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Rosow DE, Keidar E, Pasick LJ, Casellas NJ, Anis MM. Use of the 445-nm Blue Laser for Management of Early Glottic Carcinoma: Preliminary 1-Year Results. Laryngoscope 2024. [PMID: 38860434 DOI: 10.1002/lary.31569] [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: 02/26/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To analyze oncological efficacy and voice outcomes of the 445-nm blue laser (BL) in the treatment of early glottic carcinoma and compare results with the 532-nm potassium-titanyl-phosphate (KTP) laser. STUDY DESIGN Single institution, retrospective chart review. METHODS All patients who underwent microlaryngoscopic KTP or BL laser excision of early glottic carcinoma from 2018 to the present day with at least 1-year follow-up were included. Primary and recurrent disease, including radiation and surgical failures, were included. Demographic data, voice outcomes and oncologic outcomes were compared between the two laser groups. RESULTS Forty-nine patients met the inclusion criteria for the BL group and 88 for the KTP group, with average follow-up of 635 and 1236 days, respectively. Oncologic outcomes were not significantly different, with disease-specific survival rates of 95.9% for BL and 100% for KTP (p = 0.13), organ preservation rates of 98.0% for BL and 95.6% for KTP (p = 0.39), and local control rates of 93.9% for BL and 92.1% for KTP (p = 0.81). Both BL and KTP groups showed significant improvement in CAPE-V (p = 0.04, 0.006 respectively) and VHI-10 scores (p = 0.003, <0.00001) following surgery. CONCLUSIONS Photoangiolytic removal of early glottic carcinoma with BL appears to be equally safe and effective as with KTP laser at minimum one-year follow-up, and with excellent voice outcomes. Additional study will be warranted over time to assess long-term outcomes in BL patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- David E Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eytan Keidar
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luke J Pasick
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas J Casellas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mursalin M Anis
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Ben Ner D, Hamzany Y, Reuven Y, Ben-Mordechai N, Bar-On DY, Najman TM, Shoffel-Havakuk H. Too Deep: The Rate of Inappropriate Deep Resections while Practicing a Single Stage Laser Cordectomy. J Voice 2024:S0892-1997(24)00155-3. [PMID: 38811305 DOI: 10.1016/j.jvoice.2024.05.004] [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: 02/21/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Whenever a cortectomy is indicated, obviating preoperative biopsy and practicing a single-stage-laser-cordectomy (SSLC) may expedite treatment and preserve surgical planes. This may result in more superficial resections and improved vocal function. Yet, SSLC holds a risk for over-treating nonmalignant lesions. Our study aims to evaluate this risk. METHODS A retrospective cohort of patients who underwent SSLC. Cordectomy types were compared with final pathology. Type-1 cordectomy was subcategorized into superficial-type-1 (superficial-lamina-propria preserved) and deep-type-1 (ligament exposed). Superficial-type-1 cordectomy was considered adequate for epithelial lesions not invading the basement membrane: nonmalignant, dysplasia, and carcinoma-in-situ (CIS). Deeper resections for these pathologies were considered inappropriately deep. All resections were considered appropriate for squamous cell carcinoma (SCC). RESULTS Ninety-seven patients who underwent 139 SSLC were included. SCC was found in 30% (N = 42), CIS/severe-dysplasia in 15% (N = 21), mild/moderate-dysplasia in 23% (N = 32), nondysplastic lesions in 31% (N = 43), and lymphoma in 0.5% (N = 1). Superficial-type-1 cordectomy was performed in 64% (N = 89). Altogether, 15 lesions (11%) underwent inappropriately deep resections. Smoking history, current smoking status, prior glottic surgery, radiation or fungal infection, did not increase the rate of inappropriate deep resection. While the general rate of inappropriately deep resection is 11%, for deep-type-1 cordectomy or deeper the rate was 29.4%. The highest rate was associated with deep-type-1 cordectomy, reaching 52.9%. CONCLUSION The general rate of inappropriately deep resection during a SSLC is low. However, when the depth of resection involves exposure of the vocal ligament or deeper, the rate increases. Hence, to avoid unnecessary morbidity, whenever a deep resection is considered, the authors recommend preceding a deeper resection with frozen section sampling.
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Affiliation(s)
- Daniel Ben Ner
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaniv Hamzany
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Ben-Mordechai
- Department of Otolaryngology Head and Neck Surgery, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Dvir Yohai Bar-On
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzvi Menachem Najman
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dallari V, Liberale C, De Cecco F, Monzani D. Can ChatGPT be a valuable study tool for ENT residents? Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:189-190. [PMID: 37993361 DOI: 10.1016/j.anorl.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Affiliation(s)
- V Dallari
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Young Confederation of European ORL-HNS
| | - C Liberale
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - F De Cecco
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - D Monzani
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
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Piazza C, Gennarini F, Montenegro C, Lancini D, Del Bon F, Zigliani G, De Palma G, Lopomo NF, Sala E. Transoral laser exoscopic surgery of the larynx: state of the art and comparison with traditional transoral laser microsurgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S3-S11. [PMID: 38745511 PMCID: PMC11098537 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 05/16/2024]
Abstract
Objective To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic lesions, and compare outcomes with those of transoral laser microsurgery (TOLMS). Methods To demonstrate the non-inferiority of TOLES in terms of operative time, margin status and complication rates, we compared outcomes of 93 patients treated by TOLES between July 2021 and July 2023 with those of a match-paired group of 107 historical patients treated by TOLMS. To perform a multiparametric ergonomic evaluation of TOLES vs TOLMS, we used observational methods for biomechanical overload risk assessment and wearable technologies comparing 15 procedures with TOLES vs a paired match of 13 surgeries performed with TOLMS by the same surgeon. Results No significant differences were found in terms of surgical duration, positive margins, or complications between TOLES and TOLMS. Ergonomics assessment by inertial measurement units and electromyographic surface electrodes demonstrated a reduced biomechanical overload with TOLES compared to TOLMS. Conclusions The many advantages of TOLES, such as its superior didactic value, better digital control of light even through small-bored laryngoscopes, improved binocular vision, and increase in surgical performance by 3 or 4-hand techniques, are difficult to be quantified. In contrast, its non-inferiority in terms of oncological results and better ergonomics compared to TOLMS are demonstrated herein.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Francesca Gennarini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Claudia Montenegro
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe De Palma
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Occupational Health, Occupational Hygiene, Toxicology and Prevention, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Emma Sala
- Unit of Occupational Health, Occupational Hygiene, Toxicology and Prevention, ASST Spedali Civili of Brescia, Brescia, Italy
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Magnani M, Ricci Maccarini A, Morolli F, Fabbri C, Stacchini M. Flexible endoscopic phonosurgery for treatment of functional sequelae after laryngeal oncologic surgery: a narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S12-S19. [PMID: 38745512 PMCID: PMC11098542 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 05/16/2024]
Abstract
Flexible endoscopic phonosurgery (FEPS) is one of the most recent and constantly evolving operative techniques in the field of minimally invasive laryngeal surgery. Thanks in part to the possibility of using new technologies, such as digital endoscopes, laser fibres, and different laryngeal injection materials, its fields of application have rapidly expanded. This narrative review describes the current possible indications of FEPS ranging from injection laryngoplasties in cases of vocal cord paralysis or mass defect, to the correction of dysphagia after open partial horizontal laryngectomies. Use of microscissors, microforceps, and laser fibres also allows this technique to be applied for removal of superficial vocal cord lesions, avoiding general anaesthesia in an increasing number of patients.
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Affiliation(s)
| | | | | | | | - Marco Stacchini
- Department of Otorhinolaryngology, Bufalini Hospital, Cesena, Italy
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Iandelli A, Gabella G, Marchi F, Campagnari V, Filauro M, Sampieri C, Tsai TY, Vilaseca I, Peretti G. The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08610-3. [PMID: 38564009 DOI: 10.1007/s00405-024-08610-3] [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: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS. DATA SOURCES PubMed, EMBASE, and Cochrane Library. METHODS We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported. RESULTS Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97). CONCLUSIONS Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.
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Affiliation(s)
- Andrea Iandelli
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Giulia Gabella
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Valentina Campagnari
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Marta Filauro
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Claudio Sampieri
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | - Tsung-You Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taoyuan, Taiwan
| | - Isabel Vilaseca
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Catalunya, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Giorgio Peretti
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
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7
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Zhu W, Liang H, Liang F, Chen R, Zheng S, Liang W, Guan Z, Cai Q. Application of Platysma Myocutaneous Flap in Surgical Repair after T2-3 Glottic Carcinoma Resection. Laryngoscope 2024. [PMID: 38525967 DOI: 10.1002/lary.31291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Numerous methods and materials are available for vertical partial laryngectomy. In this study, the reparative effects of the platysma myocutaneous flap (PMF) and ribbon myocutaneous flap (RMF) on the postoperative voice quality of patients were compared to provide a reference for selecting a method conducive to improving postoperative voice quality. METHODS A retrospective analysis was performed on patients with unilateral T2-3 glottic carcinoma. Following vertical partial laryngectomy, the defect was repaired with a PMF or simple RMF. Twelve months after surgery, voice quality was assessed according to voice acoustics, aerodynamics, and subjective perceptual evaluation, and glottic morphology was recorded using a laryngeal stroboscopy. RESULTS A total of 70 patients were identified, including 54 in the PMF group and 16 in the RMF group. The PMF group was superior to the RMF group in terms of voice quality assessed by voice acoustics, aerodynamics, and subjective perceptual evaluation. In the PMF group, 72.2% of patients performed phonation with their vocal cords, and approximately 27.8% of patients were affected by supraglottic compression. In the RMF group, 81.3% of patients were affected by supraglottic compression. No significant difference was found in the 5-year survival rate between the two groups. CONCLUSION For defect repair following vertical partial laryngectomy, a PMF can allow better postoperative voice quality to be achieved than an RMF because a PMF can provide more tissue (including strap muscle under the flap) for padding, which enables the glottic portion corresponding to the vocal cord to close well. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Wenying Zhu
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Haifeng Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Faya Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Renhui Chen
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Shibei Zheng
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Wenting Liang
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Zhong Guan
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Qian Cai
- Department of Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
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Noy R, Shkedy Y, Habashi N, Billan S, Cohen J. Oncological outcomes and failure patterns of laser cordectomy in recurrent glottic cancer. Am J Otolaryngol 2024; 45:104109. [PMID: 37948822 DOI: 10.1016/j.amjoto.2023.104109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival. RESULTS A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9). CONCLUSIONS Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Oncology Radiation Division, Rambam Health Care Campus, Haifa, Israel.
