Surgical Treatment Of Laryngeal Cancer Research Articles

LARYNGEAL CANCER SURGICAL RESULTS; 10 YEARS OF EXPERIENCE

OBJECTIVE: In this study, it was aimed to present the patients who underwent open laryngectomy in a tertiary otolaryngology clinic with current literature information in terms of age, gender, first symptom and duration, histopathological diagnosis, localization of the primary disease, neck condition, and our surgical treatment approach and results. MATERIAL AND METHODS: In this study, the retrospective analysis of the files of 70 patients who underwent open surgical treatment for laryngeal cancer between 2011 and 2021 in a tertiary otorhinolaryngology clinic is discussed. RESULTS: Of our laryngeal cancer cases, 68 (97.1%) were male, 2 (2.9%) were female, and their mean age was 64.9 (48-89 years). Thirty-four (48.57%) of our cases were glottic, 23 (32.9%) supraglottic, and 11 (15.7%) transglottic. There were 2 (2.85%) cases with isolated subglottic locations. Total laryngectomy was performed in 38 (54.3%) cases and partial laryngectomy was performed in 32 (45.7%) cases. Vertical laryngectomy in 1 (1.42%) of patients, subtotal laryngectomy in 1 (1.42%), frontolateral laryngectomy in 6 (8.57%), supraglottic horizontal laryngectomy in 10 (14.28%), supracricoid in 14 (20%) patients laryngectomy was performed. As a histopathological diagnosis; 3 (4.2%) cases of baso-squamous carcinoma, and the remaining 67 (95.8%) cases were squamous cell carcinoma. CONCLUSIONS: Surgery has an important place in the treatment of laryngeal cancers and neck dissection is complementary to regional control. Occult metastases in the cervical region cannot be determined using noninvasive methods, neck dissection is required to identify them. Detailed histopathological evaluation of lymph nodes removed during neck dissection is currently the most reliable method available for accurate diagnosis of lymph nodes.

Anesthetic support during total laryngectomy: current status and feasibility of optimization

Topicality: Despite progress in global medicine, optimization of surgical treatment of laryngeal cancer remains an urgent task due to adverse postoperative consequences and poor patient survival. Anesthetic support during total laryngectomy needs to be improved due to the possible undesirable effect of the standard scheme of intraoperative management of patients. Aim: to evaluate the effectiveness of anesthetic support during total laryngectomy using standard doses of opioids, the severity of side effects in the early postoperative period, and the feasibility of finding alternative pain relief schemes. Materials and methods: 25 patients with T3-4N0-3M0 laryngeal cancer who underwent radical surgical treatment were examined. During total laryngectomy, patients were anesthetized using standard doses of opioids without the use of adjuvant components of anesthesia. Anesthesia control was carried out on the basis of monitoring the bispectral index (BIS) and changes in the index of analgesia and nociception (ANI). In dynamics, biochemical and immunological studies of the blood of patients were carried out. Assessment of pain syndrome was carried out according to VAS indicators. Statistical analysis was carried out using classical methods of descriptive and analytical statistics using the software product STATISTICA v.6.1 (Statsoft Inc., USA, license number AGAR909E415822FA). Results and discussion: An analysis of anesthetic support during total laryngectomy using standard doses of opioids showed that the condition of patients after surgery is characterized by a certain immunosuppression with lymphopenia, a decrease in the level of interleukin 2 and tumor necrosis factor alpha, which lasts 48 hours and is most pronounced at 2-day after surgery. As a result of the study, the dependence of the pain syndrome in patients with total laryngectomy on the injected dose of opioids was revealed – the more opioids are used intraoperatively, the more patients needed them after the operation. This phenomenon is associated with the sensitization of opioid receptors and the development of tolerance, which further leads to hyperalgesia. An increase in the dose of the painkiller also led to an immunosuppressive effect in the examined patients, which was manifested primarily in a decrease in the level of IL-2, which is a potentially unfavorable factor in the proliferation and subsequent invasion of cancer cells. Conclusions: From the given data, it follows that the introduction of new anesthetic schemes using the principles of multimodal anesthesia and the principles of opioid-limiting anesthesia should be used in patients with laryngeal cancer during total laryngectomy.

