Mendelsohn Abie H, Kiagiadaki Devora, Lawson Georges, Remacle Marc
Department of Head and Neck Surgery, Head and Neck Robotic Surgery Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,
Eur Arch Otorhinolaryngol. 2015 Feb;272(2):413-8. doi: 10.1007/s00405-014-3368-9. Epub 2014 Oct 29.
Transoral CO2 laser cordectomy for squamous cell carcinoma (SCC) of the glottis has resulted in excellent voice and oncologic outcomes as compared with non-surgical therapy. However, published experience with primary CO2 laser cordectomy specifically for glottic SCC involving the anterior commissure (AC) is limited. A review of single academic institution experience with CO2 laser cordectomy for glottic SCC involving the AC. Patients undergoing European Laryngological Society (ELS) classification cordectomy type Va or type VI between 2005 and 2013 were included. Post-surgical voice analysis was performed by speech language pathologists (SLP) from the reporting institution. Thirty patients were identified for inclusion. Mean post-surgical follow-up time was 47.6 months (range 11-59). Initial local recurrence was identified in 5/30 (16.7%) patients. 2/5 recurrences were successfully salvaged by repeat CO2 laser resections, 2/5 ultimately required salvage total laryngectomy, and 1/5 patient developed a second primary preventing further curative treatment. Overall laryngeal preservation rate was 28/30 (93.3%). Overall survival of the study cohort was 96.7%. Mean postoperative voice handicap index-120 score was 36.9 (SD = 21.4). Perceptual analysis performed on the GRBAS scale resulted in mean scores: G = 2.1 (SD = 0.9), R = 1.3 (SD = 1.1), B = 1.6 (SD = 1.2). Though cancers involving the AC represent an aggressive subgroup of glottic SCC, CO2 laser cordectomy results in encouraging oncologic and voice outcomes without the need for further therapy in the majority of cases. Clinical trials are encouraged to further define optimal treatment recommendations for glottic SCC involving the AC.
与非手术治疗相比，经口二氧化碳激光声带切除术治疗声门鳞状细胞癌（SCC）产生了优异的嗓音和肿瘤学治疗效果。然而，专门针对累及前联合（AC）的声门SCC进行原发性二氧化碳激光声带切除术的已发表经验有限。一项关于单一学术机构采用二氧化碳激光声带切除术治疗累及AC的声门SCC的经验回顾。纳入2005年至2013年间接受欧洲喉科学会（ELS）分类的Va型或VI型声带切除术的患者。由报告机构的言语语言病理学家（SLP）进行术后嗓音分析。确定30例患者纳入研究。术后平均随访时间为47.6个月（范围11 - 59个月）。30例患者中有5例（16.7%）出现初始局部复发。5例复发患者中有2例通过重复二氧化碳激光切除术成功挽救，2例最终需要挽救性全喉切除术，1例患者发生第二原发癌，无法进一步进行根治性治疗。总体喉保留率为28/30（93.3%）。研究队列的总生存率为96.7%。术后嗓音障碍指数 - 120的平均评分为36.9（标准差 = 21.4）。根据GRBAS量表进行的感知分析得出的平均分数为：G = 2.1（标准差 = 0.9），R = 1.3（标准差 = 1.1），B = 1.6（标准差 = 1.2）。尽管累及AC的癌症是声门SCC的侵袭性亚组，但二氧化碳激光声带切除术在大多数情况下可产生令人鼓舞的肿瘤学和嗓音治疗效果，无需进一步治疗。鼓励开展临床试验以进一步明确针对累及AC的声门SCC的最佳治疗建议。