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Dorr MC, Andrinopoulou ER, Sewnaik A, Berzenji D, van Hof KS, Dronkers EAC, Bernard SE, Hoesseini A, Rizopoulos D, Baatenburg de Jong RJ, Offerman MPJ. Individualized Dynamic Prediction Model for Patient-Reported Voice Quality in Early-Stage Glottic Cancer. Otolaryngol Head Neck Surg 2024; 170:169-178. [PMID: 37573487 DOI: 10.1002/ohn.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Early-stage glottic cancer (ESGC) is a malignancy of the head and neck. Besides disease control, preservation and improvement of voice quality are essential. To enable expectation management and well-informed decision-making, patients should be sufficiently counseled with individualized information on expected voice quality. This study aims to develop an individualized dynamic prediction model for patient-reported voice quality. This model should be able to provide individualized predictions at every time point from intake to the end of follow-up. STUDY DESIGN Longitudinal cohort study. SETTING Tertiary cancer center. METHODS Patients treated for ESGC were included in this study (N = 294). The Voice Handicap Index was obtained prospectively. The framework of mixed and joint models was used. The prognostic factors used are treatment, age, gender, comorbidity, performance score, smoking, T-stage, and involvement of the anterior commissure. The overall performance of these models was assessed during an internal cross-validation procedure and presentation of absolute errors using box plots. RESULTS The mean age in this cohort was 67 years and 81.3% are male. Patients were treated with transoral CO2 laser microsurgery (57.8%), single vocal cord irradiation up to (24.5), or local radiotherapy (17.5%). The mean follow-up was 43.4 months (SD 21.5). Including more measurements during prediction improves predictive performance. Including more clinical and demographic variables did not provide better predictions. Little differences in predictive performance between models were found. CONCLUSION We developed a dynamic individualized prediction model for patient-reported voice quality. This model has the potential to empower patients and professionals in making well-informed decisions and enables tailor-made counseling.
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Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Department of Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kira S van Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitirs Rizopoulos
- Department of Biostatistics, Department of Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Rovó L, Szakács L, Castellanos PF, Tóbiás Z, Pfiszterer P, Ambrus A, Csanády M, Bach Á. Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy. Laryngoscope Investig Otolaryngol 2023; 8:1328-1336. [PMID: 37899879 PMCID: PMC10601548 DOI: 10.1002/lio2.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Methods Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Results Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients. Conclusion Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. Level of Evidence 4 (retrospective case series review).
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Affiliation(s)
- László Rovó
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - László Szakács
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Paul F. Castellanos
- Division of Otolaryngology, Department of SurgerySt. Rita's Mercy HospitalLimaOhioUSA
| | - Zoltán Tóbiás
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Péter Pfiszterer
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Andrea Ambrus
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Miklós Csanády
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Ádám Bach
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
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11
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Uysal B, Gamsiz H, Colak O, Beyzadeoglu M. Outcomes of hypofractionation for early-stage glottic carcinoma. J Cancer Res Ther 2023; 19:1962-1966. [PMID: 38376304 DOI: 10.4103/jcrt.jcrt_378_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/20/2022] [Indexed: 02/21/2024]
Abstract
BACKGROUND Our goal is to evaluate hypofractionation in early-stage glottic carcinoma of a single center in line with randomized trials. MATERIALS AND METHODS Between June 2016 and January 2021, 33 early glottic carcinoma patients treated with IMRT (intensity-modulated radiotherapy) in the Radiation Oncology Department were analyzed. Descriptive statistics and survival analysis were applied. Survival analysis and curves were done via the Kaplan-Meier method. Survival curves were analyzed due to the T stage. Log-rank test was used for the analysis of T stage survival curves. RESULTS Twenty (60.1%) patients were T1 whereas six (18.2%) and seven (21.2%) were Tis. 56.25 Gy, 63 Gy, and 65.25 Gy were delivered to the patients with Tis, T1, and T2, respectively. All groups were treated with 2.25 Gy per fraction. T2 stage had lesser DFS (disease-free survival) compared to Tis and T1 stage and it was statistically significant (P = 0.035). CONCLUSION Hypofractionation with 2.25 Gy per fraction may be standard for early glottic carcinoma with similar results compared to microsurgery and conventional fractionation radiotherapy.
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Affiliation(s)
- Bora Uysal
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara, Turkey
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12
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Ahmadi N, Stone D, Stokan M, Coleman H, Heller G, Smith M, Riffat F, Kudpaje A, Veness M, Palme CE. Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:661-667. [PMID: 37274960 PMCID: PMC10235397 DOI: 10.1007/s12070-022-03392-8] [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: 05/05/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out. Results 83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9-100%), disease free survival was 86.0% (95%CI 78.1-94.6%), locoregional control was 91.2% (95%CI: 85.1-97.7%) and larynx preservation rate of 95.1% at 5 years. Conclusion TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living.
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Affiliation(s)
- Navid Ahmadi
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Danielle Stone
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
| | - Murray Stokan
- Department of Anaesthetics, Westmead Hospital, Sydney, NSW Australia
| | - Hedley Coleman
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Douglass Hanly Moir Pathology, Sydney, NSW Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW Australia
| | - Mark Smith
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Faruque Riffat
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Akshay Kudpaje
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Cytecare Cancer Hospitals, Bangalore, India
| | - Michael Veness
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
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13
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Lin Q, Huang C, Chen W, Chen X, Yi X, Wang D, Li C. Transoral CO 2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy for bilateral vocal fold paralysis: A retrospective study. Clin Otolaryngol 2023. [PMID: 37052314 DOI: 10.1111/coa.14065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/30/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To investigate the effect of transoral CO2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy for bilateral vocal fold paralysis (BVFP). DESIGN A retrospective study with medical records from 2017 to 2021 in our hospital. SETTING A single-centre study. PARTICIPANTS This retrospective study included 22 patients with BVFP. They underwent transoral CO2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy in our hospital from 2017 to 2021. MAIN OUTCOME MEASURES Preoperative and postoperative swallowing and phonation functions were evaluated in all patients. RESULTS All 22 patients with a tracheostomy were successfully decannulated within 6 months after surgery without subsequent revision operations, and the width of the posterior glottis was more than 3.9 mm in all patients when they inspired. The statistical analysis showed that there was no difference in vocal function and swallowing function in all patients compared to preoperative (p > .05). CONCLUSION Transoral CO2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy enlarges the posterior glottis in patients with BVFP, which maintains airway patency without significant worsening in voice and swallowing function.
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Affiliation(s)
- Qin Lin
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chunyan Huang
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei Chen
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoqiang Chen
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuehan Yi
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Desheng Wang
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chen Li
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China
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Stevanović S, Gregurić T, Pažanin L, Ivkić B, Geber A, Hadžavdić A, Košec A. Diagnostic Accuracy of Preoperative CT and Endoscopy Staging in Early Laryngeal Cancer. Otolaryngol Head Neck Surg 2023; 168:769-774. [PMID: 35763371 DOI: 10.1177/01945998221109819] [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: 02/27/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aims to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and intraoperative endoscopic tumor staging with regard to histopathologic staging in patients with early laryngeal cancer. STUDY DESIGN A retrospective nonrandomized single-institution comparative cohort study including 109 patients. SETTING A tertiary surgical center. METHODS Patients were treated for T1a, T1b, and T2a laryngeal squamous cell carcinoma by endoscopic laser surgery. The outcome measures were the presence of under- or overstaging in endoscopic and CT findings and positive postoperative margins. RESULTS Endoscopic overstaging as compared with histopathologic T category correlated with rising tumor category (P = .001; odds ratio [OR], 69.1) and CT findings showing anterior commissure involvement (P = .002; OR, 9.54), while endoscopic understaging correlated with rising tumor histologic grade (P = .039; OR, 4.28) and smaller tumor size (P = .011; OR, 6.39). CT overstaging vs histopathologic T category correlated with CT findings showing anterior commissure involvement (P = .001; OR, 21.76), supraglottic involvement (P = .001; OR, 59.98), subglottic involvement (P = .001; OR, 39.94), rising clinical T category (P = .01; OR, 9.11), and rising tumor histologic grade (P = .004; OR, 10.95). CT understaging as compared with histopathologic T category correlated with smaller clinical T categories (P = .002; OR, 12.72) and smaller tumor histologic grade (P = .030; OR, 7.02). Rising age, rising tumor size, anterior commissure involvement on CT, and tumor extension into the supraglottis were risk factors for positive margins. CONCLUSION Our results indicate that CT adds little valuable information in differentiating small superficial lesions in the glottis, while systematically overstaging cases of early laryngeal cancer. In T1a and T1b glottic tumors, endoscopy should be the preferred diagnostic method.
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Affiliation(s)
- Siniša Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Tomislav Gregurić
- Department of Clinical and Interventional Radiology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Leo Pažanin
- Department of Pathology "Ljudevit Jurak,", University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Boris Ivkić
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Antonela Geber
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ayla Hadžavdić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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15
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Jia W, King E. The Role of Robotic Surgery in Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:313-322. [PMID: 37030944 DOI: 10.1016/j.otc.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Transoral robotic surgery (TORS) is a growing field in the treatment of head and neck cancers. Its benefits have been proven in the treatment of oropharynx HPV-positive squamous cell carcinoma, replacing chemoradiation as primary treatment of early-stage cancers or reducing the required radiation dosage, leading to improved functional outcomes without compromising oncological outcomes. There is also interest in the application of TORS for larynx cancer with the hope of achieving similar outcomes to replace open surgery or radiation treatments. Specifically, in the larynx, TORS can be used to resect supraglottic or glottic tumors.
