T1 and T2 hypopharyngeal cancer treatment with laser microsurgery.

BACKGROUND AND OBJECTIVE: To assess the oncologic results and functional outcomes of CO(2) laser microsurgery in T1 and T2 hypopharyngeal cancer. METHODS: The files of 119 T1 and T2 hypopharyngeal carcinoma cases primarily managed with laser surgery were reviewed. Cases were assessed for 5-year disease-specific survival (DSS) as well as local control (LC) rates, with respect to T and N classification, status of surgical margins, and decision on neck management and adjuvant therapy. Cases were additionally evaluated for incidence of major complications and retention of laryngeal and pharyngeal function. RESULTS: DSS and LC rates of 72.6% and 85.4%, respectively, were noted overall in this series. Survival rates were found to be significantly better for cases with negative surgical margins. The presence of regional metastases was also found to significantly affect prognosis. Satisfactory retention of function and a low rate of major complications were noted. CONCLUSION: Laser surgery appears to be very effective for T1 and T2 hypopharyngeal cancer treatment as long as clear surgical margins can be achieved. Oncologic results are acceptable with low incidence of complications and satisfactory retention of function. The neck must always be included in the primary treatment plan of hypopharyngeal lesions.

Evaluation of available surgical management options for early supraglottic cancer.

BACKGROUND: This study was undertaken to evaluate the oncologic results of endoscopic and open surgical techniques in early supraglottic cancer. METHODS: We performed a retrospective evaluation of 101 patients surgically treated for stage I or II supraglottic carcinomas. Laser surgery, horizontal laryngectomy, and total laryngectomy were compared for disease-specific survival and local control rates. Surgical techniques were additionally compared for incidence of major complications, related tracheotomies, and swallowing function retention. RESULTS: No statistically significant differences were noted among the different types of procedures regarding disease-specific survival and local control. A lower incidence of major complications, permanent gastrostomies, and significantly lower incidence of tracheotomies were noted for laser surgery compared with open techniques. CONCLUSION: Larynx-preserving surgical modalities offer comparable oncologic results with total laryngectomy in early supraglottic cancer. In addition, laser surgery has a lower incidence of complications and better functional results compared with open partial or total laryngectomy.

Resection margins and other prognostic factors regarding surgically treated glottic carcinomas.

BACKGROUND AND OBJECTIVES: This study aims to assess the prognostic significance of free histopathologic margins in the surgical treatment of glottic cancer. Furthermore, it evaluates other prognostic factors regarding cases that receive surgical management for glottic lesions. METHODS: A retrospective case-series study was conducted at an academic tertiary referral center. The files of 1,314 cases that underwent primary surgical treatment for glottic cancer were studied. Various prognostic factors, including age, surgical procedure, T classification, N classification, histological grade, and status of margins were assessed in univariate and multivariate analyses. All variables were investigated for their association with local and regional disease control as well as disease specific and overall survival. RESULTS: Status of margins significantly affected disease specific survival and local control regardless of tumor stage in this series. All other variables assessed in the univariate analysis for their association with survival were also found to be significant. However, status of surgical margins and N classification were the only significant variables in multivariate analysis. CONCLUSION: The prognostic value of negative surgical margins for the treatment of glottic cancer cannot be overestimated. Responsibility of the surgeon during primary surgical treatment of glottic carcinomas is emphasized.

Comparison among different available surgical approaches in T1 glottic cancer.

OBJECTIVES/HYPOTHESIS: This study aims to assess the oncologic results of open and transoral surgical techniques in T1a and T1b category glottic carcinomas. STUDY DESIGN: Retrospective clinical study. METHODS: The files of 438 T1a and T1b glottic cancer cases managed with primary surgery were reviewed. Transoral laser surgery and open surgical procedures used to treat these cases, including cordectomy, vertical partial laryngectomy, and frontolateral partial laryngectomy, were compared for disease specific survival and local control rates. In addition, all techniques were compared for incidence of major complications and related tracheotomies. RESULTS: No statistically significant differences were noted between laser surgery and open procedures with regard to disease specific survival and local control for both T1a and T1b cases. Laser surgery showed a significantly lower incidence of complications and tracheotomies. CONCLUSIONS: Laser surgery appears to be a very effective management modality for T1 glottic cancer with comparable results to open procedures and a lower incidence of complications. A transcervical approach should be reserved only for selected cases where individual anatomic factors do not permit complete tumor exposure during diagnostic microlaryngoscopy.

Long-term results of endonasal dacryocystorhinostomy.

The aim of this study is to review the long-term results of endonasal endoscopic dacryocystorhinostomy (DCR) according to our experience as well as to evaluate potential prognostic factors for long-term outcomes. The files of 165 patients who underwent endonasal DCR at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. Furthermore, these cases were clinically evaluated at least 5 years after surgery and completed a subjective result evaluation questionnaire. A cure was reported by a total of 112 (67.9%) subjects and significant improvement without need for further treatment was noted in 23 cases (13.9%). Thirty (18.2%) cases were considered as failures. The overall successful outcome according to the subjective symptom evaluation was 81.8%. Poor correlation between clinical findings and subjective report of symptoms was found. None of the prognostic factors that were assessed affected outcomes significantly. In conclusion, long-term success rates for endonasal DCR seem to be comparable to previously published short-term results.