Outcomes Of Transoral Laser Microsurgery Research Articles

Oncological Outcomes of Transoral Laser Microsurgery for Early Stage Glottic Cancer with Involvement of the Anterior Commissure.

To assess the value of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for early-stage glottic cancer with special regard to involvement of the anterior commissure (AC). Single-center retrospective cohort study. Grade-A tertiary hospital. A retrospective analysis of patients with early-stage (Tis-T2) glottic cancer who underwent CO2 TOLMS. All patients had at least 2 years of follow-up. The univariate and multivariate survival analyses were used to identify the risk factors for recurrence and the Kaplan-Meier method was used to analyze OS and DSS rates. A total of 102 patients were included in the study. Eleven patients (10.78%) had recurrence. The univariate analysis showed that the recurrence was associated with the AC classification, T staging, tumor size, and tobacco use (P < .05). However, on multivariate analysis, the AC classification was the only independent risk factor for recurrence (P < .001, HR = 3.179). AC classification were distributed as follows: 59 (57.84%) AC0, 29 (28.43%) AC1, 8 (7.84%) AC2, and 6 (5.88%) AC3, 2-year/5-year OS and DSS rates were progressively reduced in the AC0, AC1, AC2, and AC3 groups (P < .001). At the same T staging, the OS rates incrementally decreased as the level of involvement of the AC became higher (P = .004). CO2 TOLMS is an effective treatment for early-stage glottic cancer. AC involvement is an independent risk factors for recurrence and poor prognosis. The AC classification system may be better at grading the prognosis of patients with early-stage glottic cancer and has prognostic value independent of T staging.

Long-Term Oncologic Outcome of Transoral Laser Microsurgery for Early Glottic Cancer

Background and Objectives Traditionally, transoral laser microsurgery (TLM) is commonly used to treat early glottic cancer. However, the long-term oncologic results have not been thoroughly investigated. Therefore, this study aimed to analyze long-term oncologic outcomes of TLM for early glottic cancer.Subjects and Method We retrospectively studied 132 patients who underwent TLM for early glottis cancer from January 2001 to August 2020. We assessed overall and disease-free survival according to the T classification and types of cordectomy proposed by the European Laryngological Society in 2007.Results Of the 132 patients, 125 were male and 7 female. The mean age was 61.6±9.3 years. We found 5 (3.8%), 112 (84.8%), and 15 (11.3%) patients staged as CIS, T1, and T2, respectively. For the cordectomy types, there were 6 in type I, 22 in type II, 83 in type III, 6 in type IV, 13 in type V, and 2 in type VI. Ten-year overall and disease-free survival rates were 99.2% and 87.1%, respectively. Overall and disease-free survival curves were not different according to different T classification and cordectomy types.Conclusion TLM is an excellent treatment modality for the long-term oncologic control of early glottic cancer.

Oncologic outcomes of transoral laser microsurgery versus open partial laryngectomies in the management of early stage glottic carcinoma

BackgroundThe oncologic outcomes between transoral laser microsurgery (TLM) and open partial laryngectomy (OPL) using comprehensive analysis in one clinical center is rare. The purpose of this study was to evaluate the oncologic outcomes of TLM in patients with early stage glottic carcinoma, and to compare the results with OPL. Subjects and methodsRecords of 425 glottic carcinoma patients with T1 - T2 stage treated with TLM, vertical partial laryngectomy (VPL), and cricohyoidoepiglottopexy (CHEP) from 2005 to 2010 were retrospectively analyzed. The overall survival (OS), disease-specific survival (DSS), and laryngeal function preservation (LFP) of these three treatments were assessed. ResultsOne hundred and twenty-two patients were treated with TLM. Regarding OPL, 167 patients underwent VPL, and 136 patients underwent CHEP. The mean age was 59.7 years, with men accounting for 97.2 % of all cases. The OS, DSS, and LFP rates of patients with anterior commissure (AC) involvement undergoing TLM were worse than those of patients without AC involvement, but these differences were not statistically significant. The 5-year OS, DSS, and LFP of patients undergoing TLM were 88.4 %, 89.9 %, and 83.5 %, respectively, and the oncologic outcomes of patients undergoing TLM, VPL, and CHEP were not statistically different. ConclusionGlottic carcinoma patients with early stage treated with TLM experience satisfactory oncologic outcomes. No compelling difference in oncologic outcomes among three treatments of TLM, VPL and CHEP, as well as VPL and CHEP can be alternatives to patients who are not suitable for receiving TLM.

