Transcanal endoscopic carbon dioxide laser resection of early-stage (A1-B1) glomus tympanicum tumours: single-centre case series.

OBJECTIVE: To report a single-centre experience in the endoscopic carbon dioxide laser-assisted approach to glomus tympanicum tumours. METHODS: A retrospective case review was conducted of patients diagnosed with class A1 to B1 glomus tympanicum tumours who underwent exclusive transcanal endoscopic carbon dioxide laser surgery. RESULTS: Seven patients fulfilled the inclusion criteria. All patients (100 per cent) were women, with a mean age of 65.4 years (standard deviation, 13.6). There were five A2 tumours, one A1 tumour and one B1 tumour. One patient presented with a delayed tympanic membrane perforation needing myringoplasty on follow up. There were no substantial post-operative complications. The mean hospitalisation time was 9.5 hours (standard deviation, 9.8). The mean follow-up period was 32.7 months (standard deviation, 13.1), with all cases having resolution of pulsatile tinnitus and no tumour recurrence. CONCLUSION: The study provides further evidence on the safety and efficacy of endoscopic carbon dioxide laser surgery as a minimally invasive technique for treating early-stage glomus tympanicum tumours.

Recurrent laryngeal squamous cell carcinoma: rTNM versus composite laryngeal recurrence staging system. Proposal for a modification of the CLRSS to improve patient classification.

BACKGROUND: Based on the initial TNM stage of the tumor and the extension of recurrence, the composite laryngeal recurrence staging system (CLRSS) has been proposed as an alternative to the rTNM system for staging patients with recurrent laryngeal carcinoma. The objective of our study was to carry out an external validation of the CLRSS, and to evaluate a modified version of the original CLRSS, that we named CLRSS-2. METHODS: We conducted a retrospective analysis of 332 patients with recurrent laryngeal carcinoma treated in our center between 1985 and 2003. RESULTS: rTNM, CLRSS, and CLRSS-2 showed a monotonic prognostic gradient with increasing stage and produced significant differences in survival between stages. Discrepancies were detected in the cross-tabulation between rTNM and CLRSS. The CLRSS-2 achieved the best results in an objective comparison of the staging systems evaluated. CONCLUSION: The CLRSS-2 was the best method to classify patients with a recurrent laryngeal carcinoma.

Supracricoid laryngectomy as salvage surgery after failure of radiation therapy.

Supracricoid laryngectomy can be an alternative in selected patients with a local recurrence after radiotherapy when endoscopic treatment or more conservative external approaches are not indicated. In this study, we reviewed our experience in patients who underwent salvage supracricoid laryngectomies for local recurrence following radiotherapy. Between 1997 and 2005, salvage supracricoid laryngectomy was performed in nine consecutive patients. The primary tumour was located in the glottis in eight cases and in the supraglottis in one case. The reconstruction method consisted of a cricohyoidoepiglottopexy in six cases and a cricohyoidopexy in three. One patient died of a complication associated to salvage treatment and another died as a consequence of a new recurrence of the laryngeal tumour. All patients were decannulated and recovered the ability to swallow. The mean cannulation and nasogastric feeding tube times were 11 and 27 days, respectively. The mean hospitalisation time was 34 days. Six patients had wound healing complications, all of which were solved without further surgery. Laryngeal function was preserved in 78% of the patients treated. In conclusion, supracricoid laryngectomy is an effective technique as salvage treatment in selected cases of local recurrence after radiotherapy and it can be an alternative to total laryngectomy when other methods of salvage conservation laryngeal surgery are not indicated.