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Michael L. Hinni - One of the best experts on this subject based on the ideXlab platform.
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Outcomes Following Transoral Laser Microsurgery With Resection of Cartilage for Laryngeal Cancer.
The Annals of otology rhinology and laryngology, 2019Co-Authors: Brent A. Chang, Richard E. Hayden, Thomas H. Nagel, David G. Lott, Brittany E. Howard, Michael L. HinniAbstract:INTRODUCTION The ability to treat more advanced laryngeal cancers by Transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety. METHODS We describe a retrospective review of patients undergoing resection of the thyroid cartilage during Transoral Laser Microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included. RESULTS Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration. CONCLUSION We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.
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Transoral Laser Microsurgery for the unknown primary: role for lingual tonsillectomy.
Head & neck, 2014Co-Authors: Thomas H. Nagel, Michael L. Hinni, Richard E. Hayden, David G. LottAbstract:Background We conducted a retrospective review of patients with unknown primary head and neck cancer who underwent a Transoral Laser Microsurgery (TLM)-assisted search for an occult tumor. Methods Fifty-two patients at a single center with unknown primaries of squamous cell carcinoma (SCC) were treated with a surgical algorithm. Results The overall rate of primary tumor identification was 75% (39 of 52 patients). When selecting those cases in which a TLM algorithm with lingual tonsillectomy was utilized, the detection rate was 86% (31 of 36). Tumors were most commonly found in the lingual (65.0%) and palatine tonsils (27.5%). When directed biopsies did not locate a tumor, a higher yield was obtained with the addition of a lingual tonsillectomy in 8 patients. Conclusion A surgical algorithm for the unknown primary that includes TLM-assisted techniques, including a lingual tonsillectomy, offers the greatest likelihood of successfully detecting the location of occult primary tumors. © 2014 Wiley Periodicals, Inc. Head Neck 36: 942–946, 2014
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Transoral Laser Microsurgery followed by radiation therapy for oropharyngeal tumors: The mayo clinic arizona experience
Head & neck, 2013Co-Authors: Samir H. Patel, Michael L. Hinni, Richard E. Hayden, William W. Wong, Amylou C. Dueck, Matthew A. Zarka, Kelly K. Curtis, Michele Y. HalyardAbstract:Background The purpose of this study was to report the treatment outcomes of patients with advanced oropharyngeal cancer treated with Transoral Laser Microsurgery (TLM) followed by radiation therapy (RT) at Mayo Clinic in Arizona. Methods A retrospective study of 80 patients treated from January 1, 2000 to November 7, 2011 was performed. All patients had stage III/IV oropharyngeal tumors and underwent TLM with neck dissection. Adjuvant RT was then given. Thirty-seven patients received concurrent adjuvant chemotherapy. The primary outcome was locoregional control. Results Median follow-up was 47.3 months (range, 9.7–139.2 months). The 3-year locoregional control, recurrence-free survival, and overall survival rates were 98.6% (95% confidence interval [CI], 91% to 100%), 91.1% (95% CI, 81% to 96%), and 93.7% (95% CI, 84% to 98%), respectively. There were a total of 5 treatment failures, 1 regional and 4 distant. Twenty-six patients underwent neck only RT with exclusion of the primary site. Conclusion TLM followed by RT for advanced oropharyngeal cancer results in excellent locoregional control rates. © 2013 Wiley Periodicals, Inc. Head Neck 36: 220–225, 2014
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Transoral Laser Microsurgery for early laryngeal cancer.