Transoral robotic cordectomy for glottic carcinoma: a rapid review.

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). 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. 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 42min and 10 to 40min, respectively. The mean duration of hospital stay ranged from 2 to 7days. Complications included dyspnea, bleeding, granuloma, synechia, and tongue hematoma and dysesthesia. The current robotic systems do not appear adequate for TORS-Co. TORS-Co was associated with higher rates of complications and tracheotomy than TLM.

Functional and Oncologic Outcomes of Octogenarians Undergoing Transoral Laser Microsurgery for Laryngeal Cancer.

ObjectiveTo evaluate the oncologic and functional outcomes of transoral laser microsurgery (TLM) for glottic cancers in patients ≥80 years.Study DesignProspectively collected case series.SettingQEII Health Sciences Centre, Halifax, Canada.MethodsThis case series used a prospectively collected glottic cancer database to examine consecutive elderly patients (≥80 years old) undergoing TLM. Kaplan-Meier analysis was used to evaluate rates of disease-free, disease-specific, and overall survival as the primary end points of oncologic control. Secondary functional outcomes included voice function, length of hospital stay, and time to readmission.ResultsFrom 2005 to 2017, 17 octogenarian patients underwent TLM for glottic cancer. Median follow-up was 4.19 years (interquartile range, 0.71-6.95). Kaplan-Meier estimates of 5-year survival were 78.4% (disease free), 92.9% (disease specific), and 81.9% (overall). The median length of hospital stay was 1 day (range, 0-8). There was only 1 readmission within 30 days of surgery. No patients in this study developed significant surgical or postoperative complications requiring unplanned readmissions. Patient-perceived voice function improved to normal after treatment in 62.5% of patients.ConclusionThe results of this study suggest that TLM is a safe and effective treatment modality for glottic cancer in patients aged ≥80 years, providing good oncologic control and satisfactory functional outcomes.

Oncologic Outcome and Predictor of Local Recurrence in Patients with Glottic Cancer Treated with Transoral Laser Microsurgery

Background and Objectives Transoral laser microsurgery (TLM) is minimally invasive and has become the standard approach for early and intermediate stage laryngeal cancers. Many studies show that the oncologic results of TLM are equivalent to those obtained by conventional conservative surgery and radiotherapy (RT). The purpose of this study were to analyze the treatment outcome and predictors of local recurrence in glottic cancer patients who underwent TLM.Subjects and Method Sixty-seven patients who received TLM for glottis cancer between 2008 and 2019 were analyzed retrospectively. Patients were predominantly male (98.5%), with a median age of 64.3 years (range 45 to 87 years). There were 35 cases of T1 (52.2%), 15 cases of T2 (22.3%), and 17 cases of T3 (25.3%) in the primary tumor stage. There were no patients with lymph node metastasis (cN0). When classified into types, there were 2 cases of type I (3%), 15 cases of type II (22.3%), 34 cases of type III (50.7%), 4 cases of type IV (5.9%), 12 cases of type V (17.9%). The local control rate and overall survival rate were calculated with KaplanMeier curve analysis. Additionally, multivariate analysis of factors associated with local recurrence used Cox proportional-hazards model.Results TLM alone was performed in 54 patients (80.5%) whereas 13 patients (19.5%) underwent TLM followed by adjuvant RT. The 5-year local control rate and 5-year overall survival rate were 81.9% and 93.3%, respectively. In the Univariate analysis, the significant factors of local recurrence were difficult laryngeal exposure [odds ratio (OR)=22.8, 95% confidence interval (CI)=1.7-297.4, &lt;i&gt;p&lt;/i&gt;-value=0.03], anterior commissure invasion (OR=17.2, 95% CI=1.9-154.7, &lt;i&gt;p&lt;/i&gt;-value=0.004, positive lymphovascular invasion (OR=18.0, 95% CI=2.9-109.8, &lt;i&gt;p&lt;/i&gt;-value=0.003) and positive resection margin (OR=9.5, 95% CI=1.6-55.6, &lt;i&gt;p&lt;/i&gt;-value=0.011). In the multivariate analysis, the independent factors of local recurrence were anterior commissure invasion [hazard ratio (HR)=18.4, 95% CI=1.98-170.99, &lt;i&gt;p&lt;/i&gt;-value=0.010] and lymphovascular invasion (HR=7.5, 95% CI=1.49-38.15, &lt;i&gt;p&lt;/i&gt;-value=0.015). No major or lethal complications were observed.Conclusion TLM is a reliable modality to treat early and select cases of moderately advanced glottic cancer. Our study found that independent factors of local recurrence included anterior commissure invasion, and lymphovascular invasion. These findings may be useful to follow-up glottic cancer patients after TLM.