Application of quality control circle activities in reducing the incidence of adverse factors for rapid recovery in patients with surgical treatment for laryngeal cancer

Application of quality control circle activities in reducing the incidence of adverse factors for rapid recovery in patients with surgical treatment for laryngeal cancer

Impact of the COVID-19 pandemic on the stage and the type of surgical treatment of laryngeal cancer

PurposeChanges in the entire health care system during COVID-19 epidemic have affected the management of patients with head and neck cancer and posed several clinical challenges for ENT surgeons. Therefore, the present study aimed to investigate the effect of COVID-19 on the stage and the type of surgical treatments used in laryngeal cancer (including total laryngectomy, supracricoid partial laryngectomy (SCPL) and transoral laser microsurgery (TLM)) and also to compare the results of April 2020 to April 2021 with the previous year. Materials and MethodsThis cross-sectional study was performed on all patients with a diagnosis of laryngeal cancer who underwent surgery in the tertiary care center from April 2020 to April 2021 and the year before the pandemic in the same time. Demographic, cancer stage, and treatment data of all patients were recorded and analysis in two groups. ResultsPatients referred at the time of the virus outbreak; 111 were male and 5 were female, and in the group of patients referred before COVID-19, 90 were male and 12 were female. The type of surgical treatment of laryngeal cancer, mean time elapsed from sampling to surgery, stage of disease and mean tumor volume was statistically significant differences in patients before and during the outbreak. ConclusionPatients who referred for diagnosis and treatment at the time of COVID-19 outbreak had more advanced stages of the disease and also the tumor volume was higher in them than patients who had referred before the outbreak. It is necessary to provide new solutions, education and treatment management for patients with laryngeal cancer in such pandemics.

Total Laryngectomy with Horizontal Mechanical Closure of the Pharyngoesophagectomy: Evaluation of the Effectiveness in Elderly Patients.

Introduction The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF). Objective In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL. Methods This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TL was performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique. Results A total of 33 patients underwent TL, and 13 of them underwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities ( p = 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old ( p = 1.00). Conclusions The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.

Evaluation of quality of life of patients who were administered surgical treatment for laryngeal cancer

Evaluation of quality of life of patients who were administered surgical treatment for laryngeal cancer

Quality of life patients after surgical treatment of laryngeal cancer

Introduction. The assessment of the quality of life in cancer patients requires a multidisciplinary approach and an evaluation of emotional, social and physical conditions. Objectives. The aim of the study was to analyze the quality of life patients after surgical treatment of laryngeal cancer but before the next stage of therapy, i.e. radiotherapy.Material and Methods. The study group comprised 60 patients aged 44–82 years, with laryngeal cancer treated at the Radiotherapy Wards of Wielkopolskie Centrum Onkologii, Poznań, Poland. The Polish versions of the QLQ C-30 and the cancer-specific EORTC QLQ H&N35 questionnaires were used.Results. Mean score for the general health status (QLQ C-30) was 56.81. Mean values for the physical, role, cognitive, social and emotional functioning were 81.11, 80.83, 75.28, 70.00 and 54.72, respectively. The following constituted the main problems for laryngectomees: difficulty gaining weight (75.00), necessity to take nutritional supplements (58.33), sense of smell and taste problems (57.78), weight loss (56.67), articulation problems (56.67). A statistically significant difference (p = 0.002) was observed with regard to emotional functioning, with mean values of 28.83 and 60.51 for women and men, respectively. Also, a statistically significant difference (p = 0.01) was observed with regard to social functioning, with mean values of 45.53 and 75.51 for women and men, respectively. Conclusions. There exists a definite need to investigate the quality of life by means of patient self-evaluation of the symptoms in order to monitor patient status and establish an individual therapeutic, care and psychological approach.

Expression of Lysyl Oxidase Predictive of Distant Metastasis of Laryngeal Cancer.