Expert review of anticancer therapy, 2010Co-Authors: David G. Grant, Costa Repanos, Gemma Malpas, John R. Salassa, Michael L. HinniAbstract:The decision to treat patients suffering from glottic cancer with either radiotherapy or surgery is both complex and controversial. Transoral Laser Microsurgery is a surgical technique that offers an attractive alternative therapy for laryngeal cancer. In addition to excellent oncologic outcomes and organ preservation, the benefits of Transoral Laser Microsurgery include low morbidity and mortality, shorter periods of hospitalization and exceptional functional results. As the evidence base for the effectiveness of Laser surgery grows, Transoral Laser Microsurgery has become established as a valid surgical option for the treatment of early laryngeal cancer. In this article we examine the surgical technique and discuss the oncologic and functional outcomes of Transoral Laser Microsurgery. Furthermore, we offer a vision of the future of endoscopic Laser surgery for the management of cancer of the larynx and the upper aerodigestive tract.
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oropharyngeal cancer a case for single modality treatment with Transoral Laser Microsurgery
Archives of Otolaryngology-head & Neck Surgery, 2009Co-Authors: David G. Grant, John R. Salassa, Michael L. Hinni, Richard E. Hayden, William C. Perry, John D. CaslerAbstract:Objective To demonstrate the role of Transoral Laser Microsurgery (TLM) in the treatment of oropharyngeal cancer. Design A 2-center retrospective case series analysis. Setting Two tertiary care medical centers. Patients The study population comprised 69 patients with previously untreated select T1 to T3, N0 to N2 squamous cell carcinoma of the oropharynx, of whom 44 (74%) had no indication for adjuvant RT and 25 (36%) had an indication for adjuvant RT to the neck alone but declined radiotherapy. The primary tumor sites were the tonsil (n = 28 [41%]), tongue base (n = 28 [41%]), pharyngeal wall (n = 8 [12%]), soft palate (n = 4 [6%]), and vallecula (n = 1 [1%]). Interventions Transoral Laser Microsurgery in 69 patients, with neck dissection in 59 patients (83%). Main Outcome Measures Complications, local and regional control, overall and disease-specific survival, swallow function, and feeding tube dependence. Results Over the mean follow-up period of 44 months, 66 of 69 patients had no disease recurrence at the primary site. The 5-year local control estimate was 94%. The mean duration of hospitalization was 3 days. There were no major complications relating to TLM. No patient required a permanent feeding or tracheostomy tube. For stage I, II, and III disease, the 5-year Kaplan-Meier estimates of locoregional control were 90%, 73%, and 70%, respectively. The 5-year overall survival estimate was 86%. Conclusions Transoral Laser Microsurgery alone with or without neck dissection is an effective approach for select T1 to T3, N0, or N1 oropharyngeal cancer. Low levels of morbidity, short treatment duration, and excellent disease control make it an attractive therapeutic strategy. The treatment option of endoscopic-assisted Laser Microsurgery should be discussed by the multidisciplinary team for patients presenting with tumors suitable for this approach.
Wolfgang Steiner - One of the best experts on this subject based on the ideXlab platform.
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Transoral Laser Microsurgery for treatment for hypopharyngeal cancer in 211 patients
Head & neck, 2019Co-Authors: Bernhard G. Weiss, Friedrich Ihler, Hendrik A. Wolff, Martin Canis, Wolfgang Steiner, Simon Schneider, Christian WelzAbstract:Background The oncologic and functional outcome of Transoral Laser Microsurgery (TLM) for primary treatment of hypopharyngeal cancer was examined in a multimodal treatment concept. Methods 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%). Results 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. Conclusion Primary TLM in multimodal concepts of treatment (+/− neck dissection, +/− [C]RT) offers favorable oncologic results as compared with other therapeutic regimes.