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16
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Silver JA, Turkdogan S, Roy CF, Kost KM. Surgical Treatment of Early Glottic Cancer. Otolaryngol Clin North Am 2023; 56:259-273. [PMID: 37030939 DOI: 10.1016/j.otc.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality.
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17
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Felicio-Briegel A, Sharaf K, Haubner F, Echternach M. Primary injection laryngoplasty after chordectomy for small glottic carcinomas. Eur Arch Otorhinolaryngol 2023; 280:1291-1299. [PMID: 36197582 PMCID: PMC9899722 DOI: 10.1007/s00405-022-07663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze the short- and middle-term effects of primary injection laryngoplasty in patients having tumor resection within the same surgery concerning the vocal outcome. Injection laryngoplasty was performed after harvesting autologous adipose tissue via lipoaspiration. METHODS A prospective study was performed with 16 patients (2 female; 14 male) who received tumor resection and an injection laryngoplasty using autologous adipose tissue during a single stage procedure. Multidimensional voice evaluation including videostroboscopy, patient self-assessment, voice perception, aerodynamics, and acoustic parameters was performed preoperatively, as well as 1.5, 3 and 6 months postoperatively. RESULTS Results show an improvement in the roughness-breathiness-hoarseness (RBH) scale, voice dynamics and subjective voice perception 6 months postoperatively. Maintenance of Voice Handycap Index, jitter and shimmer could be observed 6 months postoperatively. There was no deterioration in RBH and subjective voice perception 2 and 6 weeks postoperatively. No complications occurred in the fat harvesting site. CONCLUSIONS Using the lipoaspiration and centrifugation approach, primary fat injection laryngoplasty shows short-term maintenance und middle-term improvement in voice quality in patients with vocal fold defect immediately after chordectomy 6 months postoperatively. Cancer recurrence rate is comparable to the reported cancer recurrence rate for laryngeal carcinoma and thus not elevated through primary augmentation.
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Affiliation(s)
- Axelle Felicio-Briegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Kariem Sharaf
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Echternach
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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18
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Lechien JR, Crevier-Buchman L, Circiu MP, De Mones E, de Pemille GV, Julien-Laferriere A, Saussez S, Baudouin R, Remacle M, Hans S. Voice Quality Outcomes After Transoral CO 2 Laser Cordectomy: A Longitudinal Prospective Study. Otolaryngol Head Neck Surg 2023; 168:422-428. [PMID: 35998041 DOI: 10.1177/01945998221114762] [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] [Received: 02/08/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the evolution of voice quality in patients after type I-VI transoral CO2 laser cordectomy (TLC) by using validated voice outcome measures over a 12-month period. STUDY DESIGN Prospective uncontrolled study. SETTING Monocenter study. METHODS Patients with laryngeal carcinoma who were eligible for type I-IV TLC were prospectively recruited from a tertiary medical center. The following outcomes were assessed throughout the 12-month posttreatment period: Voice Handicap Index (VHI), GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain), maximal phonation time, fundamental frequency (F0), F0 standard deviation, percentage jitter, percentage shimmer, noise-to-harmonic ratio, and speech fluency. Analyses were performed considering 2 groups of cordectomies: type I-III vs IV-VI. RESULTS A total of 131 patients completed the evaluations, totaling 76 type I-III and 55 type IV-VI cordectomies. In type IV-VI, breathiness and maximal phonation time significantly worsened from pretreatment to 1 month posttreatment (P < .05). In the type I-III cordectomy group, VHI, shimmer, roughness, breathiness, and strain significantly improved from pretreatment to 3 months posttreatment, while VHI, F0 standard deviation, shimmer, jitter, grade of dysphonia, roughness, breathiness, and strain improved from baseline to 6 months. Assessments at 12 months posttreatment revealed significant improvements for VHI, shimmer, jitter, noise-to-harmonic ratio, grade of dysphonia, roughness, breathiness, and strain. In the type IV-VI group, VHI significantly improved from baseline to 3, 6, and 12 months posttreatment. Strain improved at 6 and 12 months while roughness improved from baseline to 12 months. Maximal phonation time significantly worsened over the 12-month evaluation period. CONCLUSION The effect of TLC on voice quality depends on its type. VHI was identified as the most indicative tool of voice changes irrespective of TLC type.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Sorbonne University, Paris, France
| | - Marta P Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Erwan De Mones
- Department of Otolaryngology-Head and Neck Surgery, Pellegrin Hospital, University Hospital, CHU Bordeaux, Bordeaux, France
| | - Grégoire Vialatte de Pemille
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Aude Julien-Laferriere
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marc Remacle
- Department of Otolaryngology-Head and Neck Surgery, Eich Luxembourg Hospital, Luxembourg, Luxembourg
| | - Stephane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Sorbonne University, Paris, France
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Mariani C, Carta F, Bontempi M, Marrosu V, Tatti M, Pinto V, Gerosa C, Puxeddu R. Management and Oncologic Outcomes of Close and Positive Margins after Transoral CO 2 Laser Microsurgery for Early Glottic Carcinoma. Cancers (Basel) 2023; 15:cancers15051490. [PMID: 36900281 PMCID: PMC10000552 DOI: 10.3390/cancers15051490] [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: 02/07/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic carcinoma. METHODS 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). RESULTS A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). CONCLUSIONS Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended.
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Affiliation(s)
- Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
- Correspondence:
| | - Mauro Bontempi
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Valeria Pinto
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Medical Sciences and Public Health, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
- ENT Department, King’s College Hospital London-Dubai, Dubai P.O. Box 340901, United Arab Emirates
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20
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Chu F, Maffini F, Lepanto D, Vacirca D, Taormina SV, De Berardinis R, Gandini S, Vignati S, Ranghiero A, Rappa A, Chiocca S, Barberis M, Tagliabue M, Ansarin M. The Genetic and Immunologic Landscape Underlying the Risk of Malignant Progression in Laryngeal Dysplasia. Cancers (Basel) 2023; 15:cancers15041117. [PMID: 36831458 PMCID: PMC9954731 DOI: 10.3390/cancers15041117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
(1) Background: The development of laryngeal cancer is a multistep process involving structural alterations of the epithelial mucosa, from dysplasia (LDy) to invasive carcinoma. In this study, we define new biomarkers, prognostic for malignant transformation, in patients affected by LDy. (2) Methods: We used targeted next-generation sequencing and immunohistochemical analysis to define the mutational and immunological landscape of 15 laryngeal dysplasia progressing to invasive cancer (progressing dysplasia), as well as 31 cases of laryngeal dysplasia that did not progress to carcinoma (non-progressing dysplasia). Two pathologists independently analyzed the presence of tumor-infiltrating lymphocytes in LDy pre-embedded paraffin-fixed specimens. The RNA-based next-generation sequencing panel OIRRA was used to evaluate the expression of 395 genes related to immune system activation. (3) Results: High TILs are significantly correlated with a higher risk of malignant transformation. The non-brisk pattern was significantly associated with an 86% reduced risk of malignant progression (OR = 0.16, 95% CI: 0.03-0.5, p = 0.008). TILs showed a highly positive correlation with CCR6, CD83, HLA-DPB1, MX1 and SNAI1, and they were inversely correlated with CD48, CIITA, CXCR4, FCER1G, IL1B, LST1 and TLR8. (4) Conclusions: TILs have a great potential to identify high-risk progression dysplasia and thus to define surveillance protocols and prevention programs.
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Affiliation(s)
- Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Daniela Lepanto
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Davide Vacirca
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Sergio Vincenzo Taormina
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Correspondence: (R.D.B.); (M.T.); Tel.: +39-02-57489380 (R.D.B. & M.T.)
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Silvano Vignati
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Alberto Ranghiero
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Alessandra Rappa
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Massimo Barberis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence: (R.D.B.); (M.T.); Tel.: +39-02-57489380 (R.D.B. & M.T.)
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
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Dorr MC, Sewnaik A, Andrinopoulou E, Berzenji D, Dronkers EAC, Bernard SE, Hoesseini A, Tans L, Rizopoulos D, Baatenburg de Jong RJ, Offerman MPJ. Longitudinal Patient-Reported Voice Quality in Early-Stage Glottic Cancer. Otolaryngol Head Neck Surg 2023; 168:1463-1471. [PMID: 36939474 DOI: 10.1002/ohn.263] [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: 09/19/2022] [Revised: 12/18/2022] [Accepted: 12/24/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Patient-reported voice quality is an important outcome during counseling in early-stage glottic cancer. However, there is a paucity of adequate longitudinal studies concerning voice outcomes. This study aimed to investigate longitudinal trajectories for patient-reported voice quality and associated risk factors for treatment modalities such as transoral CO2 laser microsurgery, single vocal cord irradiation, and local radiotherapy. STUDY DESIGN A longitudinal observational cohort study. SETTING Tertiary cancer center. METHODS Patients treated for Tcis-T1b, N0M0 glottic cancer were included in this study (N = 294). The Voice Handicap Index was obtained at baseline and during follow-up (N = 1944). Mixed-effects models were used for investigating the different trajectories for patient-reported voice quality. RESULTS The mean follow-up duration was 43.4 (SD 21.5) months. Patients received transoral CO2 laser microsurgery (57.8%), single vocal cord irradiation (24.5%), or local radiotherapy (17.5%). A steeper improvement during the first year after treatment for single vocal cord irradiation (-15.7) and local radiotherapy (-12.4) was seen, compared with a more stable trajectory for laser surgery (-6.1). All treatment modalities showed equivalent outcomes during long-term follow-up. Associated risk factors for different longitudinal trajectories were age, tumor stage, and comorbidity. CONCLUSION Longitudinal patient-reported voice quality after treatment for early-stage glottic cancer is heterogeneous and nonlinear. Most improvement is seen during the first year of follow-up and differs between treatment modalities. No clinically significant differences in long-term trajectories were found. Insight into longitudinal trajectories can enhance individual patient counseling and provide the foundation for an individualized dynamic prediction model.
