Hamzany Yaniv, Shoffel-Havakuk Hagit, Devons-Sberro Stav, Shteinberg Shani, Yaniv Dan, Mizrachi Aviram
Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Oncol. 2018 Aug 14;8:298. doi: 10.3389/fonc.2018.00298. eCollection 2018.
The purpose of the study was to present the outcome of our management protocol of a single stage transoral laser microsurgery (SSTLM), with the intention of complete removal of a lesion, considered to be an early glottic cancer. Between January 2015 to February 2017 patients with the clinical appearance of an early glottic cancer, who were candidates for (SSTLM) management protocol, were included in this study. Type of cordectomy was determined by pre- and intra-operative evaluation of the extent of lesion in cord layers. Thirty patients (6 females, 24 males; mean age 65 years) underwent SSTLM. Twenty-two patients had malignant histopathological diagnosis of severe dysplasia or Cis in 4 patients, microinvasice carcinoma in 3 patients and invasive carcinoma in 15 patients (T1a tumor in 14 and T1b tumor in 1). Eight patients had a nonmalignant histological diagnosis of keratosis without atypia in 2 patients, mild dysplasia in 2 patients and moderate dysplasia in 3 patients. Based on pre- and intra-operative evaluation, 14 subepithelial (type I), 10 subligamental (type II), and 6 transmuscular (type III) cordectomies were performed. Comparison of cordectomies types with postoperative histopathologic diagnosis showed an adequate extent of resection in 26 out of 30 patients (87%). Considering only patients without recent background of direct laryngoscopy and biopsy, an adequate resection was performed in 90% of patients. None of the patients was further treated by external beam radiation. At average follow-up of 21 months, none of the patients developed local recurrence. In selected cases, a SSTLM for clinical appearance of an early glottic cancer, allows a reliable histopathologic diagnosis and a high local control rate with favorable cost effectiveness. A careful pre- and intraoperative evaluation for selecting the appropriate cases for this management is required in order to avoid under- or over-treatment.
本研究的目的是展示我们的单阶段经口激光显微手术（SSTLM）管理方案的结果，旨在完全切除被认为是早期声门癌的病变。2015年1月至2017年2月期间，具有早期声门癌临床表现且适合（SSTLM）管理方案的患者被纳入本研究。声带切除术的类型通过术前和术中对声带各层病变范围的评估来确定。30例患者（6例女性，24例男性；平均年龄65岁）接受了SSTLM。22例患者经组织病理学诊断为恶性，其中4例为重度发育异常或原位癌，3例为微浸润癌，15例为浸润癌（14例为T1a肿瘤，1例为T1b肿瘤）。8例患者经组织病理学诊断为非恶性，其中2例为无异型性的角化病，2例为轻度发育异常，3例为中度发育异常。根据术前和术中评估，进行了14例上皮下（I型）、10例韧带下（II型）和6例穿肌（III型）声带切除术。声带切除术类型与术后组织病理学诊断的比较显示，30例患者中有26例（87%）切除范围足够。仅考虑近期无直接喉镜检查和活检背景的患者，90%的患者切除范围足够。所有患者均未接受外照射进一步治疗。平均随访21个月，所有患者均未发生局部复发。在选定的病例中，对于早期声门癌临床表现进行SSTLM，可实现可靠的组织病理学诊断和较高的局部控制率，且成本效益良好。为避免治疗不足或过度治疗，需要进行仔细的术前和术中评估以选择适合该管理方案的病例。
