Gallet P, Rumeau C, Nguyen D T, Teixeira P A, Baumann C, Toussaint B
Department of ENT and head and neck surgery, University Hospital, Nancy, France.
University of Lorraine, Nancy, France.
Clin Otolaryngol. 2017 Dec;42(6):1193-1199. doi: 10.1111/coa.12863. Epub 2017 Apr 24.
Evaluate the clinical outcome of patients treated with CO laser surgery for early-stage glottic carcinomas followed up with 3-month laryngoscopy regardless of tumor grade and margins.
Case series.
Retrospective review of the clinical records of patients treated at the ENT department of a tertiary university hospital.
Clinical records from patients with early-stage glottic carcinomas (Tis/T2) treated with curative intent by CO laser surgery in a ten-year period were evaluated. Regardless of tumor margin status, patients underwent fiber endoscopy 6 weeks after surgery and a systematic second look by direct laryngoscopy under general anesthesia at 3 months.
Local control, laryngeal preservation rate.
Ninety-three patients were included. Disease control was obtained in 90/93 cases. Laryngeal preservation rate was 96.8%. Twenty patients had a local residual disease or recurrence after the first laser surgery, but 17 were salvaged (85%). Local residual disease and recurrence were more frequent in patients with advanced disease (T1b/T2), invasion of anterior commissure and "non-safe" margins.
The proposed follow-up scheme might be a valuable option, but with caution for positive or unevaluable margins as the latter is an independent risk factor for local recurrence. An early laser excision procedure (eg, within the first two months after surgery) or an alternative strategy may be discussed in this situation. "Watchful observation" should be reserved for compliant patients only so that the risk of missing potential recurrences is minimised.
评估接受CO2激光手术治疗的早期声门癌患者的临床结局，无论肿瘤分级和切缘情况如何，均进行3个月的喉镜随访。
病例系列研究。
对一所三级大学医院耳鼻喉科治疗的患者临床记录进行回顾性分析。
评估在十年期间接受CO2激光手术根治性治疗的早期声门癌（Tis/T2）患者的临床记录。无论肿瘤切缘状态如何，患者在术后6周接受纤维内镜检查，并在3个月时在全身麻醉下通过直接喉镜进行系统的二次检查。
局部控制率、喉保留率。
纳入93例患者。90/93例患者实现疾病控制。喉保留率为96.8%。20例患者在首次激光手术后出现局部残留疾病或复发，但17例得到挽救（85%）。局部残留疾病和复发在晚期疾病（T1b/T2）、前联合受累和“非安全”切缘的患者中更常见。
所提出的随访方案可能是一个有价值的选择，但对于阳性或不可评估的切缘要谨慎，因为后者是局部复发的独立危险因素。在这种情况下，可讨论早期激光切除手术（如术后前两个月内）或替代策略。“密切观察”应仅保留给依从性好的患者，以便将错过潜在复发的风险降至最低。
