Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy.
Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy.
Braz J Otorhinolaryngol. 2022 Sep-Oct;88(5):669-674. doi: 10.1016/j.bjorl.2020.09.008. Epub 2020 Oct 17.
Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision.
The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery.
We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: "free" if macroscopic margin-tumor distance was at least 2mm, as "close" if it was less than 2mm and "positive" if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4-8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated.
Five-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients.
This study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.
经口激光显微手术是治疗早期声门型癌症的首选方法。其使用和效果主要与喉暴露和肿瘤的深度延伸有关。手术边缘的组织病理学评估是经口激光显微手术和完整肿瘤切除的主要问题。
分析早期声门型癌症患者经口激光显微手术后行修正手术对器官保留和局部疾病控制的影响。
我们对 153 例早期声门型癌症（Tis、T1、T2）患者进行了回顾性研究，这些患者均接受经口激光显微手术治疗。切除边缘分为以下几类：如果宏观边缘-肿瘤距离至少为 2mm，则为“游离”，如果小于 2mm，则为“接近”，如果边缘被癌累及，则为“阳性”。患者分为两组：游离切除边缘组（A 组）和阳性、接近或无法评估切除边缘组（B 组）。A 组（36 例）接受定期随访。B 组（117 例）在手术后 2 个月行第二次激光 CO 2 检查。A 组中 15 例患者在随访过程中怀疑有癌残留，在第一次手术后 4-8 个月后行第二次激光切除。估计总生存率、无病生存率、疾病特异性生存率、单纯激光最终局部控制率和器官保留率。
两组患者的 5 年总生存率和 5 年疾病特异性生存率均为 100%。A 组和 B 组的 5 年喉保留率分别为 100%和 95.2%。A 组和 B 组的 5 年无病生存率分别为 92.15%和 5 年单纯激光最终局部控制率为 92.15%。
本研究表明，修正经口激光显微手术能够在大多数情况下确认肿瘤的根治性，即使是在阳性、接近或无法评估的边缘。考虑到我们的结果，根据我们的经验，即使是接近或无法评估以及阳性边缘，CO 激光二次观察也是一种治疗策略。