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Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elrozy Andrinopoulou
- Department of Biostatistics and Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisa Tans
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics and Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kinberg E, Rapoport SK, Brown S, Woo P. Long-Term Voice Outcomes After Type I, Type II, or Type V Cordectomy. Ann Otol Rhinol Laryngol 2023; 132:133-137. [PMID: 35189725 DOI: 10.1177/00034894221081259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We compare long-term voice outcomes in patients treated with European Laryngeal Society (ELS) classification Type I, Type II, or Type V cordectomy. The aim is to understand the impact of Type V cordectomy on voice outcomes in relation to Type I and Type II cordectomy. METHODS A retrospective review of patients treated with Type I, Type II, or Type V cordectomy by a single surgeon over a 20-year period was performed. Voice Handicap Index-10 (VHI-10) scores, Cepstral Spectral Index of Dysphonia (CSID) measures from CAPE-V sentences, and two-rater GRBAS scores were analyzed. RESULTS Sixty-two patients were identified with a mean follow-up of 52 months. Of these, there were 43 Type I and 19 Type II cordectomies, including 8 in each group with Type V resections. Significant differences in all parameters were noted between the Type I (VHI 5.7, CSID 20.6, Grade 1.3) and the Type II cohorts (VHI 12.6, CSID 36.3, Grade 1.8) who did not undergo Type V cordectomy. Patients undergoing Type V cordectomy demonstrated voice outcomes (VHI 9.4, CSID 35.6, Grade 1.7) which fell between those of Type I and Type II cordectomies. CONCLUSIONS Better long-term subjective, objective, and computer-analyzed voice outcomes are noted for patients undergoing Type I rather than Type II cordectomy. When Type V cordectomy is performed, voice outcomes are comparable to those of both Type I and Type II cordectomy, a surprising finding given the expectation of worsened dysphonia in longer resections. Further work is needed to explain this finding and define voice outcomes after Type V cordectomy.
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Affiliation(s)
- Eliezer Kinberg
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Sarah K Rapoport
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Sarah Brown
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Peak Woo
- Mount Sinai Hospital Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
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Suppah M, Kamal A, Karle WE, Saadoun R, Lott DG. Outcomes of KTP Laser Ablation in Glottic Neoplasms: A Systematic Review and Meta-Analysis. Laryngoscope 2023. [PMID: 36606671 DOI: 10.1002/lary.30547] [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: 08/04/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the safety and clinical effectiveness of transoral laser microsurgery (TLM) with potassium-titanyl-phosphate (KTP) laser ablation for glottic neoplasms. DATA SOURCE MEDLINE via PubMed, SCOPUS, Web of Science, and Cochrane Library. REVIEW METHODS A systematic review and meta-analysis of studies assessing the safety and efficacy of KTP laser therapy in patients with early-stage glottic neoplasms. RESULTS Eight studies were included. After an average follow-up of 3.3 years, the overall survival and disease-free survival for patients who underwent KTP were 90.7% (95% CI 85%-96.5%) and 98.5% (95% CI 97.3%-99.8%), respectively. In the single-arm meta-analysis, the pooled estimate of recurrence was 7.7% (95% CI 3.4%-12%). The overall voice handicap index (VHI) estimate attributed to KTP in the single-arm meta-analysis was 6.76 (95% CI [3.05, 10.48]) and 5.21 (95% CI [2.86, 7.56]) within 6 months and after a one-year follow-up, respectively. CONCLUSION KTP laser ablation is a safe and effective method for treating patients with early glottic neoplasms. Laryngoscope, 2023.
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Affiliation(s)
- Mustafa Suppah
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Abdallah Kamal
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William E Karle
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Rakan Saadoun
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David G Lott
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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24
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Medialization Laryngoplasty After Endoscopic Laser Cordectomy. Our Experience. J Voice 2023; 37:105-109. [PMID: 33121825 DOI: 10.1016/j.jvoice.2020.10.005] [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] [Received: 05/01/2020] [Revised: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE Medialization laryngoplasty can be performed to treat glottic incompetence after endoscopic laser cordectomy. The aim of this study is to evaluate vocal outcome after this phonosurgical procedure and to analyze the critical aspects of the Montgomery and Gore-Tex laryngoplasty technique. METHODS A retrospective observational study of patients with glottic incompetence after endoscopic laser cordectomy, underwent medialization laryngoplasty with Montgomery or Gore-Tex implant between January 2013 to December 2018 at the Bufalini Hospital of Cesena, Italy. The pre- and postphonosurgery evaluation included videolaryngostroboscopy, perceptual, evaluation of dysphonia with the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, Voice Handicap Index-10, Maximum Phonation Time. The outcome was evaluated 6 months after the phonosurgical treatment. RESULTS We treated 22 patients, 19 males and 3 females. Eight cases were treated with Montgomery implant and fourteen with Gore-Tex implant. The postphonosurgical videolaryngostroboscopy showed an improvement of the glottic closure in all patients; the scores of the Voice Handicap Index-10 and of the Maximum Phonation Time showed a statistically significant improvement after phonosurgery. The GRBAS scale scores showed a statistically significant improvement of Global Grade, Breathiness, and Asthenia; the parameter Strain remained unaltered both in pre- and postoperative evaluations, because the voice was never pressed due to glottic insufficiency, especially in preoperative observation. The parameter Roughness (R) did not show a significant difference between pre- and postoperative evaluation. CONCLUSION Medialization laryngoplasty is an effective phonosurgical procedure to improve voice outcome, after extended endoscopic laser cordectomies, in patients with unacceptable results after voice therapy and injection laryngoplasty. In our experience the Gore-Tex implant allows the surgeon to perform a safer and more "tailored" phonosurgery in cases of cordectomies type IV and V, associated or not with radiotherapy and in revision surgery.
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Reinhardt P, Giger R, Seifert E, Shelan M, Riggenbach E, Terribilini D, Joosten A, Schanne DH, Aebersold DM, Manser P, Dettmer MS, Simon C, Ozsahin EM, Moeckli R, Limacher A, Caparrotti F, Nair D, Bourhis J, Broglie MA, Al-Mamgani A, Elicin O. VoiceS: voice quality after transoral CO 2 laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer-a randomized phase III trial. Trials 2022; 23:906. [PMID: 36303192 PMCID: PMC9615245 DOI: 10.1186/s13063-022-06841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and meta-analyses, functional and oncological outcomes after both treatment modalities are similar. Historically, radiotherapy (RT) has been performed by irradiation of the whole larynx. However, only the involved vocal cord is being treated with recently introduced hypofractionated concepts that result in 8 to 10-fold smaller target volumes. Retrospective data argues for an improvement in voice quality with non-inferior local control. Based on these findings, single vocal cord irradiation (SVCI) has been implemented as a routine approach in some institutions for ESGC in recent years. However, prospective data directly comparing SVCI with surgery is lacking. The aim of VoiceS is to fill this gap. Methods In this prospective randomized multi-center open-label phase III study with a superiority design, 34 patients with histopathologically confirmed, untreated, unilateral stage 0-I ESGC (unilateral cTis or cT1a) will be randomized to SVCI or transoral CO2-laser microsurgical cordectomy (TLM). Average difference in voice quality, measured by using the voice handicap index (VHI) will be modeled over four time points (6, 12, 18, and 24 months). Primary endpoint of this study will be the patient-reported subjective voice quality between 6 to 24 months after randomization. Secondary endpoints will include perceptual impression of the voice via roughness – breathiness – hoarseness (RBH) assessment at the above-mentioned time points. Additionally, quantitative characteristics of voice, loco-regional tumor control at 2 and 5 years, and treatment toxicity at 2 and 5 years based on CTCAE v.5.0 will be reported. Discussion To our knowledge, VoiceS is the first randomized phase III trial comparing SVCI with TLM. Results of this study may lead to improved decision-making in the treatment of ESGC. Trial registration ClinicalTrials.gov NCT04057209. Registered on 15 August 2019. Cantonal Ethics Committee KEK-BE 2019-01506 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06841-5.
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Affiliation(s)
- Philipp Reinhardt
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Eberhard Seifert
- Division of Phoniatrics, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Elena Riggenbach
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Dario Terribilini
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Andreas Joosten
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Daniel H Schanne
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Matthias S Dettmer
- Department of Pathology, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.,Department of Pathology, University of Bern, Murtenstrasse 31, 3010, Bern, Switzerland
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV University of Lausanne, Rue du Bugnon, 2, 1011, Lausanne, Switzerland
| | - Esat M Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Rue du Bugnon, 21, 1011, Lausanne, Switzerland
| | - Raphaël Moeckli
- Institut of Radiation Physics, Lausanne University Hospital and Lausanne University, Rue du Grand-Pré 1, 1007, Lausanne, Switzerland
| | - Andreas Limacher
- Clinical Trials Unit Bern, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, Genève University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Deepa Nair
- Department of Head Neck Surgical Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Rue du Bugnon, 21, 1011, Lausanne, Switzerland
| | - Martina A Broglie
- Department of Head and Neck Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, 1066, Amsterdam, CX, Netherlands
| | - Olgun Elicin
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Hans S, Baudouin R, Circiu MP, Couineau F, Lisan Q, Crevier-Buchman L, Lechien JR. Laryngeal Cancer Surgery: History and Current Indications of Transoral Laser Microsurgery and Transoral Robotic Surgery. J Clin Med 2022; 11:jcm11195769. [PMID: 36233637 PMCID: PMC9571943 DOI: 10.3390/jcm11195769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
The development of transoral laser microsurgery (TLM) was an important step in the history of conservative laryngeal surgery. TLM reported comparable oncological outcomes and better functional postoperative and rehabilitation outcomes than open partial laryngectomy. TLM is currently considered as the standard surgical approach for early-stage laryngeal carcinoma. However, TLM has many limitations, including the limited view of the surgical field through the laryngoscope, exposure difficulties for some tumor locations, and a long learning curve. The development of transoral robotic surgery (TORS) appears to be an important issue to overcome these limitations. The current robotic technologies used in surgery benefited from the research of the U.S. Military and National Aeronautics and Space Administration (NASA) in the 1970s and 1980s. The first application in humans started in the 2000s with the first robotic-assisted cholecystectomy in the US, performed by a surgeon located in France. The use of robots in otolaryngology occurred after the development of the Da Vinci system in digestive surgery, urology, and gynecology, and mainly concerns cT1-T2 and some selected cT3 oropharyngeal and supraglottic carcinomas. With the development of a new robotic system with smaller arms and instruments, TORS indications will probably evolve in the next few years, leading to better outcomes for laryngeal or hypopharyngeal carcinomas.
