RESUMO
OBJECTIVES/HYPOTHESIS: To analyze stapler benefits in salvage total laryngectomy in terms of surgical time, hospitalization length, oral feeding time, and occurrence of pharyngocutaneous fistula, and to evaluate risk factors for its onset. STUDY DESIGN: Retrospective analysis. METHODS: One hundred fourteen patients affected by endolaryngeal squamous cell carcinoma who underwent salvage total laryngectomy following primary treatment failure were reviewed. We divided patients into two groups based on type of pharyngeal suture performed: mechanical suture with stapler (group A) and manual suture (group B). These two groups were compared for surgical time, start of oral feeding, hospitalization length, surgical margins and pharyngocutaneous fistula incidence considering its relationship with diabetes mellitus, nutritional status, primary treatment, and neck dissection. RESULTS: In group A and group B, oral feeding restarting time was 15 ± 9.33 versus 20.03 ± 13.81 days, hospitalization was 17.63 ± 10.08 versus 23.72 ± 14.29 days, and surgery lasted 268.39 ± 76.93 versus 294.26 ± 140.58 minutes, respectively (P < .05). Surgical margins resulted infiltrated in two patients (4.3%) in group A and 12 patients in group B (17.6%) (P = .03). Twenty-one patients (18.4%) presented with pharyngocutanoeus fistula. In group A and group B the incidence of fistula was 15.2% and 20.6%, respectively (P = .468). Fistula occurred in 7 of 18 diabetic patients (38.9%) and 14 of 96 (14.6%) nondiabetic patients (P = .015). Nineteen fistulas (90.5%) occurred in patients who had undergone previous radiation treatment (P = .013). CONCLUSIONS: Using a stapler shortened operative time and hospitalization, while also providing a faster restart of oral feeding. Moreover, mechanical pharyngeal suture seems to decrease fistula rate even though its prevention role in salvage laryngectomy should be confirmed by further studies. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E473-E478, 2021.
Assuntos
Laringectomia/instrumentação , Grampeadores Cirúrgicos , Idoso , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/métodos , Laringe/cirurgia , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Terapia de Salvação/instrumentação , Terapia de Salvação/métodos , SuturasRESUMO
BACKGROUND: To investigate the feasibility of transoral robotic surgery (TORS) supraglottic laryngectomy (SGL) using a next-generation flexible surgical robot. METHODS: Preclinical human cadaver anatomic study of TORS SGL via en bloc resection. RESULTS: A single-port robotic surgical system (da Vinci Sp, Intuitive Surgical, Inc., Sunnyvale, California) provided sufficient access, reach, and visualization to perform TORS SGL. Access and exposure were achieved with a standard laryngo-pharyngoscope retractor. The remote center of the robotic system was located 10 cm from the maxillary alveolus. Three surgical instruments and one flexible camera could be deployed with minimal collision or restriction of arm movement. CONCLUSIONS: Routine resection supraglottic cancers through TORS have been hindered by challenging exposure and visualization and limited instrument maneuverability deep within the laryngopharyngeal complex. This preclinical feasibility study demonstrates the technical feasibility for TORS SGL using a next-generation flexible surgical robot.
Assuntos
Laringectomia/instrumentação , Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Cadáver , Estudos de Viabilidade , HumanosRESUMO
OBJECTIVES: The aim of this study was to compare the relative compliance and the dermatological and pulmonary outcomes when the Provox Luna system (Atos Medical, Malmö, Sweden) is added during the night to the usual tracheastoma care of laryngectomized subjects. METHODS: This was a multicenter randomized crossover trial conducted in the Netherlands Cancer Institute, Erasmus Medical Center, and Maastricht University Medical Center in The Netherlands. The study included 46 laryngectomized subjects with prior heat and moisture exchanger (HME) and adhesive experience. RESULTS: A significant improvement in the number of compliant individuals was found: Luna: n = 43 of 45 (96%); usual care: n = 35 of 46 (76%), P = 0.02. The Luna period was associated with longer intervals of daily HME use (Luna 23.2 hours [range: 15.6-24.0 hours], usual care [UC]: 21.5 hours [range: 6.0-24.0 hours], P = 0.003) and an increased frequency of skin improvement overnight (Luna 3.9 days [standard deviation (SD)]: 7.0 days), Usual Care: 8.1 days ([SD: 10.8 days], P = 0.008). Fifty-six percent (n = 26) of participants wanted to continue using the Provox Luna system at the conclusion of the study. CONCLUSION: An improvement in compliance and skin recovery overnight was observed when the Provox Luna was added to the usual adhesive and HME use. Therefore, there is utility in supplementing the usual post-total laryngectomy care with the Provox Luna system at night, particularly in the setting of compliance concerns and in subjects who desire dermatological relief overnight. LEVEL OF EVIDENCE: 1b Laryngoscope, 129:2354-2360, 2019.
