Purpose: CO2laser transoral microsurgery for glottic carcinoma, when indicated, has the well-established advantages of low morbidity and positive oncological outcomes. The present study aims to determine how patient age, and tumor site could negatively impact prognosis; other variables such as the status of the margins of resection, tobacco and alcohol intake, and the grade of differentiation of the tumors have been evaluated. Methods: This was a retrospective analysis on 261 patients with a glottic carcinoma who underwent CO2laser transoral microsurgery. The impact of different variables was calculated using univariate and multivariate analyses. Results: The study included 248 males and 13 females. The median follow-up period was 4.3 years. Five-year disease-specific survival, recurrence-free survival, local control with laser alone, overall laryngeal preservation, and overall survival rates were 99.4, 92.2, 93.8, 97.6, and 85.5%, respectively. Equivalent results were observed in young and elderly patients. Patients with positive margins after CO2laser transoral microsurgery showed a reduced local control with laser alone. T2 patients with true subglottic spreading and patients with anterior commissure involvement of grade 3 (Rucci’s classification) experienced worse local control rates, despite free surgical margins confirmed by histology. Conclusions: CO2laser transoral microsurgery is an effective and reproducible single-stage modality therapy for young and elderly patients with glottic carcinoma. Superficial close margins can be managed by a careful wait-and-see policy, while positive margins should undergo surgical enlargement. In our experience, undifferentiated tumors, true subglottic extension, and anterior commissure involvement of grade 3 were associated with worse outcomes.

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

Carta, Filippo;Bandino, Fabrizio;Olla, Aurora Marta;Gerosa, Clara;Puxeddu, Roberto
2018

Abstract

Purpose: CO2laser transoral microsurgery for glottic carcinoma, when indicated, has the well-established advantages of low morbidity and positive oncological outcomes. The present study aims to determine how patient age, and tumor site could negatively impact prognosis; other variables such as the status of the margins of resection, tobacco and alcohol intake, and the grade of differentiation of the tumors have been evaluated. Methods: This was a retrospective analysis on 261 patients with a glottic carcinoma who underwent CO2laser transoral microsurgery. The impact of different variables was calculated using univariate and multivariate analyses. Results: The study included 248 males and 13 females. The median follow-up period was 4.3 years. Five-year disease-specific survival, recurrence-free survival, local control with laser alone, overall laryngeal preservation, and overall survival rates were 99.4, 92.2, 93.8, 97.6, and 85.5%, respectively. Equivalent results were observed in young and elderly patients. Patients with positive margins after CO2laser transoral microsurgery showed a reduced local control with laser alone. T2 patients with true subglottic spreading and patients with anterior commissure involvement of grade 3 (Rucci’s classification) experienced worse local control rates, despite free surgical margins confirmed by histology. Conclusions: CO2laser transoral microsurgery is an effective and reproducible single-stage modality therapy for young and elderly patients with glottic carcinoma. Superficial close margins can be managed by a careful wait-and-see policy, while positive margins should undergo surgical enlargement. In our experience, undifferentiated tumors, true subglottic extension, and anterior commissure involvement of grade 3 were associated with worse outcomes.
Anterior commissure; CO2laser; Endoscopy; Glottic carcinoma; Subglottic extension; Transoral microsurgery; Age factors; Aged; Carcinoma, squamous cell; Female; Follow-up studies; Glottis; Humans; Laryngeal neoplasms; Lasers, gas; Male; Margins of excision; Microsurgery; Middle aged; Prognosis; Retrospective studies; Survival rate; Otorhinolaryngology; Pathology and forensic medicine
File in questo prodotto:
File Dimensione Formato  
Carta2018_Article_PrognosticValueOfAgeSubglottic.pdf

Solo gestori archivio

Tipologia: versione editoriale
Dimensione 728.61 kB
Formato Adobe PDF
728.61 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11584/250957
Citazioni
  • ???jsp.display-item.citation.pmc??? 6
  • Scopus 20
  • ???jsp.display-item.citation.isi??? 21
social impact