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Affiliation(s)
- Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Marta P. Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Florent Couineau
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Jerome R. Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
- Division of Laryngology and Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Polyclinic of Poitiers—Elsan, 86000 Poitiers, France
- Correspondence:
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Colizza A, Ralli M, D'Elia C, Greco A, de Vincentiis M. Voice quality after transoral CO 2 laser microsurgery (TOLMS): systematic review of literature. Eur Arch Otorhinolaryngol 2022; 279:4247-4255. [PMID: 35505113 PMCID: PMC9363323 DOI: 10.1007/s00405-022-07418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech outcomes: acoustic and aerodynamics analysis, perceptual evaluation and patient-reported outcomes (PROs). The aim of this study was to systematically review the literature about the voice quality outcomes of TOLMS according to type of cordectomy. METHODS A systematic literature review was performed and all the results until December 2021 were extrapolated. We evaluated the acoustic and aerodynamics parameters (fundamental frequency, harmonics to noise ratio, jitter, shimmer and maximum phonation time), perceptual data (GRBAS scale) and patient-related outcomes (VHI scale). RESULTS 24 studies met the inclusion criteria for a total number of 1207 patients enrolled. The number for each type of cordectomy are: 287 type I (23.78%), 311 type II (25.78%), 328 type III (27.14%), 129 type 4 (10.69%) and 152 type V (12.60%). Patients are grouped according to the type of cordectomy in: limited cordectomy (type I and II) and extended cordectomy (types III-IV-V). The difference between two groups is statistically significative in terms of acoustic analysis, perceptual data and patient-related outcomes (p < 0.05). CONCLUSIONS Patients who underwent type I or II cordectomy have significantly better quality of voice in terms of VHI, perceptual voice quality evaluations and acoustic parameters compared to type III, IV and V cordectomies. The effect of TOLMS on the voice should depend from the extent of the resection and in particular from the scar of the vocal muscle.
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Affiliation(s)
- Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Chiara D'Elia
- Otorhinolaryngology Unit, Policlinico Umberto I, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Fermi M, Lo Manto A, Di Massa G, Gallo G, Lupi M, Maiolo V, Montrone G, Lovato L, Presutti L, Mattioli F. Paraglottic Space Invasion in Glottic Laryngeal Cancer: A Clinical‐Pathological Study. Laryngoscope 2022; 133:1184-1190. [PMID: 37042776 DOI: 10.1002/lary.30335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to prospectively compare endoscopic, radiological, and pathological features of a cohort of patients with glottic laryngeal squamous cell carcinoma (LSCC) undergoing open partial horizontal laryngectomy (OPHL) type II/III or total laryngectomy to better understand the reliability of preoperative endoscopy and computed tomography (CT) to predict the inferior paraglottic space (iPGS) involvement. METHODS We prospectively compared the endoscopic, radiological, and pathological findings in patients with glottic LSCC who underwent OPHL II/III, or total laryngectomy. RESULTS Endoscopy achieved a diagnostic accuracy of 87.2% for the anterior iPGS (iPGSa) and 86.1% for the posterior iPGS (iPGSp). There was no statistically significant difference in terms of histopathologic iPGSa involvement between reduced (85%-17/20 pts) and absent (92%-24/26 pts) vocal cord mobility (p = 0.39). CT alone did not improve the diagnostic performance of the endoscopy, reaching a diagnostic accuracy of 62.9% and 73.7% for the iPGSa and iPGSp, respectively. When endoscopy and CT were combined, the diagnostic performance improved for the iPGSp, achieving a sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) of 100%, 89.8%, 68.7%, and 100%, respectively. On the contrary, the combination of CT and endoscopy improved only the Se and NPV for the iPGSa with respect to the sole endoscopic assessment. CONCLUSIONS Whenever motility impairment is present, a histopathologic invasion of the iPGS should be suspected. Endoscopic assessment of laryngeal motility achieved a satisfactory value of Se, Spe, PPV, and NPV in predicting the involvement of the iPGS. CT scan is still the mainstay imaging technique in the clinical staging of patients with LSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1184-1190, 2023.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology, Head and Neck Surgery IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum Università di Bologna Bologna Italy
| | - Alfredo Lo Manto
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital of Modena Modena Italy
| | | | - Graziana Gallo
- Department of Pathology University Hospital of Modena Modena Italy
| | - Massimo Lupi
- Department of Pathology University Hospital of Modena Modena Italy
| | - Vincenzo Maiolo
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
| | - Grazia Montrone
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
| | - Luigi Lovato
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
| | - Livio Presutti
- Department of Otorhinolaryngology, Head and Neck Surgery IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico S.Orsola‐Malpighi Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum Università di Bologna Bologna Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital of Modena Modena Italy
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Lechien JR, Baudouin R, Circiu MP, Chiesa-Estomba CM, Crevier-Buchman L, Hans S. Transoral robotic cordectomy for glottic carcinoma: a rapid review. Eur Arch Otorhinolaryngol 2022; 279:5449-5456. [PMID: 35731294 DOI: 10.1007/s00405-022-07514-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The objective of this study was to investigate feasibility, surgical, oncological, and functional outcomes of transoral robotic cordectomy (TORS-Co) and whether TORS-Co reported comparable outcomes of transoral laser microsurgery (TLM). METHODS PubMed, Scopus, and Cochrane Library were searched by three laryngologists for studies investigating feasibility, surgical, oncological, and functional outcomes of patients benefiting from TORS-Co. The following outcomes were investigated according to the PRISMA statements: age; cT stage; types of cordectomy; surgical settings; complications; and functional and feasibility features. RESULTS Nine studies published between 2009 and 2021 met our inclusion criteria, accounting for 114 patients. There was no controlled study. TORS-Co was performed in cT1 or cT2 glottic cancer through types II, III, IV, V, or VI cordectomies. The exposure was inadequate in 4% of cases, leading to conversion in transoral laser cordectomy. Margins were positive in 4.5% and local recurrence occurred in 10.7% (N = 8/75). Tracheotomy and feeding tube requirement varied across studies, depending on the types of TORS-Co. The mean duration of robot installation/vocal cord exposure and operative times ranged from 20 to 42 min and 10 to 40 min, respectively. The mean duration of hospital stay ranged from 2 to 7 days. Complications included dyspnea, bleeding, granuloma, synechia, and tongue hematoma and dysesthesia. CONCLUSION The current robotic systems do not appear adequate for TORS-Co. TORS-Co was associated with higher rates of complications and tracheotomy than TLM.
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Affiliation(s)
- Jérôme R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Otolaryngology, Elsan Hospital, Paris, France.
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta P Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
| | - Stephane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
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Printz T, Mehlum CS, Godballe C, Iwarsson J, Pedersen SG, Christensen JH, Jørkov AS, Grøntved ÅM. Vocal Outcome After Cordectomy by Transoral CO 2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions. J Voice 2022:S0892-1997(22)00129-1. [PMID: 35732537 DOI: 10.1016/j.jvoice.2022.04.018] [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: 12/09/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. STUDY DESIGN Prospective, longitudinal, quasi-experimental time series. METHODS Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. RESULTS Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. CONCLUSION Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.
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Affiliation(s)
- Trine Printz
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Camilla Slot Mehlum
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.
| | - Christian Godballe
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Jenny Iwarsson
- Department of Scandinavian Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Solveig Gunvor Pedersen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Andreas Schellerup Jørkov
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Ågot Møller Grøntved
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
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Pribuisis K, Pribuisiene R, Padervinskis E, Ulozas V. Substitution voicing index: towards improved speech assessment in patients who have undergone laryngeal oncosurgery. CLINICAL LINGUISTICS & PHONETICS 2022:1-16. [PMID: 35656723 DOI: 10.1080/02699206.2022.2059398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to develop a multidimensional model for the evaluation of substitution voicing (SV) after laryngeal oncosurgery. The study group consisted of 121 adult male individuals: 59 patients with SV after laryngeal oncosurgery (endolaryngeal cordectomy, partial laryngectomy, total laryngectomy with tracheoesophageal prosthesis) and 62 healthy controls. A multidimensional protocol for the assessment of SV included, 1) self-reported speech evaluation with a short version of the Speech Handicap Index, 2) auditory-perceptual assessment, and 3) acoustic speech analysis using AMPEX® (Auditory Model Based Pitch Extractor) software. Moderate correlations were observed between parameters from self-reported auditory-perceptual and acoustic speech analysis domains. The multidimensional Substitution Voicing Index (SVI), including markers from these domains, was elaborated by using linear stepwise regression to determine the optimal set of parameters for categorising SV patients. The lowest mean SVI score was revealed in the control subgroup corresponding to the normal speech, followed by cordectomy subgroup and partial laryngectomy subgroup. The highest mean SVI score was revealed in the total laryngectomy subgroup, reflecting the most severely deteriorated quality of SV. One-way analysis of variance identified statistically significant differences between the mean SVI scores in separate subgroups. The results demonstrated the potential benefits of the SVI for a multidimensional evaluation of SV in patients after laryngeal oncosurgery.
