Distant metastases after transoral laser microsurgery for laryngeal and hypopharyngeal squamous cell carcinoma.

BACKGROUND

Transoral CO(2) laser microsurgery (TLM) resection of laryngeal-hypopharyngeal squamous cell carcinomas has become a standard procedure. The objective was to evaluate whether there is a relationship between TLM and a higher incidence of distant metastases.

METHODS

We conducted a retrospective analysis of 340 consecutive patients with laryngeal or hypopharyngeal squamous cell carcinoma treated with TLM.

RESULTS

Distant metastases occurred in 24 of 340 (7.1%) patients. The mean time of distant metastases diagnosis was 19.1 months (range, 1-41) postsurgery. Univariate study demonstrated an association with alcoholism (p = .008), tumor site (p<.001), grade of differentiation (p = .032), stage (p<.001), tumor classification (T; p = .001), node involvement (N; p<.001), extracapsular node spread (p<.001), and positive surgical margin (p = .004). In multivariate logistic regression analysis, location (sinus piriform: OR = 15.37, p = .025), node involvement (N2: OR = 7.36, p = .003; N3: OR = 19.28, p = .027), and the affected surgical margin (OR 5.32; p = .005) predicted an increased likelihood of distant metastases.

CONCLUSIONS

Development of distant metastases after TLM in patients with squamous cell carcinoma depends mainly on the tumor site, the presence of metastatic lymph node disease, and the margin status after resection.