the need for jet ventilation or intubation and reached statistical significance for the type of airway management employed during the case (P-value < .001).

CONCLUSION

Airway fire and other major complications are preventable with the use of THRIVE during TLM if standardized laser safety practices are implemented.

Induction chemotherapy followed by transoral laser microsurgery with or without adjuvant therapy for advanced hypopharyngeal cancer patients: A preliminary result

BACKGROUND

Hypopharyngeal squamous cell carcinoma (HPSCC) has the poorest prognosis among head and neck cancers. Its treatment may significantly affect breathing, speaking, and swallowing. Induction chemotherapy (ICT) followed by transoral laser microsurgery (TLM) could reduce these adverse effects and achieve good outcomes.

METHODS

This was a retrospective study of 11 patients with advanced HPSCC. All patients underwent ICT and TLM alongside tailor-made adjuvant therapy based on the pathological features.

RESULTS

Adjuvant therapy was done in seven of 11 patients (64%). The 3-year disease-free survival and laryngeal preservation rates were 78% and 91%, respectively. At the last follow-up, 10 of 11 patients (91%) had no tracheostomy or feeding tube.

CONCLUSION

ICT followed by TLM is an appropriate treatment for good tumor control in select patients with advanced HPSCC while preserving laryngeal function.

Robotic Surgery for Head and Neck Tumors: What are the Current Applications?

BACKGROUND

The journey from radical treatments to the precision of robotic surgery underscores a commitment to innovation and patient-centered care in the field of head and neck oncology.

PURPOSE OF REVIEW

This article provides a comprehensive overview that not only informs but also stimulates ongoing discourse and investigation into the optimization of patient care through robotic surgery. The literature on current robotic applications within head and neck region was systematically reviewed.

RECENT FINDINGS

Thirty-four studies with a total of 1835 patients undergoing robotic surgery in head and neck region were included. Clinical staging, histological types, operative duration, postoperative complications, functional recovery and survival outcomes were compared and evaluated. Clinical outcomes have shown promising results and thus the indication on the robotic usage has no longer been limited to oropharyngeal region but from skull base to neck dissection. The latest advancement in robotic surgery further refines the capabilities of surgeons into previously difficult-to-access head and neck regions and heralds a new era of surgical treatment for head and neck oncology.

Influencing Factors of Survival in Hypopharyngeal Squamous Cell Cancer

Objectives: This study examined the effects of various factors on survival in hypopharyngeal cancer, involving a total of 100 patients. Methods: Comorbidities, treatment modalities, survival times, and potential factors affecting survival were retrospectively analysed. The expression of p16 was also examined. A statistical analysis was conducted using IBM SPSS V25 software. Results: The mean overall survival time was determined to be 30.8 months. Smoking was observed in 95%, and regular alcohol consumption was reported in 75% of the cases. The expression of p16 did not significantly affect survival (p = 0.74) or the maximum tumour size (p = 0.21). The Kaplan-Meier method demonstrated significantly longer survival times (p = 0.047 *) in the group that underwent partial pharyngolaryngectomy with or without adjuvant therapy (median: 75.25 months, 95% CI: 31.57-118.93), compared to the other four treatment groups (i.e., total laryngectomy with pharyngectomy with or without adjuvant therapy, chemoradiation, chemotherapy, and radiotherapy). Conclusions: The study found that factors such as sex, comorbidities (e.g., type 2 diabetes and chronic obstructive pulmonary disease), TNM and stage, weight loss, smoking, and alcohol consumption did not have a significant effect on survival. In conclusion, the longest survival was observed after partial pharyngolaryngectomy with or without adjuvant therapy. Risk factors and comorbidities did not show a significant effect on survival. p16 expression was not a factor that affected either survival or tumour size.

Oncological and functional outcomes of transoral laser surgery for hypopharyngeal carcinoma

BACKGROUND

Surgical resection or radiotherapy (RT) are standard approaches for early-staged hypopharyngeal squamous cell carcinoma (HPSCC). Transoral laser microsurgery (TOLMS) seems to provide good oncological and functional results with few local complications. The aim of our study was to analyze the outcomes of TOLMS, with or without neck dissection or RT, in the treatment of HPSCC in a tertiary referral center.

METHODS

A retrospective study was conducted in patients with early T-category (T1-T2) HPSCC treated by TOLMS.

RESULTS

A total of 34 patients were included in the study. The series includes 17 (50%) T1 and 17 (50%) T2 classified tumors. The 5-year overall survival and disease-specific survival rates were 51% and 66%, respectively, with a 5-year local control rate of 92%. All patients reassumed oral diet and none of them had a tracheostomy at the end of the follow-up.

CONCLUSIONS

TOLMS offers an effective treatment option in terms of oncologic control and function preservation in locally circumscribed HPSCC.

Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience

OBJECTIVE

Investigate oncologic and functional outcomes associated with transhyoid and lateral pharyngotomy (transpharyngeal) approaches in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).

STUDY DESIGN

Retrospective review.

SETTING

Single institution (tertiary care center).

METHODS

This is a retrospective case series of patients with OPSCC undergoing transpharyngeal resection from 1990 to 2017 at Mayo Clinic. Oncologic outcomes, postoperative complications, objective swallowing data, and rates of tracheostomy and percutaneous gastrostomy tube dependence were recorded.

RESULTS

Of 83 patients meeting inclusion criteria, 56 (68%) were human papillomavirus positive. Overall survival rates at 5 and 10 years following surgery were 85% and 80%, respectively. Cancer-specific survival rates at these same time points were 90% and 88%. Following treatment, 35 of 49 patients (71%) had a Functional Oral Intake Scale score ≥5, indicating total oral intake of multiple consistencies; 79 of 82 (96%) were without tracheostomy or laryngectomy; and 71 of 81 (88%) were on a full oral diet.

CONCLUSION

Transpharyngeal approaches provide adequate functional and oncologic outcomes in the majority of patients with OPSCC. These results may have important implications for patients who are not candidates for, or are unwilling to undergo, nonoperative therapy or for those without access to radiation therapy.