Outcomes of transoral laser microsurgery and transoral robotic surgery in oropharyngeal squamous cell carcinoma

ObjectiveTransoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due to its advantages compared with open surgery. However, knowledge about its benefits compared with transoral laser microsurgery (TLM) are scarce. This study compares oncological and functional results of TLM or TORS in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). MethodsThis retrospective analysis comprises all patients with OPSCC treated with TLM (n = 30) or TORS (n = 24) between April 2003 and May 2018 (follow-up 43 ± 38.3 months). Both treatment groups (TLM and TORS) were comparable in terms of the stage of the disease, prognosis-determining factors, and adjuvant therapy modalities. ResultsThere were no significant differences regarding to the resection status (p = 0.272), the rate of local- (p = 0.834) and distant- recurrence (p = 0.416), with a disease-free survival of 86.7 % and 87.5 %, respectively (p = 0.892). In addition, we could not confirm any differences regarding to operating time (p = 0.860), intraoperative blood loss (p = 0.660), inpatient stay (p = 0.585) and postoperative bleeding rate (p = 0.245). The frequency of tracheostomy and percutaneous endoscopic gastrostomy between both groups is comparable, with a longer duration of tube feeding in patients who have received TLM (p = 0.030). ConclusionIn conclusion, TORS allows for similar oncological outcomes compared with TLM at comparable perioperative risks. The postoperative swallowing function may benefit from TORS.

Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: Equitable survival and enhanced function compared with contemporary standards of care

IntroductionWe describe the 5-year oncological and functional outcomes of transoral laser microsurgery, neck dissection (TLM + ND) and adjuvant radiotherapy (PORT) used to treat patients with oropharyngeal carcinoma. The effectiveness of external carotid artery (ECA) ligation in reducing post-operative bleeding, and fibrin glue following ND in reducing wound drainage and length of hospital stay is reported. Materials and methodsThis retrospective case review of consecutive patients undergoing TLM between 2006 and 2017 used the Kaplan-Meier Estimator and Log-Rank Test for univariate, time-to-event analyses, and Cox-Proportionate Hazard modelling for multivariate analysis. Results264 consecutive patients were included. Mean follow-up was 49.4 months. 219 (82.9%) patients received PORT. Five-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 74.9%, 73.7%, and 86.2%, respectively. Five-year locoregional control was 89.4%. 65.5% of cases were Human papillomavirus associated (HPV+), for whom OS, DFS and DSS was 85.6%, 84.7% and 92.7%, respectively, and demonstrated significantly higher OS (hazard ratio (HR) 0.28, CI 0.16–0.49, p < 0.0001), DFS (HR 0.28, CI 0.17–0.47, p < 0.0001) and DSS (HR 0.2, CI 0.09–0.44, <0.001). Post-operative oropharyngeal bleeding occurred in 23 patients (8.7%), of which 5 were major/severe, in patients without ECA ligation. Fibrin glue significantly reduced neck drain output (p < 0.001), and length of hospital stay (p < 0.001). One-year gastrostomy dependence rate was 2.3%. ConclusionsTLM + ND + PORT results in favourable 5-year survival and locoregional control rates, and low feeding tube dependency rates. ECA ligation and fibrin glue appear to reduce major post-operative haemorrhage, wound drainage and length of hospital stay.

KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study.

The primary objectives were to report oncologic outcomes of transoral laser microsurgery with potassium-titanyl-phosphate (KTP) laser (TLM-KTP) ablation of early glottic cancer (EGC). The secondary objectives were to report vocal outcomes and to analyze factors that might influence outcomes. A multi-institutional, retrospective analysis of consecutive patients treated for T1 or T2 glottic squamous cell carcinoma undergoing TLM-KTP ablation with at least 2 years of follow-up was performed. Patients with prior radiation or surgery for laryngeal disease were excluded. surgical failures requiring radiation or laryngectomy, disease-specific survival (DSS), and overall survival (OS). Secondary outcome measures included: pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. The effects of smoking status, stage, and anterior commissure involvement on outcomes were analyzed. Overall 88 patients met inclusion criteria (83% male, 79.5% current or former smokers). Mean age was 68 (standard deviation (SD): 12). Mean follow-up was 39.5 months (SD: 15.3). Staging included 50 T1a, 21 T1b, and 20 T2 tumors, including three metachronous second primaries. Radiation and/or laryngectomy avoidance was achieved in 87/88 (98.9%) of patients, inclusive of 24 patients requiring KTP re-treatments. Two patients had biopsy-proven recurrence (2.3%), but only 21 of 24 re-treated patients received a formal biopsy. No patients died from laryngeal cancer. DSS and OS were 100% and 92.3%, respectively. The mean VHI-10 scores were 19.3 preoperatively, 3.8 at 6-months postop, and 3.8 at 2-years postop. Smokers had a longer interval to re-treatment (P = .03), patients with T2 lesions had a shorter interval to re-treatment (0.02), and patients with T2 lesions presented with worse initial VHI-10 scores (0.002). A multi-institutional, retrospective case series of TLM-KTP ablation of EGC demonstrated excellent oncologic outcomes when close surveillance and proactive re-treatments were utilized. Disease-specific survival, overall survival, and vocal function were excellent. Additional studies are necessary to further analyze the merits and risks of this treatment approach.

Transoral laser microsurgery for treatment of oropharyngeal cancer in 368 patients.

Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept. A total of 368 patients with oropharyngeal squamous cell carcinoma (pT1-4, pN0-2, M0) underwent TLM +/- neck dissection (85%), +/- (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%). Five-year Kaplan-Meier estimates for local control were 83.5% for pT1, 74.1% for pT2, 77.3% for pT3, and 76.0% for pT4a tumors. Five-year estimates of overall, disease-specific, and recurrence-free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16-positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency. Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced-stage oropharyngeal cancer.

Early Outcomes of Transoral Laser Microsurgery for T1-T2 Oropharyngeal Cancer

The optimal treatment strategy for oropharyngeal carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as Transoral Laser Microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of early oropharyngeal carcinomas. This is a prospectively observational study of 30 early stages (T1/T2) oropharyngeal cancer patients who underwent transoral laser microsurgery from January 2016 to March 2019. 30 patients of early-staged oropharyngeal carcinoma (19 tongues, 5 soft palates, 4 tonsils and 2 posterior pharyngeal walls) were included in this study. 19 (63.3%) patients were male and 11 (36.7%) were female. The mean age was 54.8 years (± 10.6 years). 76.7% tumours are T1 and 23.3% T2. The bleeding complications occurred in 2 patients. The most frequent complication of TLM was bleeding. 30% of patients had normal voices and a further 63.3% had only mild or moderate voice change. At their last follow up, no patients had any difficulty in breathing or swallowing. TLM is a safe, minimally invasive and effective method in the treatment for early oropharyngeal cancer

Transoral laser microsurgery for glottic cancer in the elderly: Efficacy and safety.