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Affiliation(s)
- Kipras Pribuisis
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ruta Pribuisiene
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evaldas Padervinskis
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Virgilijus Ulozas
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Ujvary LP, Blebea CM, Dindelegan MG, Tiple C, Sevastre B, Maniu AA, Chirilă M, Cosgarea M. Experimental model for controlled endoscopic subepithelial vocal fold injury in rats. Acta Cir Bras 2022; 37:e370106. [PMID: 35416860 PMCID: PMC9000975 DOI: 10.1590/acb370106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: To present a detailed, reproducible, cost-efficient surgical model for
controlled subepithelial endoscopic vocal fold injury in the rat model. Methods: Six male Sprague Dawley rats were enrolled in the experiment. The left vocal
folds were used to carry out the injury model, and the right vocal fold
served as control. After deep sedation, the rats were placed on a custom
operating platform. The vocal fold injury by subepithelial stripping was
carried out using custom-made microsurgical instruments under endoscopic
guidance. Data were analyzed for procedural time and post-procedural pain.
Microcomputed tomography (micro-CT) scan and histologic images were obtained
to assess the length, area, and depth of injury to the vocal fold. Results: The mean procedural time was 112 s. The mean control vocal fold length was
0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The
mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion
area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ±
42.8 μm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as
well as lesion area to vocal fold surface area was 0.29 ± 0.02. Conclusions: Our described experimental vocal fold injury model in rats is found to be
fast, safe, cost-efficient, and reproducible with a rapid learning
curve.
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Affiliation(s)
| | | | | | - Cristina Tiple
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Romania
| | - Bogdan Sevastre
- University of Agricultural Sciences and Veterinary Medicine, Romania
| | | | | | - Marcel Cosgarea
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Romania
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Stomeo F, Gueli S, Corazzi V, Albi C, Cogliandolo C, Malagutti N, Ciorba A, Bianchini C, Pelucchi S. Transoral laser surgery for early glottic cancer: focus on oncologic results and margin status. Minerva Surg 2022; 77:183-185. [PMID: 35416006 DOI: 10.23736/s2724-5691.21.09012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Stomeo
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Simona Gueli
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Virginia Corazzi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Cecilia Albi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Cristina Cogliandolo
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Nicola Malagutti
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy -
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
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Sjogren E, Hendriksma M, Piazza C, Hartl DM, Suarez C, Cohen O, de Bree R, Quer M, Poorten VV, Rodrigo JP, Civantos F, Genden E, Kowalski LP, Makitie A, Shaha A, Takes RP, Sanabria A, Guntinas-Lichius O, Rinaldo A, Ferlito A. Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review. J Voice 2022:S0892-1997(22)00069-8. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
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Affiliation(s)
- Elisabeth Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dana M Hartl
- Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Oviedo, Spain
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric Genden
- Ear, Nose, Throat / Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolarynglology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School
| | - Antti Makitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Al Afif A, Rigby MH, MacKay C, Brown TF, Phillips TJ, Khan U, Trites JRB, Corsten M, Taylor SM. Injection laryngoplasty during transoral laser microsurgery for early glottic cancer: a randomized controlled trial. J Otolaryngol Head Neck Surg 2022; 51:12. [PMID: 35317850 PMCID: PMC8939150 DOI: 10.1186/s40463-022-00564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transoral laser microsurgery is widely used for treating T1/T2 glottic cancers. Hyaluronic acid (HA) is commonly used in vocal cord augmentation. We investigated the impact of intra-operative injection laryngoplasty on voice outcomes in early glottic cancer. METHODS Twenty patients were randomized to the treatment group receiving HA injection to the vocal cord contralateral to the lesion; or the control group, receiving no injection. Patients had a Voice Handicap Index-10 (VHI-10) questionnaire and a Maximum Phonation Time (MPT) measurement preoperatively and at 3, 12 and 24 months post-operatively. Mean change in VHI-10 and MPT, compared to baseline and between time points, were compared. Survival estimates were calculated. RESULTS Mean VHI-10 scores improved over time amongst all patients. There were no changes in mean VHI-10 from pre-operative values to 3, 12 or 24 months post-operatively. There were no significant differences when comparing various timepoints between groups. There were no significant changes in MPT amongst the groups, or the time-points compared. Two-year overall survival was 91.7%; disease free survival was 80.9%; no difference in recurrence free survival was seen between the groups. CONCLUSION Subjective voice scores improved over time in both groups; there were no improvements in VHI-10 or MPT scores in the injection group, over control, at any time points. We saw no significant impact for intra-operative HA injection laryngoplasty on subjective or objective voice outcomes following surgery for early glottic cancers.
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Affiliation(s)
- Ayham Al Afif
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada. .,University of Alabama at Birmingham, 1155 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35233, USA.
| | - Matthew H Rigby
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Colin MacKay
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Timothy F Brown
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Timothy J Phillips
- Department of Surgery, Queen's University, Victory 3, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Usman Khan
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Jonathan R B Trites
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Martin Corsten
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - S Mark Taylor
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
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Ujvary PL, Blebea CM, Maniu AA, Pop S, Sarpataki O, Cosgarea M. Vocal fold injury models in rats: a literature review on techniques and methodology. J Med Life 2022; 15:336-343. [PMID: 35449991 PMCID: PMC9015177 DOI: 10.25122/jml-2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
This study reviewed the current literature on technical aspects regarding controlled vocal fold injuries in the rat model. Data from PubMed, Embase, and Scopus database for English language literature was collected to identify methodological steps leading to a controlled surgical injury of the rat vocal fold. Inclusion criteria: full disclosure of anesthesia protocol, positioning of the rat for surgery, vocal fold visualization method, instrumentation for vocal fold injury, vocal fold injury type. Articles with partial contribution were evaluated and separately included due to the limited number of original methodologies. 724 articles were screened, and eleven articles were included in the analysis. Anesthesia: ketamine hydrochloride and xylazine hydrochloride varied in dose from 45 mg/kg and 4.5 mg/kg to 100 mg/kg and 10 mg/kg. Visualization: The preferred method was the 1.9 mm, 25-30 degree endoscopes. The widest diameter endoscope used was 2.7 mm with a 0 or 30 degree angle of view. Instruments for lesion induction range from 18 to 31G needles, microscissors, micro forceps to potassium titanyl phosphate, and blue light lasers. Injury types: vocal fold stripping was the main injury type, followed by vocal fold scarring and charring. One article describes scaffold implantation with injury to the superior aspect of the vocal fold. Rats are good candidates for in vivo larynx and vocal folds research. A more standardized approach should be considered regarding the type of vocal fold injury to ease data comparison.
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Affiliation(s)
- Peter Laszlo Ujvary
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Maria Blebea
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Corresponding Author: Cristina Maria Blebea, Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:
| | - Alma Aurelia Maniu
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sever Pop
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Orsolya Sarpataki
- Department of Physiology, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Liu CH, Chien PJ, Hung LT, Wang LM, Kao YC, Tsai YJ, Chu PY. Long-term Oncologic Results and Voice Outcomes in Patients With Glottic Cancer After Modified Type III Cordectomy. Otolaryngol Head Neck Surg 2022; 167:839-845. [PMID: 35167384 DOI: 10.1177/01945998221075317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Transoral laser microsurgery and radiotherapy provide high and comparable cure rates for the treatment of early glottic cancer. However, the voice outcomes after treatment remain controversial. A modified type III cordectomy technique was proposed in 2006, and preliminary results showed it to be an oncologically safe method with satisfactory voice outcomes. This study aimed to evaluate oncologic and voice outcomes after long-term follow-up of these patients. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. METHODS Between 2006 and 2018, 42 patients with glottic cancer underwent a modified type III cordectomy. This technique resected the tumor and upper part of the vocal folds and preserved the lower part of the vocalis muscle as a scaffold to improve glottis closure. The oncologic results and voice outcomes were evaluated at a median follow-up of 68 months. RESULTS The primary tumor stages included 13 T1 (31%), 26 T2 (64%), and 3 T3 (7%). Eight patients (19%) had local recurrence, and 6 underwent successful salvage with transoral laser microsurgery with or without postoperative radiotherapy with laryngeal preservation. The 5-year rate of local control was 80%; laryngeal preservation, 95%; overall survival, 89%; and disease-specific survival, 97%. The final laryngeal preservation rate was 95% (40/42). The voice outcomes were satisfactory and comparable to those of patients who underwent type I and II cordectomies. CONCLUSION The modified type III cordectomy has been proven to be an oncologically safe method with satisfactory voice outcomes after long-term follow-up in selected cases of early glottic cancer.
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Affiliation(s)
- Chin-Hsuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Li-Mei Wang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Ya-Chuan Kao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Yueh-Ju Tsai
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei
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Is the exoscope ready to replace the operative microscope in transoral surgery? Curr Opin Otolaryngol Head Neck Surg 2022; 30:79-86. [PMID: 35131988 DOI: 10.1097/moo.0000000000000794] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Exoscopes are external digital devices that provide enhanced and magnified visualization of the surgical field. They usually have dedicated digital controls and a more compact mechanical structure than operative microscopes and current robotic surgical systems. This technology has significant potential in otolaryngology - head and neck surgery, especially concerning the field of transoral approaches. We herein analysed the overall technical characteristics of currently available exoscopic systems and contextualized their advantages and drawbacks in the setting of transoral surgery. RECENT FINDINGS The actual advantages of exoscopy are still indeterminate, as it has only been applied to limited surgical series. However, its specific properties are herein compared with conventional transoral microsurgery and transoral robotic surgery, discussing the available literature on such a topic, filtered on the basis of the authors' experience and its possible future evolutions. Finally, a summary of current experiences in the field of three-dimensional (3D) transoral exoscopic surgery is presented, highlighting differences compared with standard approaches. SUMMARY 3D-exoscopic transoral surgery will possibly play an essential role in future management of early laryngeal and oropharyngeal lesions, significantly shifting the paradigms of this type of procedures.