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Transoral Laser Microsurgery for T1b glottic cancer: review of 51 cases.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated wi, 2016Co-Authors: Bernhard G. Weiss, Friedrich Ihler, Yiannis Pilavakis, Hendrik A. Wolff, Martin Canis, Christian Welz, Wolfgang SteinerAbstract:For the treatment of T1b glottic carcinoma, different treatment options, such as Transoral Laser Microsurgery, open surgical techniques, and primary radiotherapy, are under discussion. In this context, the aim of the present study was to describe oncologic results and complication rates of Transoral Laser Microsurgery in treatment of T1b glottic carcinoma. This is a retrospective unicenter chart review of patients treated at an academic tertiary referral center between 1986 and 2006. Fifty-one previously untreated T1b cases were exclusively treated by Transoral Laser Microsurgery and included into this study, 47 were male, and 4 were female. The main outcome measures included local control rate and complications, overall, disease specific, and recurrence-free survival. The median follow-up period was 98 months. The 5-year local control rate was 90.2%; larynx preservation rate was 92.2%. No intra- or postoperative complications, such as wound infections, postoperative bleeding, hematoma, edema, and fistula development, were observed. A single patient required revision surgery due to synechia. Five-year survival rates were: overall 84.7%, disease specific 97.7%, and recurrence free 72.4%. Our data support the conclusion that Transoral Laser Microsurgery is a considerable treatment option in T1b glottic carcinoma. The oncologic outcome was at least comparable to other treatment options, while the perioperative morbidity and complication rate were lower.
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HEAD AND NECK Results of Transoral Laser Microsurgery for supraglottic carcinoma in 277 patients
2016Co-Authors: Martin Canis, Friedrich Ihler, Alexios Martin, Christoph Matthias, Wolfgang SteinerAbstract:Abstract The objective of the study was to evaluate the oncological and functional results of Transoral Laser micro-surgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and Decem-ber 2006, 277 patients with squamous cell supraglottic car-cinoma of all stages were treated by primary carbon dioxide Laser Microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan–Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85 % for pT1/pT2, 82 % for pT3, and 76 % for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92 %, for stages III and IVa 59, 65, and 81 %, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radio-therapy. Transoral Laser Microsurgery results in a low mor-bidity, rapid recovery, and superior function compared with standard therapy
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Transoral Laser Microsurgery for t1a glottic cancer review of 404 cases
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2015Co-Authors: Martin Canis, Friedrich Ihler, Alexios Martin, Christoph Matthias, Wolfgang SteinerAbstract:Background Various therapeutic options exist for treatment of T1a glottic squamous cell cancer (SCC). Radiotherapy (RT) has been favored over surgical excision. This has been challenged by Transoral Laser Microsurgery (TLM) showing low morbidity and good functional results. Methods A retrospective chart review was carried out. Patients with untreated T1a glottic SCC were included in the study. Endpoints were locoregional control, overall survival, disease-specific survival, and absolute rate of larynx preservation. Results Four hundred four patients were included in this study. Five-year Kaplan–Meier estimates were: local control 86.8%, overall survival 87.8%, disease-specific survival 98.0%, recurrence-free survival 76.1%, and larynx preservation 97.3%. The complication rate was 1%; the majority of patients had either normal or mildly dysphonic voices. Conclusion Low complication rates, excellent functional outcome, and high rates of organ preservation favor TLM. In agreement with the literature, TLM should be the treatment of choice for patients presenting with T1a glottic SCC. © 2014 Wiley Periodicals, Inc. Head Neck 37: 889–895, 2015
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Transoral Laser Microsurgery in treatment of pt2 and pt3 glottic laryngeal squamous cell carcinoma results of 391 patients
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Martin Canis, Friedrich Ihler, Hendrik A. Wolff, Alexios Martin, Martina Kron, Christoph Matthias, Wolfgang SteinerAbstract:Background The purpose of this study was to evaluate oncological and functional results of Transoral Laser Microsurgery (TLM) in patients with T2 and T3 glottic laryngeal squamous cell carcinoma (SCC). Methods A retrospective chart analysis was carried out. Cases were classified into categories pT2a, pT2b, and pT3. Treatment was exclusively TLM ± selective neck dissection and adjuvant (chemo)radiotherapy. Results Three hundred ninety-one patients were treated by TLM; 142 cases were category pT2a, 127 were pT2b, and 122 were pT3. Median follow-up was 71 months. Five-year overall, recurrence-free, and disease specific survival rates were 72.2%, 76.4%, and 93.2% for pT2a tumors, 64.9%, 57.3%, and 83.9% for pT2b tumors, and 58.6%, 57.8%, and 84.1% for pT3 tumors, respectively. Larynx preservation was achieved in 93% (pT2a) and 83% (pT2b and pT3). Conclusion Results are comparable to open partial or total laryngectomy and superior to primary (chemo)radiotherapy. TLM results in a lower morbidity and superior function compared to standard treatment. © 2013 Wiley Periodicals, Inc. Head Neck 36: 859–866, 2014
Richard E. Hayden - One of the best experts on this subject based on the ideXlab platform.