Objective To investigate the prognostic significance of lysyl oxidase (LOX) expression in laryngeal cancer. Study Design Retrospective chart review and histologic analysis. Setting Tertiary referral academic center. Subjects and Methods Patients (N = 100) underwent surgical treatment for laryngeal cancer and had tissue specimens available. Immunohistochemical staining for LOX was performed on laryngeal cancer tissue microarrays, and the proportion and intensity of staining were evaluated. Patients with LOX scores ≤6 were classified into the low LOX group, while those with scores >6 were classified into the high LOX group. We analyzed the correlation between LOX expression and clinical factors as well as prognosis. Results LOX was predominantly expressed in the cytoplasm and nuclei of tumor cells. Kaplan-Meier analysis revealed that the high LOX group had worse overall survival and recurrence-free survival rates than the low LOX group ( P < .05). LOX expression exhibited marginally significant correlation with lymph node metastasis. In the Cox regression analysis, LOX expression and lymph node metastasis were significant factors correlated with overall survival rate (odds ratio [OR] = 3.92, 95% confidence interval [95% CI]: 1.35-11.37, P = .012; OR = 1.96, 95% CI: 0.93-1.43, P = .024, respectively). LOX expression was related to distant metastasis free survival rate (OR = 7.72, 95% CI: 1.02-19.18, P = .048). Conclusion A high expression level of LOX is associated with lymph node and distant metastasis as well as poor prognosis among patients with laryngeal cancer.

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

Subpopulations of natural killer-T-like cells before and after surgical treatment of laryngeal cancer.

IntroductionTumours connected with head and neck comprise about 5% of all tumours. The most frequent histological type of laryngeal carcinoma is squamous cell carcinoma. Different research projects suggest that the role of T lymphocytes might be significant in tumour development. iNKT cells are a new subpopulation of T cells and show cytotoxic activity against tumours. iNKT cells participate in modulating the function of other cells which have anti-tumour properties and secrete cytokines, which have pro-inflammatory and anti-inflammatory effects. In animal models the significance of iNKT cells in various diseases including cancer was shown.Aim of the studyThe aim of this study was to determine the percentages of iNKT cells, CD161+ cells, CD161– cells, iNKT CD4+ cells, and iNKT CD8+ cells, NK cells, NKT-like cells, and T cells subsets present in peripheral blood of patients with laryngeal cancer before and two months after the tumour resection, in comparison to healthy volunteers.Materials and methodsThis study included material from laryngeal patients who were treated at the Department of Otolaryngology and Laryngological Oncology (Medical University of Lublin) between 2012 and 2013. A total of 50 patients (40 men and 10 women) aged between 45 and 77 years (median age: 60 years) were enrolled. Based on the TNM classification, the patients were classified as having stage I-IV laryngeal cancer. The control group was composed of 15 healthy volunteers (12 men and three women) aged between 43 and 82 years (median age: 61 years). The protocol of the study was approved by the Local Bioethical Committee at the Medical University of Lublin.Peripheral blood samples (15 ml) from the basilic vein were collected by venipuncture using sterile, sodium heparin-treated tubes (20 units per ml of blood) and used for cytometric analyses.ResultsiNKT cells were analysed among T CD3+ cells. The percentage of CD3+ and CD3+CD4+ T cells before tumour resection was higher than in the control group, but the increase of CD3+ T cells was not significant. The T CD3+CD4+ / T CD3+CD8+ cell ratio was significantly higher than in healthy donors. After tumour resection a decreased percentage of CD3+CD4+ T cells but an increased percentage of CD8+CD3+T cells was noted. The T CD3+CD4+ / T CD3+CD8+ cell ratio was significantly higher in patients before and after the surgery than in the control group. The amount of NKT-like cells increased after resection and was significantly higher than in the control group.ConclusionsOur study exhibited the change in percentage of iNKT, NK, NKT-like cells, and T lymphocytes after tumour resection in patients with laryngeal cancer. The research explains the contribution of those cells in immunological response against tumour.