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Wang CC, Lin WJ, Wang JJ, Chen CC, Liang KL, Huang YJ. Transoral Robotic Surgery for Early-T Stage Glottic Cancer Involving the Anterior Commissure—News and Update. Front Oncol 2022; 12:755400. [PMID: 35174080 PMCID: PMC8841867 DOI: 10.3389/fonc.2022.755400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background About 20% of all glottic carcinomas involve the anterior commissure (AC), and AC involvement was deemed to be a risk factor of local recurrence and poor prognosis. Transoral robotic surgery (TORS) has been developed for a panoramic view of the AC and en-bloc resection of the tumor by multidirectional dissection with endo-wristed instruments. With satisfactory preliminary results, we would like to update the data with a bigger cohort and present the news on using TORS for salvage treatment of recurrence from irradiation failure. Methods From July 2010 to December 2019, 22 patients with early T1 and 2 stage primary (n = 11) or recurrent (n = 11) glottic cancer with AC involvement received TORS without adjuvant therapy. TORS exposure was found to be better than TLM by conventional laryngoscopy in diagnostic biopsy. Seven of the 22 patients had recurrent cancer from irradiation failure. The perioperative factors that may be associated with survival were retrospectively analyzed, and the 5-year overall survival (OS)/disease-specific survival (DSS)/recurrence-free survival (RFS)/and organ preservation survival (OPS) rate were estimated by the Kaplan–Meier Method. Their voice and swallowing functions were evaluated by questionnaires of Voice Handicap Index-10 (VHI-10) and Functional Outcome Swallowing Scale (FOSS). Results All 22 TORSs were completed smoothly. After a mean follow-up of 49 ± 35.9 months, the Kaplan–Meier method estimated 5-year OS/DSS/RFS/OPS was 93.8%, 93.8%, 74.6%, and 86.3%, respectively. Our 11 patients with fresh cancer had 100% recurrence-free survival. Although the recurrent rate was higher in patients with history of RT, they could be rescued by further open laryngectomy without compromising the OS and DSS. Only one patient expired. The other 21 patients had satisfactory swallowing function with FOSS of 0.33 ± 0.66. Five patients depended on tracheostomy, but the rest 17 patients had serviceable voice with VHI-10 of 18.41 ± 11.29. Conclusions TORS could be used in the primary or salvage management of glottic cancer with AC involvement while TORS was confirmed to have better exposure to TLM. The RFS was good for patients with primary cancer. In patients having irradiation failure, TORS could also be a minimally invasive transoral approach before trying open surgery to preserve the organ.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
- *Correspondence: Chen-Chi Wang,
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jing-Jie Wang
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Chih Chen
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Kai-Li Liang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Jung Huang
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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Dallari S, Giannoni L, Filosa A. Scanning Super/Ultrapulsed CO2 Laser Efficacy in Laryngeal Malignant Lesions. Medicina (B Aires) 2022; 58:medicina58020200. [PMID: 35208524 PMCID: PMC8877357 DOI: 10.3390/medicina58020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The authors review their experience in transoral laryngeal microsurgery (TLM) that they performed with two different CO2 laser devices from the same company, which were both equipped with a micromanipulator and digital scanner. Material and Methods: A total of 91 glottic and glotto-supraglottic cancers were treated during the years 2009–2016 and then analyzed in relation to the laser performances and the long-term oncologic results. Results: Laser devices proved to be very efficient and the UP mode was confirmed to be the best in terms of cutting precision and lowest thermal damage. Conclusions: CO2 laser TLM is the preferred option for the majority of small–medium size glottic and supraglottic cancers and may also be used for bigger tumors, especially in older patients.
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Affiliation(s)
- Stefano Dallari
- Otorhinolaryngology Unit, Department of Surgery, “A. Murri” Hospital—ASUR Marche, Area Vasta n. 4, 63900 Fermo, Italy
- Correspondence: ; Tel.: +39-333-123-5287
| | - Luca Giannoni
- Reasearch and Developement, El.En. Group, 50041 Florence, Italy;
| | - Alessandra Filosa
- Pathology Department, “A. Murri” Hospital—ASUR Marche, Aree Vaste n. 4 and 5, 63900 Fermo, Italy;
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Korkmaz MH, Bayır Ö, Hatipoğlu EB, Tatar EÇ, Han Ü, Öcal B, Keseroğlu K, Karahan S, Saylam G. Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience. Eur Surg Res 2021; 63:132-144. [PMID: 34818662 DOI: 10.1159/000519718] [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: 06/27/2021] [Accepted: 09/16/2021] [Indexed: 12/09/2022]
Abstract
Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study. METHODS Patients with early-stage (Tis-1-2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. RESULTS One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of "wait and see" modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001). CONCLUSION The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.
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Affiliation(s)
- Mehmet Hakan Korkmaz
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey.,Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ömer Bayır
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey,
| | | | - Emel Çadalli Tatar
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ünsal Han
- Department of Pathology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bülent Öcal
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Lechien JR, Crevier-Buchman L, Circiu MP, Lisan Q, Hans S. Evolution of Voice Quality in Type 1-2 Transoral CO 2 Laser Cordectomy: A Prospective Comparative Study. Laryngoscope 2021; 132:1421-1426. [PMID: 34704611 DOI: 10.1002/lary.29924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the 12-month evolution of voice quality outcomes in patients who benefited from types 1-2 transoral CO2 laser cordectomy (TLC) for an early-stage vocal fold squamous cell carcinoma (VFSCC). STUDY DESIGN Prospective uncontrolled study. METHODS Sixty patients with cT1 VFSCC were consecutively recruited from a single medical center. Thirty patients benefited from type 1 TLC, while type 2 TCL was performed in 30 patients. The following voice quality outcomes were evaluated at baseline, 3-, 6-, and 12-month post-TLC: voice handicap index (VHI), GRBAS, speech rate, maximum phonation time (MPT), and acoustic parameters. Voice quality evolution was compared between type 1 and type 2 TLC. RESULTS Fifty-seven patients completed the evaluations. Type 1 TLC patients reported significant improvements of VHI, grade of dysphonia, and breathiness at 3-, 6-, and 12-month post-TLC. Speech rate and jitter values improved 6- and 12-month post-TLC. A few voice quality outcomes reported 3- or 6-month post-TLC improvements in type 2 TLC group, while VHI, grade of dysphonia improved at 6- and 12-month post-TLC. MPT significantly decreased at 6- and 12-month post-TLC, while there were no acoustic measurement changes in type 2 TLC. CONCLUSIONS The effect of TLC on voice quality may depend on the type of TLC. Type 1 TLC was associated with faster voice quality improvements compared with type 2 TLC. VHI and dysphonia grade were identified as the most relevant tool of voice changes irrespective to the TLC type. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France.,Phonetics and Phonology Lab, CNRS UMR7018, University of Sorbonne-Nouvelle, Paris, France
| | - Marta P Circiu
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Stephane Hans
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France.,Phonetics and Phonology Lab, CNRS UMR7018, University of Sorbonne-Nouvelle, Paris, France
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Abstract
OPINION STATEMENT Dysplasia and early laryngeal cancer lie on a spectrum of cellular changes. These start with early changes to the cells including epithelial hyperplasia and expand to dysplasia, squamous cell carcinoma in situ and finally developing in to invasive cancer. Dysplasia can range from low to high grade, with each being treated in a different manner. Treatment options are typically determined by where the dysplasia/invasive cancer lie on this spectrum along with the site within the larynx. Hyperkeratosis, mild dysplasia and moderate dysplasia typically involve primary endoscopic excision. Severe dysplasia and squamous cell carcinoma in situ involve primary endoscopic resection with the addition of possible laser resection and/or ablation. At this stage, surgery will be followed by close surveillance. Finally, early laryngeal cancer such as T1 and T2 lesions is typically more involved. Treatment depends on the site and degree of involvement of the structures, along with spread to surrounding structures. Typical treatment options of more involved early laryngeal cancer can range from radiation therapy, endoscopic transoral laser resection, endoscopic transoral robotic resection to open resection. Often times, my choice of treatment will be aimed at voice preservation but patient preference will also play a role in the decision making between treatment modalities. Chemotherapy and immunotherapy are typically not used in early stage laryngeal cancer.
