ABSTRACT
OBJECTIVES/HYPOTHESIS: In 2013, we introduced a modified technique for mucosal/muscle layer defect coverage with fibrin glue and polyglycolic acid (PGA) sheets (mMCFP technique) in patients undergoing endoscopic transoral surgeries for laryngopharyngeal cancers. This technique allows easy and convenient coverage of the wound surface, even when it involves the laryngopharyngeal lumen. To our knowledge, use of the MCFP technique for coverage of postoperative mucosal and/or muscle layer defects involving the laryngopharyngeal lumen has not been reported. The aim of the present study was to retrospectively evaluate the safety of our mMCFP technique used simultaneously with endoscopic transoral resection of Tis, T1, T2, and select T3 pharyngeal and supraglottic cancers. STUDY DESIGN: A single centre retrospective study. METHODS: Between June 2013 and February 2019, 102 patients underwent simultaneous end-flexible-rigidscopic transoral surgery and wound coverage using our mMCFP technique. All patients required mucosal and/or muscle layer resection. For all patients, we recorded the incidence of postoperative complications and the time period for which the PGA sheets could be observed after surgery. RESULTS: In 41%, 35%, and 8% patients, the PGA sheets could be observed on the wound surface for 2, 3, and 4 weeks, respectively. Other than postoperative bleeding in two patients (2%), no postoperative complications were recorded. CONCLUSIONS: The findings of this study suggest that our mMCFP technique is a safe and simple method for the repair of mucosal and/or muscle layer defects after endoscopic transoral surgery for laryngopharyngeal cancers. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1740-1745, 2020.
Subject(s)
Fibrin Tissue Adhesive/pharmacology , Laryngeal Neoplasms/surgery , Natural Orifice Endoscopic Surgery/adverse effects , Polyglycolic Acid/pharmacology , Postoperative Complications/therapy , Wound Closure Techniques , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Laryngeal Neoplasms/diagnosis , Male , Middle Aged , Mouth , Neoplasm Staging , Retrospective Studies , Tissue Adhesives/pharmacology , Treatment OutcomeABSTRACT
BACKGROUND: Endoscopic laryngo-pharyngeal surgery (ELPS), which is a transoral minimally invasive surgery using a gastrointestinal endoscope and a curved laryngopharyngeal retractor, is effective to treat primary lesions of superficial laryngopharyngeal cancers. To extend concepts of ELPS to invasive laryngopharyngeal cancers, we developed end-flexible-rigidscopic transoral surgery (E-TOS) from ELPS by changing a gastrointestinal endoscope to a flexible-tip rigid endoscope. AIMS/OBJECTIVES: To retrospectively evaluate oncological outcomes and laryngopharyngeal functional preservation of E-TOS in patients with T1-selected T3 laryngopharyngeal cancers. MATERIAL AND METHODS: In 47 patients T1-selected T3 pharyngeal and supraglottic cancers were resected by E-TOS using the flexible-tip rigid endoscope and curved instruments. Negative resection margin was histopathologically evaluated. The survival, preservation of larynx, and disease control rates were estimated using Kaplan-Meier method. RESULTS: Curative resection was achieved in 94% of patients. No patient complained prolonged swallowing dysfunction or hoarseness after E-TOS. Postoperative bleeding, stenosis of the pharynx and esophageal entrance, and local recurrence was observed each in one patient. The 3-year overall survival, disease-specific survival, laryngeal preservation, local control, and locoregional control rates were, 86%, 93%, 100%, 98%, and 79%, respectively. CONCLUSION: E-TOS is an effective minimally invasive surgery for T1-selected T3 pharyngeal and supraglottic cancers with preserving laryngeal function.