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Outcomes Following Transoral Laser Microsurgery With Resection of Cartilage for Laryngeal Cancer.
The Annals of otology rhinology and laryngology, 2019Co-Authors: Brent A. Chang, Richard E. Hayden, Thomas H. Nagel, David G. Lott, Brittany E. Howard, Michael L. HinniAbstract:INTRODUCTION The ability to treat more advanced laryngeal cancers by Transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety. METHODS We describe a retrospective review of patients undergoing resection of the thyroid cartilage during Transoral Laser Microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included. RESULTS Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration. CONCLUSION We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.
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Transoral Laser Microsurgery for the unknown primary: role for lingual tonsillectomy.
Head & neck, 2014Co-Authors: Thomas H. Nagel, Michael L. Hinni, Richard E. Hayden, David G. LottAbstract:Background We conducted a retrospective review of patients with unknown primary head and neck cancer who underwent a Transoral Laser Microsurgery (TLM)-assisted search for an occult tumor. Methods Fifty-two patients at a single center with unknown primaries of squamous cell carcinoma (SCC) were treated with a surgical algorithm. Results The overall rate of primary tumor identification was 75% (39 of 52 patients). When selecting those cases in which a TLM algorithm with lingual tonsillectomy was utilized, the detection rate was 86% (31 of 36). Tumors were most commonly found in the lingual (65.0%) and palatine tonsils (27.5%). When directed biopsies did not locate a tumor, a higher yield was obtained with the addition of a lingual tonsillectomy in 8 patients. Conclusion A surgical algorithm for the unknown primary that includes TLM-assisted techniques, including a lingual tonsillectomy, offers the greatest likelihood of successfully detecting the location of occult primary tumors. © 2014 Wiley Periodicals, Inc. Head Neck 36: 942–946, 2014
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Transoral Laser Microsurgery followed by radiation therapy for oropharyngeal tumors: The mayo clinic arizona experience
Head & neck, 2013Co-Authors: Samir H. Patel, Michael L. Hinni, Richard E. Hayden, William W. Wong, Amylou C. Dueck, Matthew A. Zarka, Kelly K. Curtis, Michele Y. HalyardAbstract:Background The purpose of this study was to report the treatment outcomes of patients with advanced oropharyngeal cancer treated with Transoral Laser Microsurgery (TLM) followed by radiation therapy (RT) at Mayo Clinic in Arizona. Methods A retrospective study of 80 patients treated from January 1, 2000 to November 7, 2011 was performed. All patients had stage III/IV oropharyngeal tumors and underwent TLM with neck dissection. Adjuvant RT was then given. Thirty-seven patients received concurrent adjuvant chemotherapy. The primary outcome was locoregional control. Results Median follow-up was 47.3 months (range, 9.7–139.2 months). The 3-year locoregional control, recurrence-free survival, and overall survival rates were 98.6% (95% confidence interval [CI], 91% to 100%), 91.1% (95% CI, 81% to 96%), and 93.7% (95% CI, 84% to 98%), respectively. There were a total of 5 treatment failures, 1 regional and 4 distant. Twenty-six patients underwent neck only RT with exclusion of the primary site. Conclusion TLM followed by RT for advanced oropharyngeal cancer results in excellent locoregional control rates. © 2013 Wiley Periodicals, Inc. Head Neck 36: 220–225, 2014