Evidence-Based Review of Laryngeal Cancer Surgery

Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number of organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery and transoral robotic surgery, have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the U.S.. Improving the evidence base in laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.

Histopathological evaluation of the subtotal laryngectomy specimen

Abstract Background The goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors. Objective To highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy. Conclusion The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen.

Evaluación histopatológica del espécimen de laringectomía subtotal

IntroductionThe goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors. ObjectiveTo highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy. ConclusionThe proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen.

The history and current status of surgical treatment of laryngeal cancer

The purpose of this study is to review the development of modern surgery of laryngeal carcinoma. The main focus is pointed at the laryngeal saving surgical techniques, their indications, possibilities and limitations. The main principals of the the open operative procedures have been described – vertical partial laryngectomy, supraglottic and supracricoid laryngectomy, as also the transoral laser excision of early carcinomas.

Transoral Laser Microsurgery for Locally Advanced Laryngeal Cancer

In recent years, surgical treatment of laryngeal cancer has evolved towards transoral resections. Transoral laser microsurgery (TLM) combines microscopic control with the precise cutting and coagulation capability that laser equipment has, making it possible to remove laryngeal tumours by the transoral approach, with very good oncological and functional outcomes. In early tumours, local control with TLM has been proved to be as good as in open surgery and totally comparable to that achieved under radiation protocols, at a much lower cost. Consequently, TLM is presently considered a first line treatment in early laryngeal cancer.These good oncological and functional results have led to an increase in TLM indications for intermediate or advanced carcinomas. In this article we review the role of TLM in the treatment of locally advanced tumours of the larynx, with special emphasis on appropriate patient selection and different technical considerations.Although TLM is not presently considered a standard treatment for locally advanced laryngeal tumours, the outcomes published in the literature are very encouraging, with results comparable to other treatment alternatives in appropriately selected patients. Compared to external surgical procedures, TLM reduces patient morbidity, provides faster recovery and makes it possible to avoid tracheotomy in a high number of patients.

Tratamiento de los tumores laríngeos localmente avanzados mediante microcirugía transoral láser

In recent years, surgical treatment of laryngeal cancer has evolved towards transoral resections. Transoral laser microsurgery (TLM) combines microscopic control with the precise cutting and coagulation capability that laser equipment has, making it possible to remove laryngeal tumours by the transoral approach, with very good oncological and functional outcomes. In early tumours, local control with TLM has been proved to be as good as in open surgery and totally comparable to that achieved under radiation protocols, at a much lower cost. Consequently, TLM is presently considered a first line treatment in early laryngeal cancer.These good oncological and functional results have led to an increase in TLM indications for intermediate or advanced carcinomas. In this article we review the role of TLM in the treatment of locally advanced tumours of the larynx, with special emphasis on appropriate patient selection and different technical considerations.Although TLM is not presently considered a standard treatment for locally advanced laryngeal tumours, the outcomes published in the literature are very encouraging, with results comparable to other treatment alternatives in appropriately selected patients. Compared to external surgical procedures, TLM reduces patient morbidity, provides faster recovery and makes it possible to avoid tracheotomy in a high number of patients.

Communication adjustment of patients with a laryngectomy in Turkey: Analysis by type of surgery and mode of speech