Data about the results of transoral laser microsurgery (TLM) in elderly patients are limited. A retrospective study of 72 consecutive cases of glottic carcinoma (63 pT1 and 9 pT2 cases) in elderly patients (≥70 years old, mean 76 years) treated with TLM was made. A systematic review of the literature was performed. Six patients (8%) had postoperative complications, but no treatment-related deaths were observed. Local recurrences occurred in 12 patients (16.5%): nine with pT1 (14%) and three with pT2 (33%) tumors. Five-year disease-specific survival (DSS), overall survival, and laryngectomy-free survival were 95%, 68%, and 88%, respectively. The literature review indicated that TLM is safe and effective treatment for these patients, with few complications and good local control (>85%) and DSS (>90%) rates. Our results and the information from the literature show that TLM for glottic cancer in elderly patients can lead to satisfactory treatment results.

Long Term Oncological Results of Transoral Laser Microsurgery for Early and Moderately Advanced Glottic Carcinoma in Primary and Salvage Settings

The aim of the study is to document the long term oncological results of trans-oral laser microsurgery (TLM) for early and moderately advanced glottic cancer in primary and salvage settings. In this prospective cohort study 43 consecutive patients of glottic cancer (T1-30, T2-7, and selected T3 with mobile cords-6) were recruited. TLM was performed in these 35 primary and 8 previously treated cases. In our series, the local disease control rate with TLM was 90% (27/30) for T1 disease, 71.4% (5/7) for T2 cancer and 66.6% (4/6) for T3 lesions. The overall disease control rates after subsequent treatment for locoregional recurrences were 100% (30/30), 85.7% (6/7) and 83.3% (5/6) for T1, T2, and T3 glottic cancers respectively. The 5-years disease free survival rate for primary cases was 100% and 50% for salvage cases. The 5-years local disease control rate was 96.4% and 41.67% in primary and salvage TLM settings respectively. The 5-years laryngectomy free rates were 96.3% and 18.75% for primary and salvage cases respectively. TLM offers a minimally invasive and oncologically robust treatment option for early glottic cancer with an overall disease free survival of 100% at 5years noted for primary untreated cases in this experience. TLM for post radiation salvage cases has however been disappointing and alternate larynx preserving option of open partial laryngectomy needs to be considered in this setting.

Outcomes of transoral laser microsurgery for oropharyngeal squamous cell carcinoma in Ireland and review of the literature on transoral approaches.

The optimal treatment for oropharyngeal squamous cell carcinoma (OPSCC) is controversial. There is increasing evidence that, in selected cases, minimally invasive transoral surgery can offer improved functional outcomes, with equivalent oncologic outcomes, compared to chemoradiotherapy. We report the outcomes of transoral laser microsurgery (TLM) for treatment of OPSCC at our institution. Patients with OPSCC undergoing TLM at the South Infirmary Victoria University Hospital, Cork, between 2010 and 2016, were identified from an institutional database. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry. Survival outcomes were analysed using the Kaplan-Meier method. Complications following surgery and gastrostomy tube dependence were evaluated. The study cohort consisted of 26 patients, with mean age of 56years (range 29-71). Primary tumours were located in the tonsil (18), base of tongue (4) and other subsites (4). Seventeen cases were p16-positive. Complications included haemorrhage necessitating return to theatre (1) and aspiration pneumonia (1). Four patients underwent tracheostomy, all of whom were successfully decannulated. One patient underwent gastrostomy tube insertion during postoperative radiotherapy. No patient was gastrostomy dependent at latest follow-up. Twenty-two patients received adjuvant treatment, with radiation alone (21) or chemoradiotherapy (2). Mean follow-up was 27months. Five-year locoregional control was 92% and disease-specific survival was 81%. In selected patients with OPSCC, TLM offers excellent functional and survival outcomes, and as such offers an alternative approach to chemoradiotherapy as primary treatment. We compare TLM to other transoral approaches and discuss its potential use in the Irish healthcare system.