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oropharyngeal cancer a case for single modality treatment with Transoral Laser Microsurgery
Archives of Otolaryngology-head & Neck Surgery, 2009Co-Authors: David G. Grant, John R. Salassa, Michael L. Hinni, Richard E. Hayden, William C. Perry, John D. CaslerAbstract:Objective To demonstrate the role of Transoral Laser Microsurgery (TLM) in the treatment of oropharyngeal cancer. Design A 2-center retrospective case series analysis. Setting Two tertiary care medical centers. Patients The study population comprised 69 patients with previously untreated select T1 to T3, N0 to N2 squamous cell carcinoma of the oropharynx, of whom 44 (74%) had no indication for adjuvant RT and 25 (36%) had an indication for adjuvant RT to the neck alone but declined radiotherapy. The primary tumor sites were the tonsil (n = 28 [41%]), tongue base (n = 28 [41%]), pharyngeal wall (n = 8 [12%]), soft palate (n = 4 [6%]), and vallecula (n = 1 [1%]). Interventions Transoral Laser Microsurgery in 69 patients, with neck dissection in 59 patients (83%). Main Outcome Measures Complications, local and regional control, overall and disease-specific survival, swallow function, and feeding tube dependence. Results Over the mean follow-up period of 44 months, 66 of 69 patients had no disease recurrence at the primary site. The 5-year local control estimate was 94%. The mean duration of hospitalization was 3 days. There were no major complications relating to TLM. No patient required a permanent feeding or tracheostomy tube. For stage I, II, and III disease, the 5-year Kaplan-Meier estimates of locoregional control were 90%, 73%, and 70%, respectively. The 5-year overall survival estimate was 86%. Conclusions Transoral Laser Microsurgery alone with or without neck dissection is an effective approach for select T1 to T3, N0, or N1 oropharyngeal cancer. Low levels of morbidity, short treatment duration, and excellent disease control make it an attractive therapeutic strategy. The treatment option of endoscopic-assisted Laser Microsurgery should be discussed by the multidisciplinary team for patients presenting with tumors suitable for this approach.
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Postoperative bleeding in Transoral Laser Microsurgery for upper aerodigestive tract tumors.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008Co-Authors: John R. Salassa, David G. Grant, Michael L. Hinni, Richard E. HaydenAbstract:OBJECTIVES: To report the incidence, cause, and outcome of bleeding after Transoral Laser Microsurgery. STUDY DESIGN: A two-center prospective case series analysis. SUBJECTS AND METHODS: Seven hundred one patients underwent Transoral Laser Microsurgery for tumors of the oral cavity, pharynx, and larynx from June 1996 through September 2006. RESULTS: Ten patients (1.4%) experienced postoperative bleeding between 0 and 17 days after surgery. Five patients had previously untreated tumors, and five patients had salvage surgery. Two patients (0.3%) had minor bleeding and required observation only. Five patients (0.7%) experienced major bleeding requiring exploration under general anesthesia. Three patients (0.4%) had catastrophic life-threatening bleeds, two of whom died. The bleeding vessel was identified as the lingual artery in four patients, the superior laryngeal artery in two, the facial artery in two, and unknown in two. CONCLUSIONS: Bleeding after Transoral Laser Microsurgery is rare but potentially life-threatening.
James Ohara - One of the best experts on this subject based on the ideXlab platform.
