CO2 laser cordectomy as a day-case procedure (original) (raw)
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Ear, Nose & Throat Journal, 2020
Objective: To investigate the feasibility and the outcomes of transoral laser CO2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure. Methods: Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS). Results: A total of 148 patients were included. The TLM was realized in 95.3% of cases. External...
Otolaryngology - Head and Neck Surgery, 2005
OBJECTIVE: To analyze oncologic results in patients with glottic cancers treated respectively, by laser CO 2 or open surgery, taking into account specificdisease survival, rate of locoregional recurrences, and their salvageability. STUDY DESIGN: Retrospective study of 198 patients treated from January 1993 to June 2002 in the department of otorhinolaryngology at a Catholic university in Rome.
Early-Stage Glottic Cancer: Oncological Results and Margins in Laser Cordectomy
Archives of Otolaryngology-head & Neck Surgery, 2006
Objectives: To assess local control of early-stage glottic cancer by laser cordectomy in comparison with previously published external partial laryngectomy series and to determine the relevance of histological margins in glottic cancers excised with laser cordectomy.
Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy
The Laryngoscope, 2015
Anterior commissure involvement is considered to be a risk factor for poorer outcomes after transoral laser cordectomy (TLC) for early glottic cancer. The objective of this study was to determine the outcomes and relevance of the tumor-node-metastasis (TNM) classification in a large series of patients with early glottic cancer involving the anterior commissure treated by TLC. The clinical and surgical parameters, as well as follow-up results, of the patients treated consecutively for early-stage glottic squamous cell carcinoma involving the anterior commissure (Tis, T1a, T1b, and T2) by transoral CO2 laser cordectomy in an urban academic medical center from January 2001 to March 2013 were analyzed retrospectively. The main outcomes measures were: 5-year disease free survival (DFS), ultimate local control with laser alone, laryngeal preservation, overall-survival (OS) rates, and disease-specific survival (DSS) rates (Kaplan-Meier). Ninety-six patients treated from January 2001 to Mar...
Head & Neck, 2007
Background. The clinical results of radiotherapy and endoscopic cordectomy for T1a glottic carcinoma are reported to be similar, but costs of both treatments may differ. Therefore, we retrospectively evaluated the costs, voice quality, quality of life, and clinical results of both treatments. Methods. Costs and effects from the first visit up to 2 years of follow-up were calculated, based on chart data of 35 and 54 patients who were treated with curative intent for T1a glottic carcinoma from 1995 to 1999 with radiotherapy and endoscopic cordectomy, respectively. Voice quality and quality of life were evaluated by means of patient questionnaires. Results. Total costs (in Euros) of radiotherapy and CO 2-laser cordectomy were e8322 and e4434, respectively, including the costs of treating possible recurrences. The effects of both treatments were equal, including voice quality and quality of life. Conclusions. We conclude that endoscopic cordectomy is an efficient alternative for radiotherapy for these patients.
Identifying outcome predictors of transoral laser cordectomy for early glottic cancer
Head & neck, 2015
BACKGROUND To determine the predictors of outcomes in patients with early glottic cancer treated by transoral laser cordectomy. METHODS Inception cohort study: 201 patients. Five-year Kaplan-Meier analysis were realized. RESULTS Patients with anterior commissure involvement (n = 75) had a significantly lower disease free survival rate (54.6% vs 79.8%, p = 0.0004), ultimate local control with laser alone rate (71.0% vs 95.7%, p <0.0001), laryngeal preservation rate (91.6% vs 100%, p = 0.0003) and disease-specific survival rate (90.8% vs 99.0%, p = 0.03). There was no significant difference in overall-survival rates (76.9% vs 88.5%, p = 0.29). Surgical margin status was not found to be a significant predictor of outcomes in this series. CONCLUSIONS While anterior commissure involvement has a significant impact on outcomes, laser cordectomy remains a valuable option considering its high organ preservation and survival rates. In cases of local recurrence, all standard further treatme...
European Archives of Oto-Rhino-Laryngology, 2012
The financial costs of laryngeal cancer treatment are a notable burden on healthcare budgets. In this study, we assess whether CO 2 laser surgery is cheaper than radiotherapy or laryngofissure and cordectomy in the treatment of T1-2, N0, M0 glottic squamous cell carcinoma. 56 patients with a mean age of 65.88 years (SD = 10.04), 53 men and 3 women, with T1-2, N0, M0 glottic squamous cell carcinoma were retrospectively analysed. We conducted a comparative analysis of costs associated with three treatments: carbon dioxide laser cordectomy (n = 21), radiotherapy (n = 20), and laryngofissure cordectomy (n = 15). Complications of the radiotherapy and surgical treatments, need for tracheotomy and its permanence, length of hospital stay, occupation and ability to work and economic costs of treatments were recorded. Cost-minimisation and cost-effectiveness analysis were obtained. The cost of transoral laser cordectomy (2,289.79 €) is statistically significantly lower than that of radiotherapy (4,804.72 €) or laryngofissure cordectomy (13,229.75 €) (p \ 0.001). Transoral carbon dioxide laser surgery is the best option in terms of cost-effectiveness for the treatment of T1-2, N0, M0 glottic cancer.