Oncological and functional outcomes of transoral laser surgery for laryngeal carcinoma.

Transoral laser microsurgery (TLM) has become the standard approach for treatment of early-stage laryngeal carcinoma in most institutions due to their good oncological and functional results with few local complications. The purpose of this study was to analyze the oncological and functional results of TLM in the treatment of laryngeal tumors at our Hospital. Patients with laryngeal squamous cell carcinoma (LSCC) treated from 1998 to 2013 with TLM with curative intention, and with a minimum follow-up of 24 months, were reviewed. 203 patients with LSCC were included. 195 patients were men (96%) and 8 women (4%), with a mean age of 63years. The series includes 134 (66%) T1, 40 (20%) T2, and 29 (14%) T3-classified tumors. 116 tumors (57%) were in the glottis, 79 (39%) in the supraglottis and 8 (4%) in the anterior commissure. 16 patients (8%) received adjuvant radiotherapy. Initial local control was obtained in 75.5% of patients. The 5-year overall survival rate was 84% and the 5-year disease-specific survival was 90%. The presence of nodal metastasis (p < 0.001) and the involvement of the surgical margins (p = 0.004) were associated with a lower disease-specific survival in the multivariate analysis. All but three patients with local control of the disease reassumed oral diet, and none were tracheostomy-dependent. The 5-year laryngeal preservation rate was 85%. TLM is a minimally invasive treatment for early and moderately-advanced laryngeal carcinomas, with good oncologic and functional outcomes, and few complications as well.

Oncologic outcomes of transoral laser microsurgery for early glottic carcinoma

Introduction: Laryngeal carcinoma comprises 2%–5% of all malignant diseases. Treatment options for early glottic cancers are open partial laryngectomy, radiotherapy (RT), and transoral laser microsurgery (TLM). The goals of management of early glottic carcinoma are complete oncological clearance, organ preservation, and functional preservation (voice, swallowing, and airway). This study aims to review oncologic results of TLM for management of early glottic carcinoma at our institute. Methodology: Patients with early glottic squamous cell carcinoma, i.e., Tis, T1, and T2 stage lesions managed with TLM from January 2011 to 2014 were included in the study. Medical records were analyzed to acquire data. Results: Sixty-six patients underwent TLM for management of early glottic cancer between 2011 and 2014. Tumor-free margins were obtained after TLM in all 10 cases with Tis. For T1a, T1b, and T2 lesions, surgery obtained tumor-free margins in 89.5%, 77.8%, and 77.8% cases, respectively. Nine patients were found to have a positive margin and they underwent revision surgery. The overall local cure rate obtained by TLM was 92.4%. The overall 3-year survival rate was 98.5%. One patient died of myocardial infarction 2 years after TLM, giving a disease-specific 3-year survival rate of 100%. Conclusion: TLM is a safe and effective treatment option for management of early glottic cancer. Its outcomes are comparable to those of RT, and it has lesser cost, treatment duration, and morbidity.

Transoral laser microsurgery for treatment for hypopharyngeal cancer in 211 patients.