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one year swallowing outcomes following Transoral Laser Microsurgery adjuvant therapy versus primary chemoradiotherapy for advanced stage oropharyngeal squamous cell carcinoma
Clinical Otolaryngology, 2016Co-Authors: Diane Goff, Helen Cocks, James W. Moor, Chris Hartley, Colin Muirhead, James Ohara, Joanne PattersonAbstract:OBJECTIVES To assess the between-group change in swallowing function from baseline to 12 months following treatment, for patients treated for resectable stage III and IVA oropharyngeal squamous cell carcinoma. To assess the within-group change in swallowing function between 3 and 12 months following treatment. DESIGN Non-randomised cohort study. SETTING A single head and neck cancer unit with oncology services held at the nearby regional treatment centre. PARTICIPANTS Twenty-five patients treated with Transoral Laser Microsurgery +/- adjuvant (chemo)radiotherapy (Transoral Laser Microsurgery) observed alongside an historic cohort of 33 patients treated with (chemo)radiotherapy. MAIN OUTCOME MEASURES The patient reported MD Anderson Dysphagia Inventory (MDADI), an objective timed Water Swallow Test, and the clinician rated normalcy of diet subsection of the Performance of Swallowing Scale . RESULTS Between baseline and 12 months, patients treated with primary (chemo)radiotherapy demonstrated greater deterioration in swallowing function compared to Transoral Laser Microsurgery for all 3 swallowing measures. Between 3 and 12 months, the only significant change was an improvement in Performance of Swallowing Scale scores in the (chemo)radiotherapy group. CONCLUSIONS This is the first study to report the results of a complimentary set of swallowing measures for patients treated with Transoral Laser Microsurgery, observed alongside a cohort of (chemo)radiotherapy patients. The preliminary results suggest a benefit in swallowing function for Transoral Laser Microsurgery over (chemo)radiotherapy during the year following treatment.
Isabel Vilaseca - One of the best experts on this subject based on the ideXlab platform.
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long term quality of life after Transoral Laser Microsurgery for laryngeal carcinoma
Journal of Surgical Oncology, 2016Co-Authors: Meritxell Vallsmateus, José Luis Blanch, Alexis Ortega, Francesc Sabater, Manuel Bernalsprekelsen, Isabel VilasecaAbstract:BACKGROUND AND OBJECTIVES Previous studies showed good short-term Quality of life (QOL) after Transoral Laser Microsurgery (TLM) for laryngeal cancer. Here, we aimed to evaluate QOL after TLM in the long-term. METHODS Prospective longitudinal study. Sixty-two consecutive disease-free patients were evaluated using UW-QOL v4 and SF-12 questionnaires, 1 and 5 years after TLM. Changes over time were assessed according to age, location, and tumor size. Long-term VHI-10 was also evaluated. RESULTS The mean follow-up time was 5.41 ± 2.02 years. No differences in the global UW-QOL score were observed between 1 and 5 years after TLM (1135.00 vs. 1127.20; P = 0.4). Activity worsened slightly in the long-term (93.03 vs. 87.70; P = 0.02). Forty-two and 58% of the patients reported that their health 1 and 5 years after treatment was much better than prior to diagnosis. Initially, 3.3% considered their health much worse, which was reduced to 1.7% at 5 years. SF-12 scores remained unchanged for both physical and mental aspects (P > 0.05). The VHI-10 was 3.81 ± 5.7 for supraglottic and 7.2 ± 9.6 for glottic tumors. CONCLUSION Patients treated with TLM present a very good long-term QOL. Only activity deteriorates over time, while voice and swallowing remain satisfactory in the majority of patients. J. Surg. Oncol. 2016;114:789-795. © 2016 2016 Wiley Periodicals, Inc.