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2016
Several therapeutic options are used for treatment of early stage glottic carcinoma (Tis/T1/T2): open partial laryngectomy (OPL), radiotherapy and CO2 laser-assisted endoscopic surgery. Laser surgery has gradually gained approval in the management of laryngeal cancer. We present our experience in endoscopic laser surgery for early stage glottic carcinomas. This was a retrospective analysis of 72 patients with T1-T2 glottic cancer treated with laser cordectomy between 2006 and 2012. All patients had at least a 36-month follow-up period. Percentages for disease-specific survival, disease-free survival (DFS) and laryngeal preservation rates were 98.6%, 84.7% and 97.2% respectively. Considering neoplastic features that could predict long-term oncological outcome, tumoural involvement of anterior commissure and pathological staging (pT) significantly correlate with local recurrence (p = 0.021 and p = 0.035) and with a lowered DFS (p = 0.017 and p = 0.023). Other variables such as clinica...
European annals of otorhinolaryngology, head and neck diseases, 2011
The small size of endoscopic laser cordectomy (ELC) specimens frequently leads the histopathologist to assess excision margins as pathologic. The present study sought to assess the prognostic value of margin status in terms of overall and of recurrence-free survival in a population of T1a glottic carcinoma operated on by ELC. Sixty-four records of T1a squamous-cell carcinoma treated between 1996 and 2006 were retrospectively analyzed. Overall and recurrence-free survival for the group with negative margins (group 1) and with positive margins (group 2) were analyzed following Kaplan-Meier. The influence of resection margin histologic status was assessed on Log Rank test. Six female and 58 male patients were included. Forty (62.5%) had negative margins (group 1) and 24 (37.5%) positive margins (group 2). Overall five-year survival was 97% (95% in group 1 and 100% in group 2). Five-year recurrence-free survival was 94% (91.7% in group 1 and 95% in group 2). There was no significant dif...
European Archives of Oto-Rhino-Laryngology, 2008
All the classiWcation of precancerous lesions are based on the progression of speciWc histopathological characteristics, which in turn considers the grade of epithelial hyperplasia and dysplasia, nevertheless the transformation of laryngeal keratosis into carcinoma occurs through progressive modiWcations of normal epithelium in keratosis without dysplasia, to the point of degenerating into carcinoma in situ. The treatment of laringeal precancerosis has not yet deWned a gold standard: according to some authors, a simple excision biopsy may be suYcient, others, instead, perform the stripping of the involved vocal cord, while others yet perform vaporization by means of CO 2 laser. The aim of this paper is to evaluate and possibly validate the treatment of mild and moderate laryngeal dysplasia (LIN1-2) by CO 2 laser, with particular attention to oncological and functional results. Fifty-eight patients (44 males and 14 females, mean age 54.3 years) aVected by mild and moderate dysplasia (32 LIN I and 26 LIN II) diagnosed by a bioptic exam, were treated by performing a CO 2 laser cordectomy (following the European Society of Laryngology's criteria). Before surgery to the patients was given a questionnaire to identify primary risk factors such as smoking, alcohol use and gastroesophageal reXux, were also handed a Vocal Performance Questionnaire. In all patients was performed a pH measurement over a 24-h period, a voice evaluation using a Kay digital Strobe 920. 84% of patients were smokers; the presence of reXux was reported in 11 patients (19%). The 32 LIN1 cases treated with type I cordectomy determined four recurrences (12.4%), of which two LIN1, one LIN2 and one carcinoma in situ. Of the 26 LIN2 cases examined, the 12 treated with type 1 cordectomy generated 1 recurrence alone with the presence of an invasive carcinoma (T1a) (8.3%), while no recurrences were reported in the group of 14 LIN2 cases treated with type II cordectomy. 93.1% (54/58) of cases showed a complete closing of the glottal plane over time. Considering the results in terms of disease control, and functional outcomes, our experience suggests subepithelial cordectomy (ELS I) for LIN 1 and subligament cordectomy (ELS II) for LIN 1 recurrences; therefore we suggest subligament cordectomy (ELS II) in LIN 2 cases.