The oncologic and functional outcome of transoral laser microsurgery (TLM) for primary treatment of hypopharyngeal cancer was examined in a multimodal treatment concept. Two hundred eleven patients with squamous cell carcinoma (SCC) of the hypopharynx (pT1-4a, pN0-2, M0) were treated by TLM +/- neck dissection (88%) +/- (chemo)radiotherapy ([C]RT; 51%). The majority of cases were advanced stages III and IVa (85%). The 5-year Kaplan-Meier estimates for local control after TLM were pT category-related 88.1%, 74.8%, 77.3%, and 61.8% for pT1-4a tumors. The 5-year estimates of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for early stages I and II were 68.2%, 96.7%, and 74.6%, respectively; for stage III they were 65.9%, 83.8%, and 56.4%, respectively; and the rates for stage IVa were 44.5%, 60.7%, and 50.3%, respectively. Overall, 95.7% of the patients maintained regular oral nutrition without feeding tube dependency. Primary TLM in multimodal concepts of treatment (+/- neck dissection, +/- [C]RT) offers favorable oncologic results as compared with other therapeutic regimes.

Outcomes of transoral laser microsurgery in patients with cancer of the hypopharynx

Outcomes of transoral laser microsurgery in patients with cancer of the hypopharynx

Voice outcome according to surgical extent of transoral laser microsurgery for T1 glottic carcinoma.

To evaluate the outcomes of transoral laser microsurgery (TLM) for T1 glottic carcinoma using longitudinal voice analysis. Retrospective analysis of medical records. We conducted a retrospective review of 57 patients (50 T1a, seven T1b) who underwent TLM for T1 glottic carcinoma, and longitudinal voice analysis was performed before surgery, during the early postoperative period (within 3 months), and during the late postoperative period (more than 6 months). Acoustic, perceptual (Grade, Roughness, Breathiness, Asthenia, Strain scale), and subjective voice analysis using the Voice Handicap Index (VHI) was conducted. Voice quality deteriorated in the early postoperative period in terms of several parameters. However, no significant differences in voice quality were observed in the late postoperative period, whereas Grade (from 1.85 ± 0.83 to 1.50 ± 0.90) and Roughness (from 1.74 ± 0.73 to 1.48 ± 0.87) had improved significantly. Patients who underwent lesser-extent cordectomy (type I, II) showed improvement in VHI-Physical (from 12.93 ± 11.10 to 6.07 ± 8.69) and Grade (from 1.60 ± 0.68 to 0.98 ± 0.83), whereas improvement was not identified in those who underwent larger-extent cordectomy (type III, IV, V). Improvement in Grade (from 1.70 ± 0.80 to 1.23 ± 0.91) and Roughness (from 1.77 ± 0.73 to 1.25 ± 0.76) was identified in patients who had unilateral tumor without involvement of anterior commissure. However, those with involvement of the anterior commissure or bilateral vocal cord showed a tendency toward deterioration in voice quality. Voice quality of patients following TLM for T1 glottic carcinoma may improve significantly over time in cases with lesser-extent types of cordectomy or unilateral tumor without involvement of the anterior commissure. 4 Laryngoscope, 126:2051-2056, 2016.

Voice and Functional Outcomes of Transoral Laser Microsurgery for Early Glottic Cancer: Ventricular Fold Resection as a Surrogate.

BackgroundThe aim of the study was to evaluate the oncological and functional outcomes with transoral laser microsurgery (TOLM) of patients with early glottic cancer.MethodsWe have prospectively evaluated patients treated with TOLM for Tis, T1 or T2 glottic squamous cell carcinoma. Evaluation of oncological outcomes, and voice and functional outcomes was assessed using voice-handicap index 10 (VHI-10) and performance status scale for head & neck cancer patients (PSS-H&N). Predictors of poor voice quality were evaluated using Student’s t-test.ResultsThirty patients were included, with 17.7 months mean follow-up. There were no cases of locoregional recurrence. Twelve patients (40%) were considered as having a problematic voice outcome. Four subjects out of 30 (13.3%) had significant problems with understandability of speech. Significant differences (P < 0.05) in VHI-10 score were found with tumor stage and partial resection of the ventricular fold.ConclusionsWe report excellent oncological and functional outcomes in early glottic cancer treated with TOLM, with advanced tumors and partial resection of the ventricular fold as a surrogate predicting worse voice outcomes.