Assuntos
Manuseio das Vias Aéreas/instrumentação , Laringectomia/instrumentação , Laringe Artificial/psicologia , Cooperação do Paciente/estatística & dados numéricos , Traqueostomia/instrumentação , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Países Baixos , Desenho de Prótese , Traqueostomia/métodos , Resultado do TratamentoRESUMO
OBJECTIVES:: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. METHODS:: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. RESULTS:: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). CONCLUSION:: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.
Assuntos
Carcinoma , Ressecção Endoscópica de Mucosa , Glote , Neoplasias Laríngeas , Laringectomia , Complicações Pós-Operatórias , Lesões Pré-Cancerosas , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma/diagnóstico , Carcinoma/patologia , Carcinoma/cirurgia , Intervalo Livre de Doença , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Feminino , Retalhos de Tecido Biológico , Glote/diagnóstico por imagem , Glote/patologia , Glote/cirurgia , Humanos , Itália , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/instrumentação , Laringectomia/métodos , Lasers de Gás/uso terapêutico , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Estudos Retrospectivos , Prega Vocal/patologia , Prega Vocal/cirurgia , Qualidade da VozRESUMO
Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.
Assuntos
Laringectomia/reabilitação , Equipe de Assistência ao Paciente/normas , Humanos , Laringectomia/instrumentação , Otolaringologia , Sociedades Médicas , EspanhaRESUMO
OBJECTIVE: This study aimed to present a novel technique for stapler-assisted laryngectomy under direct visualization using a videoendoscope with narrow-band imaging (NBI-endoscopy). METHODS: A case series of five consecutive patients were treated with stapler-assisted total laryngectomy from December 2014 to March 2016. The technique involved monitoring the stapler closure of laryngopharyngeal cavity under NBI-endoscopic vision, triple checking of neo-pharynx cavity by an endoscopic view inside and transillumination verification outside, air leakage test, and guiding the insertion of feeding tube under direct visualization. The main evaluation of this study was pharyngocutaneous fistula, surgical margin, and oral feeding time. RESULTS: All the patients healed well without a pharyngocutaneous fistula. The mean of surgical time, oral feeding, and hospitalization time were 40â¯min, 6â¯days, and 8â¯days, respectively. CONCLUSION: This study demonstrated a technique simple to learn and associated with decreased complication rates, which could be safe and efficient for stapler-assisted laryngectomy.
Assuntos
Endoscopia/métodos , Laringectomia/instrumentação , Laringectomia/métodos , Faringe/cirurgia , Técnicas de Fechamento de Ferimentos/instrumentação , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Prognóstico , Estudos Retrospectivos , Suturas , Resultado do Tratamento , Cirurgia Vídeoassistida/métodosRESUMO
BACKGROUND: Adult laryngeal haemangiomas are rare vascular tumours that have been managed by a variety of surgical techniques. METHODS: This paper describes a case of near-fatal acute airway obstruction secondary to such a lesion, followed by our approach to surgical resection using a laparoscopic bipolar tissue-sealing device. RESULTS: This technique resulted in successful excision of the lesion, with no evidence of recurrence at one year of follow up. CONCLUSION: Laparoscopic bipolar instruments can be used for the resection of moderate to large laryngeal haemangiomas as an alternative to laser excision.
Assuntos
Glote/cirurgia , Hemangioma/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/instrumentação , Adulto , Glote/patologia , Humanos , Masculino , Resultado do TratamentoRESUMO
Summary It is very obvious that the linear stapler can shorten the operation time, reduce the incidence of pharyngeal fistula, and shorten the oral feeding time in total laryngectomy. However the stapler was used in the total laryngectomy not as widespread as in gastrointestinal surgery. In order to further understanding the function of the linear stapler device in the total laryngectomy, the stapler's composition, working principle, classificationï¼method to use, operation method, and application of advantages and disadvantages will be reviewed.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/instrumentação , Laringectomia/métodos , Faringe/cirurgia , Grampeadores Cirúrgicos , Fístula Cutânea/prevenção & controle , Fístula/prevenção & controle , Humanos , Doenças Faríngeas/prevenção & controle , Faringe/patologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
Traditional external surgical approaches have been used for the surgical management of the oropharyngeal and laryngeal tumors. Trans-oral robotic surgery allows surgeon to operate oropharyngeal and supraglottic tumors through the mouth with preservation of functions. The surgeons must be knowledgeable about the anatomy of the oral cavity and oropharynx medial to lateral perspective. In this article, we will describe the relevant inside out surgical anatomy and its clinical implications for trans-oral robotic surgery.
