Gurău Petru, Arnaut Oleg
Department of Thoracic Surgery, "Timofei Moșneaga" Republican Clinical Hospital, Chișinău, Republic of Moldova.
Bioinformatics and Computational Medicine Laboratory, National Institute for Health and Medical Research, "Nicolae Testemițanu" State University of Medicine and Pharmacy, Chișinău, Republic of Moldova.
J Voice. 2024 Oct 14. doi: 10.1016/j.jvoice.2024.09.007.
The objective of this study was to demonstrate the long-term oncologic efficacy of flexible endoscopic laryngeal surgery (FELS) in treating T1-T2 glottic carcinoma.
From 134 patients who underwent FELS, 90 patients (males-82, females-8), aged 18-83 (mean-56.9 ± 10.7) with early glottic carcinoma (T1a-27, T1b-24, and T2-39) were included in the study. Fifty-seven patients (63.3%) underwent FELS under local anesthesia with spontaneous ventilation, the rest of the patients were operated on under general anesthesia with superimposed high-frequency jet ventilation (SHFJV). Tumor ablation by Nd:YAG laser was performed in all the cases, preceded by diathermy snare excision in one-third of cases. In 20 of the T2 cases, adjuvant radiotherapy (RT) was performed.
Five-year overall survival and ultimate disease control, including salvage treatment, was obtained in 82/90 patients (91.1%), cure with larynx preservation-in 88.9% of cases, disease-free survival-in 83.3% of cases, and ultimate local control with FELS alone-in 86.7% of cases. The best 5-year oncological results were obtained in the T1a group of treated patients, all the patients being alive and free of disease with the preserved larynx due to FELS alone. There was no evidence of better oncological results by FELS under general anesthesia with SHFJV over FELS under local anesthesia with spontaneous ventilation. Anterior commissure (AC) involvement worsened the treatment results. Adjuvant RT did not demonstrate an improvement of oncological results in the T2 group of patients.
FELS demonstrates oncological outcomes that are comparable to RT and transoral laser microsurgery and can be considered an oncologically efficient method of treatment of T1-T2 glottic carcinoma. Awake FELS is not inferior to FELS under general anesthesia with SHFJV concerning oncological efficacy. More studies on a bigger clinical material are necessary for definitive conclusions concerning the impact of AC affection and adjuvant RT on the oncological results.
本研究的目的是证明软性内镜下喉部手术（FELS）治疗T1 - T2声门型癌的长期肿瘤学疗效。
在134例行FELS手术的患者中，纳入90例年龄在18 - 83岁（平均56.9±10.7岁）的早期声门型癌患者（男性82例，女性8例）（T1a 27例，T1b 24例，T2 39例）。57例患者（63.3%）在局部麻醉下自主通气下行FELS手术，其余患者在全身麻醉叠加高频喷射通气（SHFJV）下进行手术。所有病例均采用Nd:YAG激光进行肿瘤消融，三分之一的病例在激光消融前先行圈套电凝切除术。20例T2病例接受了辅助放疗（RT）。
82/90例患者（91.1%）获得了5年总生存率和最终疾病控制率，包括挽救性治疗，88.9%的病例实现了保喉治愈，83.3%的病例无病生存，仅通过FELS实现最终局部控制的病例占86.7%。在接受治疗的T1a组患者中获得了最佳的5年肿瘤学结果，所有患者均存活且因单纯FELS手术而保喉无病。没有证据表明全身麻醉下SHFJV辅助的FELS手术在肿瘤学结果上优于局部麻醉下自主通气的FELS手术。前联合（AC）受累会使治疗结果变差。辅助放疗在T2组患者中未显示出肿瘤学结果的改善。
FELS显示出与放疗和经口激光显微手术相当的肿瘤学结果，可被认为是治疗T1 - T2声门型癌的一种肿瘤学上有效的治疗方法。清醒状态下的FELS在肿瘤学疗效方面并不逊于全身麻醉下SHFJV辅助的FELS。关于AC受累和辅助放疗对肿瘤学结果的影响，需要对更大规模的临床资料进行更多研究才能得出明确结论。