Previous studies have routinely shown that individuals with a laryngectomy (IWL) have a decreased quality of life (QoL). However, the questionnaires frequently used are not specifically designed for persons with laryngeal cancer and may not reflect the issues of most concern to IWL. The purpose of this study was to investigate (1) the overall communication adjustment of IWL in Turkey, (2) the differences in communication adjustment among types of surgery for the treatment of laryngeal cancer, and (3) the differences in communication adjustment among types of speech following treatment for laryngeal cancer. Fifty-two patients (50 males and two females) who underwent surgical treatment for laryngeal cancer (i.e. total, supraglottic, frontolateral, vertical, supracricoid) and were being seen for follow-up care were recruited from an ENT clinic in Bursa, Turkey. Patients were provided with a written translation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) which yielded information on three subscales (General, Environment, and Attitude) and a Total score. Kruskall–Wallis and Wilcoxon signed ranks nonparametric tests of significance showed that overall adjustment was within the well-adjusted range for all types of surgery and modes of speech with two exceptions: Mean scores for supracricoid laryngectomy with cricohyoidopexy (28.5) and esophageal speech (29.3) were both within the poorly adjusted range on the Environment subscale [lowest mean score = 8.7 (supraglottic)]. Total mean scores ranged from 19.8 (supraglottic) to 49.9 (esophageal speech). Mean scores of the General subscale ranged from 4.0 (electrolaryngeal speech) to 7.7 (tracheoesophageal speech). Mean scores of the Attitude subscale ranged from 6.2 (supraglottic) to 19 (electrolaryngeal). Results of the Kruskall–Wallis test also showed a significant difference between type of surgery for the Environment subscale (p = 0.003), the Attitude subscale (p = 0.039), and the Total score (p = 0.007). The results suggest that overall, IWL in Turkey are well-adjusted to their new voice. However, results also showed that certain conservation surgeries (i.e. supraglottic, frontolateral, vertical) yielded more favorable outcomes than either supracricoid laryngectomy or speech following total laryngectomy. This finding is most likely related to the amount of tissue preserved following conservation surgery, in particular the preservation of the vocal folds.

Mental health after laryngectomy and partial laryngectomy: a comparative study

Patients treated for laryngeal cancer are confronted daily with the effects of the operation. The choice of treatment method can have a significant impact on psychosocial adjustment. Three hundred and six out-patients who underwent surgical treatment for laryngeal cancer within the last two decades were interviewed in their own homes using the structured clinical interview for DSM-IV (SCID).Psychiatric disorders were diagnosed among 17.3% of the partial laryngectomy patients (PL) and 22.2% of the patients with total laryngectomy (LE). In comparing four variables (age, time elapsed since diagnosis, gender and subjective speech intelligibility), subjective speech intelligibility and age were the variables with a unique, significant effect on the frequency of psychiatric disorders, albeit only in the case of PL patients. The need for psychosocial rehabilitation for patients with partial laryngectomy tends to be underestimated. It is concluded that screening for psychological variables and subjective speech intelligibility can be beneficial for the identification of out-patients lacking appropriate treatment.

CT Findings after Laryngectomy

The goal of surgical treatment of laryngeal cancer is to achieve tumor control while preserving, whenever possible, the three primary functions of the larynx: breathing, swallowing, and phonation. The surgical procedure may consist of either a partial, conservative excision (eg, cordectomy, vertical partial laryngectomy, horizontal supraglottic laryngectomy, supracricoid laryngectomy with cricohyoidopexy or cricohyoidoepiglottopexy, or near total laryngectomy) or a radical excision (total laryngectomy). The procedure depends largely on the location and extension of the tumor, the stage of disease, and the patient's needs and preferences. Familiarity with the typical imaging appearance of the larynx after each procedure is crucial for differentiating normal postsurgical changes from persistent or recurrent disease as well as for diagnosing associated second primary malignancies. Since computed tomography (CT) is often used for follow-up evaluations, an ability to interpret the characteristic CT features is particularly important.

Wiek a powikłania po laryngektomii

Between 1989–1999, 573 patients (501 male and 72 female) with laryngeal cancer underwent laryngectomy in the Otolaryngological Clinic of the Medical University in Bydgoszcz. The age varied from 32 to 88 years (mean age – 56,5 years). The aim of the investigations was the analysis of correlation between age and postoperative complications after laryngectomy. The greatest percentage of fever as a postoperative complication was observed in the youngest group of patients. The least number of pharyngo-cutaneous fistulae occurred in the group of patients older than 65 years. Both relationships were not statistically significant. The numbers of other complications were almost similar in all groups related to age. The results of our investigation suggest, that the advanced age as a sole factor (without additional diseases of circulatory or respiratory organ, or neurological diseases) is not a contraindication for surgical treatment of laryngeal cancer.