[EARLY LARYNGEAL CANCER - TREATMENT OUTCOMES OF TRANSORAL LASER MICROSURGERY].

AIMS: To evaluate predictive factors for local control, larynx preservation and overall survival in patients with early laryngeal cancer, who were treated with endoscopic transoral CO2 laser microsurgery. BACKGROUND: Transoral laser microsurgery (TLM) is the treatment of choice for early laryngeal cancer. The current study aimed to assess the outcomes and validity of carbon dioxide (CO2) laser microsurgery in patients with early larynx cancer and to determine predictors for outcomes. METHODS: A retrospective study included all patients who were treated with laser microsurgery, in the Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, between the years 2009-2016. We evaluated outcomes according to local control, margin status, larynx preservation, and overall survival. Cordectomy types I-V were classified by the European Laryngological Society (ELS). RESULTS: Laser microsurgery was performed in 74 patients with early laryngeal cancer, mean age 68.2±10.4 years, M: F 65:9, mean follow-up 58±28 months. Seventy-three percent (73%) were smokers. Primary tumor location was glottic in 68 patients (92%), supraglottic (5 patients - 7%), and subglottic (1 patient - 1%). Tumor stage was as follows: Tis: 18 patients (24%), T1a: 35 patients (47%), T1b:10 patients (14%) and T2: 11 patients (15%). In 72 patients (97%), margins were taken from the patient side, 64% (46 patients) had negative margins, whereas 26 patients (36%) had positive margins. Patients with positive margins had either further laser surgery (19%), or radiotherapy (14%). Two patients were not treated for positive margins, both had recurrent disease in a mean follow-up of 26 months, and both had total laryngectomy. Five years local control rate (LCR) stratified by stage was as follows: Tis-81.5%, T1a- 88%, T1b-100% and T2 - 58% (NS). Overall 5-year local control rate (LCR) was 83%, with no significant difference between patients with positive or negative margins. Overall 5-year survival was 87% and organ preservation rate was 93. CONCLUSIONS: Laser microsurgery provides an excellent rate of disease free/overall survival for early laryngeal cancer and has a valuable role in organ preservation. No significant differences were found in LRC and overall survival between patients with positive margins compared to patients with negative margins, most probably due to immediate further intervention in patients with positive margins.

Risk Factors for Rectal Cancer Recurrence after Local Excision of T1 Lesions from a Decade-Long Multicenter Retrospective Study.

Background: Local surgical excision of T1 rectal adenocarcinoma is a well-established approach. Yet, there are still open questions regarding the recurrence rates and its risk factors. Methods: A retrospective multicenter study including all patients who underwent local excision of early rectal cancer with an open or MIS approach and had a T1 lesion from 2010 to 2020 in six academic centers. Data included demographics, preoperative studies, surgical findings, postoperative outcomes, and local and systemic recurrence. A univariable and multivariable logistic regression analysis was performed to identify risk factors for recurrence. Results: Overall, 274 patients underwent local excision of rectal lesions. Of them, 97 (35.4%) patients with a T1 lesion were included in the cohort. The mean age was 69 ± 10.5 years, and 42 (43.3%) were female. The mean distance of the lesions from the anal verge was 7.8 ± 3.2 cm, and the average tumor size was 2.7 ± 1.6 cm. Eighty-two patients (85%) had a full-thickness resection. Eight patients (8%) had postoperative complications. Kikuchi classification of submucosal (SM) involvement was reported in 29 (30%) patients. Twelve patients had SM1, two SM2, and fifteen SM3. Following pathology, 24 patients (24.7%) returned for additional surgery or treatment. The overall recurrence rate was 14.4% (14 patients), with 11 patients having a local recurrence and 6 having a systemic metastatic recurrence, 3 of which had both. The mean time for recurrence was 2.78 ± 2.8 years and the overall mortality rate was 11%. On univariable and multivariable logistic regression analysis of recurrence vs. non-recurrence groups, the strongest and most significant association and possible risk factors for recurrence were larger lesions (4.3 vs. 2.5 cm, p < 0.001) with an OR of 6.67 (CI-1.82-24.36), especially for tumors larger than 3.5 cm, mucinous histology (14.3% vs. 1.2%, p = 0.004, OR of 14.02, CI-1.13-173.85), and involved margins (41.7% vs. 16.2%, p = 0.003, OR of 9.59, CI-2.14-43.07). The open transanal excision (TAE) approach was also identified as a possible significant risk factor in univariant analysis, while SM3 level penetration showed only a trend. Conclusion: Surgical local excision of T1 rectal malignancy is a safe and viable option. Still, one in four patients received additional treatment. There is an almost 15% chance for recurrence, especially in large tumors, mucinous histology, or involved margin cases. These high-risk patients might warrant additional intervention and stricter surveillance protocols.

Rectal Cancer following Local Excision of Rectal Adenomas with Low-Grade Dysplasia-A Multicenter Study.

Purpose: Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to assess the rectal cancer rate following local excision of LGD rectal lesions. Methods: A retrospective multicenter study including all patients that underwent LE for rectal polyps over a period of 11 years was conducted. Demographic, clinical, and surgical data of patients with LGD werecollected and analyzed. Results: Out of 274 patients that underwent LE of rectal lesions, 81 (30%) had a pathology of LGD. The mean patient age was 65 ± 11 years, and 52 (64%) were male. The mean distance from the anal verge was 7.2 ± 4.3 cm, and the average lesion was 3.2 ± 1.8 cm. Full thickness resection was achieved in 68 patients (84%), and four (5%) had involved margins for LGD. Nine patients (11%) had local recurrence and developed rectal cancer in an average time interval of 19.3 ± 14.5 months, with seven of them (78%) diagnosed less than two years after the initial LE. Seven of the nine patients were treated with another local excision, whilst one had a low anterior resection, and one was treated with radiation. The mean follow-up time was 25.3 ± 22.4 months. Conclusions: Locally resected rectal polyps with LGD may carry a significant risk of recurring and developing cancer within two years. This data suggests patients should have a closer surveillance protocol in place.