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Cohen JT, Goldman T, Paker M, Fridman E. Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy. Otolaryngol Head Neck Surg 2021; 166:901-906. [PMID: 34399642 DOI: 10.1177/01945998211037658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition. STUDY DESIGN Retrospective study. SETTING A voice and swallowing clinic at a tertiary referral hospital. METHODS We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer. RESULTS For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons' estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I. CONCLUSION Surgeons' reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; The Technion, Haifa, Israel
| | - Tal Goldman
- Tissue Diagnosis and Cancer Research Institute, Ha'Emek Medical Center, Afula, Israel
| | - Miki Paker
- Department of Otolaryngology Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; The Technion, Haifa, Israel
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Ryan MA, Brodsky MB, Blumin JH, Bock JM, Carroll TL, Garrett CG, Lechien JR, Ongkasuwan J, Simpson CB, Akst LM. Twenty-One for 2021: The Most Influential Papers in Laryngology Since 2000. Laryngoscope 2021; 132:406-412. [PMID: 34318936 DOI: 10.1002/lary.29781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify the most influential publications in laryngology since 2000. STUDY DESIGN Modified Delphi process. METHODS Samples of laryngologists drawn from editors of leading journals, organization officers, and thought leaders were invited to participate in a modified Delphi identification of influential laryngology papers. Influential was defined as follows: yielding meaningful practice changes, catalyzing further work as a foundation for an important topic, altering traditional views, or demonstrating durability over time. Quality and validity were not among the selection criteria. Each participant nominated 5 to 10 papers in Round 1. These nominations, augmented with papers from bibliometric analysis, were narrowed further in Round 2 as participants identified their top 20. The 40 papers with the most Round 2 votes were discussed by video conference and then subjected to Round 3 voting, with each participant again selecting their top 20 most influential papers. Final results were collated by the number of Round 3 votes. RESULTS Sixteen of 18 invited laryngologists participated overall (all 16 in Rounds 1 and 3; 14 in Round 2). Twenty-one papers were identified as most influential. One paper appeared on all 16 Round 3 lists; three papers with eight (50%) votes each were lasted to make the list. Eleven of these 21 focused on voice; three each related to cancer, airway, and swallowing; and one encompassed all of these clinical areas. CONCLUSIONS This list of 21 influential laryngology papers serves to focus further research, provides perspective on recent advances within the field, and is an educational resource for trainees and practicing physicians. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation; Division Pulmonary and Critical Care Medicine; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Joel H Blumin
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Thomas L Carroll
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Jerome R Lechien
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France.,Department of Otolaryngology, Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.,School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Paderno A, Lancini D, Bosio P, Del Bon F, Fior M, Berretti G, Alparone M, Deganello A, Peretti G, Piazza C. Transoral Laser Microsurgery for Glottic Cancer in Patients Over 75 Years Old. Laryngoscope 2021; 132:135-141. [PMID: 34233029 PMCID: PMC9291037 DOI: 10.1002/lary.29738] [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: 02/27/2021] [Revised: 06/16/2021] [Accepted: 06/28/2021] [Indexed: 12/22/2022]
Abstract
Objectives/Hypothesis Laryngeal squamous cell carcinoma (LSCC) has a non‐negligible incidence in elderly patients. However, there is still no clear indication on the ideal treatment for early‐intermediate glottic LSCC in this specific age group. Both surgical and nonsurgical approaches may be burdened by complications and sequelae that negatively impact patient's health. In this setting, carbon dioxide transoral laser microsurgery (CO2 TOLMS) is a promising minimally invasive treatment option. Study Design Retrospective case series in a single tertiary academic institution. Methods Patients who underwent CO2 TOLMS for Tis‐T3 glottic LSCC from 1997 to 2017 were reviewed. Demographic, clinical, and tumor characteristics, as well as postoperative complications were recorded. Overall (OS), disease‐specific (DSS), recurrence‐free (RFS), laryngo‐esophageal dysfunction free survivals (LEDFS), and organ preservation (OP) were calculated. Results A total of 134 patients (mean age, 80 ± 4 years; median, 79; range, 75–93) were included in the study. Seven lesions were classified as pTis, 65 as pT1a, 22 as pT1b, 35 as pT2, and 5 as pT3. No treatment‐related death was observed. Twenty‐eight (20.9%) patients reported 10 surgical and 19 medical complications. Five‐year OS, DSS, RFS, LEDFS, and OP were 68.9%, 95.4%, 79.5%, 66%, and 92.5%, respectively. Age and comorbidities were associated with OS and LEDFS. Advanced T categories were negatively correlated with OS, DSS, RFS, LEDFS, and OP. Age and comorbidities were not significant risk factors for complications. Conclusions CO2 TOLMS can be considered a valuable therapeutic approach for selected Tis‐T3 glottic LSCC even in the elderly given its favorable oncologic outcomes and minimal aggressiveness. Level of Evidence 4 Laryngoscope, 132:135–141, 2022
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Affiliation(s)
- Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Paolo Bosio
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Milena Fior
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Berretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Alparone
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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47
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Pecorari G, Perottino F, Riva G, Nora V, Poupart M, Zrounba P. Pignat's vertical partial laryngectomy with crico-hyoido-epiglotto-plasty. Eur Arch Otorhinolaryngol 2021; 279:979-986. [PMID: 34117535 DOI: 10.1007/s00405-021-06858-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Pignat's partial laryngectomy with crico-hyoido-epiglotto-plasty (CHEPL) is a vertical laryngectomy with resection of the anterior portion of the thyroid cartilage and reconstruction with a wires net and the subhyoid muscles. The aim of this retrospective study was to evaluate and analyze oncologic and functional outcomes in patients affected by laryngeal squamous cell carcinoma and treated with Pignat's partial laryngectomy. METHODS Seventy patients with cT1-cT3 glottic cancer were surgically treated with Pignat's technique. EXCLUSION CRITERIA invasion of posterior cricoid arch, more than 3 mm under glottis, of more than one arytenoid, of posterior portion of thyroid cartilage, of the suprahyoid epiglottis. Overall survival, disease free survival, rates of decannulation and enteral feeding were analyzed. RESULTS 23 (32.9%) pT1, 37 (52.9%) pT2, 5 (7.1%) pT3, 5 (7.1%) pT4a, 64 (91.5%) pN0, 5 (7.1%) pN1, 1 (1.4%) pN2. Adjuvant treatment was administered to 13 patients (18.6%). All patients had tracheotomy. Five year OS and DFS were 81.66 and 77.95%, respectively. A statistically significant DFS difference was observed between early and late stages. Five year local control was 81.16%. Five year larynx preservation rate was 89.16%. Median decannulation time was 12 days. Median duration of enteral nutrition was 16 days. All patients achieved efficient phonation. CONCLUSION Pignat's partial laryngectomy with CHEPL can represent an alternative to horizontal supracricoid laryngectomy to achieve laryngeal preservation. Good oncologic and functional outcomes are possible as long as indications are followed.
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Affiliation(s)
- Giancarlo Pecorari
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Flavio Perottino
- Otorhinolaryngology Division, Escarton's Hospital, 6 Avenue Daurelle, Briançon, France.
| | - Giuseppe Riva
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Valsecchi Nora
- Otorhinolaryngology Division, Escarton's Hospital, 6 Avenue Daurelle, Briançon, France.,Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marc Poupart
- Otorhinolaryngology Division, Leon Berard Cancer Center, Lyon, France
| | - Philippe Zrounba
- Otorhinolaryngology Division, Leon Berard Cancer Center, Lyon, France
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48
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Li X, Li G, Li J, Yu P, Hu X, Sun G, Cui X. Reconstruct the anterior commissure with intralaryngeal mucosal flap. Clin Otolaryngol 2021; 46:1073-1076. [PMID: 33740834 DOI: 10.1111/coa.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 12/15/2020] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Xumao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangfei Li
- Department of Otolaryngology Head and Neck, Nanjing Tongren Hospital, Southeast University, Nanjing, China
| | - Jiaying Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Pengcheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinqi Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xidong Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
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49
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Ronen O, Robbins KT, de Bree R, Guntinas-Lichius O, Hartl DM, Homma A, Khafif A, Kowalski LP, López F, Mäkitie AA, Ng WT, Rinaldo A, Rodrigo JP, Sanabria A, Ferlito A. Standardization for oncologic head and neck surgery. Eur Arch Otorhinolaryngol 2021; 278:4663-4669. [PMID: 33982178 DOI: 10.1007/s00405-021-06867-6] [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: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
The inherent variability in performing specific surgical procedures for head and neck cancer remains a barrier for accurately assessing treatment outcomes, particularly in clinical trials. While non-surgical modalities for cancer therapeutics have evolved to become far more uniform, there remains the challenge to standardize surgery. The purpose of this review is to identify the barriers in achieving uniformity and to highlight efforts by surgical groups to standardize selected operations and nomenclature. While further improvements in standardization will remain a challenge, we must encourage surgical groups to focus on strategies that provide such a level.
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Affiliation(s)
- Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Dana M Hartl
- Head and Neck Oncology Service, Gustave Roussy, Villejuif, France
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza Y Cuello, Medellín, Colombia
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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50
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Meulemans J, Narimani S, Hauben E, Nuyts S, Laenen A, Delaere P, Vander Poorten V. Introduction of a New Pathology Workup Protocol for Glottic Cancer Treated With Transoral Laser Microsurgery (TLM): Prospective Analysis of Oncological Outcomes and Matched Case-Control Study. Front Oncol 2021; 11:685255. [PMID: 34017690 PMCID: PMC8130557 DOI: 10.3389/fonc.2021.685255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
Background/Purpose The value of margin status after TLM for glottic cancer is debatable, due to difficulties in specimen orientation and margin analysis. To reduce these difficulties, we recently introduced a standardized protocol of oriented fixation of TLM specimens. This proved feasible and resulted in high margin evaluability rates and a decreased rate of false positive deep margins, when compared to a historical TLM cohort. For the patients whose specimens were processed according to this protocol, we prospectively analyzed oncological outcomes, identified prognostic factors and assessed the influence of the protocol introduction on outcomes compared with a historical TLM cohort. Methods Ninety-six patients with glottic malignancies treated with TLM were included. Resection specimens were processed according to the new protocol. Descriptive statistics and survival analyses were used to determine oncological outcomes. To assess the effect of the protocol introduction on outcomes, a matched-case-control analysis was performed, using a historical TLM-cohort as controls. The Cox proportional hazards model was used to analyze prognostic effects of patient and treatment characteristics, including the pathology protocol introduction, on overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and local recurrence-free survival (LRFS). Results Two-year outcomes were favorable: 88.5% OS, 97.0% DSS, and 87.6% LRFS. At multivariable analysis, the presence of multiple positive superficial margins was a negative prognosticator for OS (HR 4.102) and increasing cT classification proved a negative prognosticator for DFS (HR 2.828) and LRFS (HR 2.676). Matched case-control analysis did not reveal a significant difference in oncological outcomes between cohorts. Deep margin status had a strong differential effect for DFS (p-value for interaction = 0.0205) and for LRFS (p-value for interaction = 0.0176) between cohorts, indicating a prognostic effect of deep margin status on both outcomes in the current cohort, but not in the historical cohort. Discussion/Conclusion The introduction of a new standardized technique of oriented fixation of TLM specimens did not affect oncological outcomes when compared to a historical TLM cohort, but assigned a significant prognostic effect to deep margin status for DFS and LRFS, facilitating the decision making process with regards to planning of second-look procedures, administration of adjuvant radiotherapy or determination of follow-up intensity.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Sara Narimani
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Esther Hauben
- Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology and Imaging, KU Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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