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Long‐term quality of life after Transoral Laser Microsurgery for laryngeal carcinoma
Journal of surgical oncology, 2016Co-Authors: Meritxell Valls-mateus, Manuel Bernal-sprekelsen, José Luis Blanch, Alexis Ortega, Francesc Sabater, Isabel VilasecaAbstract:BACKGROUND AND OBJECTIVES Previous studies showed good short-term Quality of life (QOL) after Transoral Laser Microsurgery (TLM) for laryngeal cancer. Here, we aimed to evaluate QOL after TLM in the long-term. METHODS Prospective longitudinal study. Sixty-two consecutive disease-free patients were evaluated using UW-QOL v4 and SF-12 questionnaires, 1 and 5 years after TLM. Changes over time were assessed according to age, location, and tumor size. Long-term VHI-10 was also evaluated. RESULTS The mean follow-up time was 5.41 ± 2.02 years. No differences in the global UW-QOL score were observed between 1 and 5 years after TLM (1135.00 vs. 1127.20; P = 0.4). Activity worsened slightly in the long-term (93.03 vs. 87.70; P = 0.02). Forty-two and 58% of the patients reported that their health 1 and 5 years after treatment was much better than prior to diagnosis. Initially, 3.3% considered their health much worse, which was reduced to 1.7% at 5 years. SF-12 scores remained unchanged for both physical and mental aspects (P > 0.05). The VHI-10 was 3.81 ± 5.7 for supraglottic and 7.2 ± 9.6 for glottic tumors. CONCLUSION Patients treated with TLM present a very good long-term QOL. Only activity deteriorates over time, while voice and swallowing remain satisfactory in the majority of patients. J. Surg. Oncol. 2016;114:789-795. © 2016 2016 Wiley Periodicals, Inc.
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Clinical significance of granulation tissue after Transoral Laser Microsurgery for glottic cancer.
Journal of Laryngology and Otology, 2015Co-Authors: Elena Rioja, J. L. Blanch, Borés A, Manuel Bernal-sprekelsen, Isabel VilasecaAbstract:Background: Granulation tissue after Transoral Laser Microsurgery can make it difficult to distinguish between normal healing and tumour recurrence. Materials and methods: We carried out a retrospective analysis of 316 consecutive glottic carcinomas (T is –T 3 ). Presence of granulation tissue at one and six months was correlated with demographic and clinical data, tumour and surgical characteristics, and tumour relapse. Results: Granulation tissue appeared in 53.8 per cent of patients at month 1, resolving spontaneously in 41.8 per cent. Revision surgery was performed in 60.1 per cent and was effective in 41.1 per cent. At month 6, 14.9 per cent of patients presented with granulation tissue. In 74.5 per cent the tissue was surgically removed and was positive for malignancy in 62.9 per cent. Tumour relapse presented in 29.4 per cent with granulation tissue at month 1 and in 61.7 per cent at month 6 ( p = 0.000). Granulation tissue at month 1 correlated with thyroid cartilage exposure and continued smoking. At month 6, granulation tissue correlated with thyroid cartilage exposure, the affected surgical margins and diabetes. Conclusion: Granulation tissue after Transoral Laser Microsurgery is frequent. When it persists at six months, revision surgery is formally recommended.
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Prognostic factors of quality of life after Transoral Laser Microsurgery for laryngeal cancer.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated wi, 2014Co-Authors: Isabel Vilaseca, Manuel Bernal-sprekelsen, Ruth Him, Alexandra Mandry, Eduardo Lehrer, José Luis BlanchAbstract:We aimed to evaluate factors influencing quality of life (QOL) after Transoral Laser Microsurgery (TLM) of laryngeal cancer. Four hundred and one consecutive disease-free patients were evaluated 1 year after treatment using the University of Washington-QOL v4, the SF-12 (short form of SF-36), and a questionnaire about self-rated health status. The importance of age, gender, tumor location, tumor size, tumor stage, neck dissection and adjuvant treatment were evaluated. One year after TLM patients had a good QOL, with only 6 % of patients reporting a worsening in their health status. Radiation therapy (p = 0.000) and neck dissection (p = 0.000) were negative factors for disease-specific QOL, whereas age ≥70 (p = 0.01) was a positive independent factor for mental score of SF-12. Speech was negatively influenced by tumor size (p = 0.001) as was swallowing by age (p = 0.001) and postoperative radiation (p = 0.000). Patients treated with TLM present a good QOL 1 year after surgery. Radiation and neck dissection negatively impact QOL. Elderly patients cope better with their disabilities.
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Transoral Laser Microsurgery for Locally Advanced Laryngeal Cancer
Acta otorrinolaringologica espanola, 2012Co-Authors: Isabel Vilaseca, Manuel Bernal-sprekelsenAbstract:Abstract 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.
