Abstract
Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position. We reviewed the clinical records of 62 patients affected by Tis-T2 SCC of the posterior laryngeal compartment treated by TLM between 02/2012 and 12/2016. The cohort was divided into two groups according to the anesthesiologic technique used: Group A included patients treated using intraoperative infraglottic HFJV, while Group B encompassed patients treated by standard orotracheal intubation. The main outcome was postoperative surgical margin status. Group comparison analysis was performed. Significant difference in deep margin status was observed between the two groups: in Group A, the rate of negative deep margins was 86% compared to 56% in Group B (p = 0.04). A trend of better overall and superficial margin control was observed for patients treated using HFJV (Group A), although no statistical significance was achieved. Use of HFJV during TLM allows easier and safer management of patients affected by Tis-T2 SCC of the posterior laryngeal compartment, reducing the rates of positive superficial and deep surgical margins.
Highlights
Transoral laser microsurgery (TLM), mostly applied in early-intermediate categories laryngeal squamous cell carcinomas (SCC), is characterized by an “ultra-narrow margins” approach requiring paramount target exposure and precise visualization of the superficial tumor extent, which together make the process of surgical resection within 1 mm clear margins oncologically safe
Obtaining adequate laryngeal exposure is one of the main issues crucially influencing the successful feasibility of TLM and its preoperative objective assessment should be always considered as an essential prerequisite [3, 4]
Orotracheal intubation is considered the routine standard of care for carbon dioxide laser procedures under general anesthesia, even though the tube located at the level of the interarytenoid area may blind the posterior third of both vocal cords, the medial surface of the arytenoids, and the posterior commissure
Summary
Transoral laser microsurgery (TLM), mostly applied in early-intermediate categories laryngeal squamous cell carcinomas (SCC), is characterized by an “ultra-narrow margins” approach requiring paramount target exposure and precise visualization of the superficial tumor extent, which together make the process of surgical resection within 1 mm clear margins oncologically safeHFJV during TLM for Laryngeal Cancer but, at the same time, technically challenging [1, 2]. Transoral laser microsurgery (TLM), mostly applied in early-intermediate categories laryngeal squamous cell carcinomas (SCC), is characterized by an “ultra-narrow margins” approach requiring paramount target exposure and precise visualization of the superficial tumor extent, which together make the process of surgical resection within 1 mm clear margins oncologically safe. Treatment of lesions involving such areas is penalized by suboptimal visualization, with risk of incomplete resection and a higher rate of positive superficial margins even when an experienced surgeon tries to work by displacing the tube toward the anterior commissure, intercalating dedicated laryngoscopes like the Karlan-Ossoff (Pilling, Philadelphia, PA, USA) between the tube itself and the posterior commissure. Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position
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