Assuntos
Laringe/anatomia & histologia , Esvaziamento Cervical , Orofaringe/anatomia & histologia , Procedimentos Cirúrgicos Robóticos , Cadáver , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Laringectomia/instrumentação , Laringectomia/métodos , Laringe/cirurgia , Boca , Esvaziamento Cervical/instrumentação , Esvaziamento Cervical/métodos , Orofaringe/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Tonsilectomia/instrumentação , Tonsilectomia/métodosRESUMO
Transoral robotic surgery (TORS) is increasingly used in laryngeal/hypopharyngeal cancer surgery. Ablative procedures described in these anatomical sites include: (i) supraglottic laryngectomy, (ii) total laryngectomy, (iii) glottic cordectomy, and (iv) partial pharyngectomy. TORS supraglottic laryngectomy remains the most commonly performed of these procedures. Initial oncologic and functional outcomes with these procedures are promising and comparable to other treatment options. As robotic instrumentation technology advances a rise in TORS laryngeal/hypopharyngeal surgery is anticipated.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Faringectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ergonomia , Humanos , Laringectomia/instrumentação , Curva de Aprendizado , Destreza Motora , Boca , Seleção de Pacientes , Faringectomia/instrumentação , Carcinoma de Células Escamosas de Cabeça e Pescoço , Resultado do TratamentoRESUMO
The transoral resection of pharyngeal and laryngeal tumors is challenging due to their location in a narrow anatomic space. In this study, the visualization and resection in the area of the pharynx and larynx using a novel computer-assisted flexible endoscopic robotic system are evaluated. The Medrobotics(®) Flex(®) System (Medrobotics Corp., Raynham, MA, USA) is an operator-controlled flexible endoscope robotic system that includes a flexible endoscope and computer-assisted controllers, with two accessory channels for the use of compatible, 3.5 mm flexible instruments. In six human cadavers, four basic procedures (tonsillectomy, base of tongue resection, hemi-epiglottectomy and resection of false vocal cords) were performed bilaterally by two surgeons. Success in appropriate visualization of the target structure and resection was documented. The driving and resection time was determined for each procedure. An appropriate exposure and resection within the pharynx and larynx was achieved in all cases. Both surgeons experienced a learning curve in driving the system and performing the procedures. The Medrobotics Flex(®) system is a promising tool for transoral resections within the pharynx and larynx. Good visualization, access, and resectability are hereby clear advantages of the system compared to commonly used systems.
Assuntos
Glossectomia/instrumentação , Laringectomia/instrumentação , Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Assistida por Computador/instrumentação , Tonsilectomia/instrumentação , Idoso , Epiglote/cirurgia , Estudos de Viabilidade , Feminino , Glossectomia/métodos , Humanos , Laringectomia/métodos , Laringe/cirurgia , Masculino , Cirurgia Endoscópica por Orifício Natural/métodos , Faringe/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Tonsilectomia/métodos , Prega Vocal/cirurgiaRESUMO
OBJECTIVE: To evaluate variation in rima glottidis (RG) area and lack of epiglottic-glottic seal (LEGS) of the canine larynx associated with different suture anchor points in the arytenoid and cricoid cartilages, dissection of the cricoarytenoid joint capsule, section of the interarytenoid band, and disarticulation of the cricothyroid joint. STUDY DESIGN: Experimental study. ANIMALS: Cadaveric canine larynges (n = 18). METHODS: Larynges were assigned to 2 groups: group 1 = intact cricothyroid articulation and group 2 = cricothyroid articulation sharply sectioned. In each group, the arytenoid cartilage was lateralized successively as follows: (a) intact cricoarytenoid articulation, (b) cricoarytenoid articulation sharply sectioned, and (c) division of the interarytenoid band. Each variation was performed initially with the suture passed dorsally into the cricoid cartilage then with the suture passed laterally. Each time, the increase of rima glottis area (%) and the LEGS (mm(2) ) were measured. RESULTS: Rima glottis area (RGA): when the suture was placed dorsally, division of the interarytenoid band resulted in a significant increase in RGA compared with groups with an intact band. Laryngeal distortion: when the suture through the cricoid cartilage was dorsal, LEGS increased with section of the cricothyroid articulation, dissection of cricoarytenoid articulation, and division of the interarytenoid band. CONCLUSION: Unilateral arytenoid lateralization results in some degree of LEGS with a misalignment of the epiglottis over the RG. Our results revealed that the optimal RGA associated with the minimal LEGS was obtained with dorsal placement of a cricoarytenoid suture when the cricothyroid joint and the interarytenoid band were intact.
Assuntos
Doenças do Cão/cirurgia , Doenças da Laringe/veterinária , Laringectomia/veterinária , Animais , Cartilagem Aritenoide/cirurgia , Fenômenos Biomecânicos , Cadáver , Cartilagem Cricoide/cirurgia , Cães , Epiglote/cirurgia , Glote/cirurgia , Doenças da Laringe/cirurgia , Laringectomia/instrumentação , Laringe/cirurgia , Âncoras de Sutura/veterináriaRESUMO
Total laryngectomy is a well established method for the treatment of laryngeal cancer. In some cases such as elderly patients or patients with severe complications, a shorter surgical time is preferred. Total laryngectomy using a linear stapler is reportedly advantageous for shortening of the surgical time and for lowering the rate of pharyngeal fistula formation. We applied this surgical technique in three laryngeal cancer cases. After skeletonization of the larynx, the linear stapler is inserted between the larynx and the pharyngeal mucosa. Excision of the larynx and suturing of the pharyngeal mucosa are performed simultaneously. Although the number of cases is small for statistical analysis, the surgical time was shortened by about 30 minutes compared to laryngectomy with manual suturing. Total laryngectomy by linear stapler cannot be applied in all cases of advanced laryngeal cancer. However, if the tumor is confined to the endolarynx, it is a useful tool for some cases that require a shorter surgical time.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/instrumentação , Laringe/cirurgia , Doenças Faríngeas/cirurgia , Suturas , Idoso , Idoso de 80 Anos ou mais , Humanos , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Laringectomia/métodos , Doenças Faríngeas/complicações , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/patologia , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study is to evaluate the evolution of supracricoid partial laryngectomy (SCPL) in indications, surgical techniques and outcomes through last decades. MATERIALS AND METHODS: A retrospective analysis of 146 patients affected by laryngeal cancer treated with SCPL was carried on. We defined: (1) group A, 100 patients treated by cold instruments between 1995 and 2004; (2) group B, 46 patients treated by harmonic scalpel between 2005 and 2010. Complications rate, and functional and oncological results were documented and a comparison between the two groups was made; histopathological analysis of surgical margins was evaluated and correlated with local incidence of recurrence. RESULTS: Significant differences in age mean-value (p=0.02), T classification (p=0.007), and in indication for more advanced-staged patients were found in group B (p=0.001). Surgical procedure was shorter in group B (p<0.001), with shorter swallowing recovery (p=0.003). Oncological outcomes did not report any significant differences. Group B showed a higher incidence of post- operative arytenoid edema (p=0.03) associated with a lower rate of pneumonia (p=0.038). Despite a higher rate of close or positive-margins found in group B no higher incidence of local-recurrence was reported (p=0.02) compared to group A. CONCLUSIONS: We documented changing in indications and surgical technique for SCPL because of the development of modern diagnostic techniques and the introduction of low-thermal injury device allowing a more challenging tumor excision as well as with a shorter swallowing recovery in our series.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/radioterapia , Laringectomia/instrumentação , Laringectomia/tendências , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Terapia de Salvação , Carcinoma de Células Escamosas de Cabeça e Pescoço , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To investigate the surgery management of glottic carcinoma with high-frequency electrotome. METHOD: Twenty cases of patients with glottic carcinoma were treated by cordectomy under micro-laryngoscopy with high-frequency electrotome. RESULT: The 20 patients were followed up from 5 months to 6 years, retained good laryngeal function and structure: 1 case had local recurrences after 6 months, underwent total laryngectomy, and now no recurrence had been found: 19 cases (mild adhesions of vocal cords formed in 2 cases) had no local recurrence nor lymph node metastasis. CONCLUSION: It is unnecessary to invest in expensive equipment in the cordectomy under micro-laryngoscopy with high frequency electrotome under general anesthesia and the result is satisfactory.
Assuntos
Eletrocirurgia/instrumentação , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Idoso , Glote/patologia , Humanos , Neoplasias Laríngeas/patologia , Laringectomia/instrumentação , Masculino , Microcirurgia , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: The TNM classification of glottic tumors defined T1b as a tumor involving both vocal cords with normal mobility of such. In the last fifteen years, in the medical literature, the role of open surgery for management of laringeal cancer has decreased considerably owing to the development of transoral laser microsurgery which is an oncologically and functionally reliable treatment particularly for early glottic cancers. AIM: Report the efficacy of different surgical techniques (laser CO2 cordectomy or supracricoid partial laryngectomy) in T1b glottic cancers treatment with a 10-years follow-up. PATIENTS AND METHODS: 92 patients with T1b glottic cancer undergoing surgery between 1986 and 2002, of which 39 were treated with CO2 laser cordectomy while 53 with supracricoid partial laryngectomy (14 crico-hyoid-pexy and 39 crico-hyoid-epiglotto-pexy). Each of the three groups was recalled and evalued with the aim to calculate the survival, initially at 3 and 5 years and thereafter, provide a 10 years follow-up, including local recurrence. RESULTS: 10 years absolute survival of the 39 patient treated with CO2 laser was 56.25%, while that of the two groups subjected to supracricoid partial laryngectomy was respectively of 66.6% for crico-hyoid-pexy and 58.82% for crico-hyoid-epiglotto-pexy. CONCLUSIONS: Our data suggest an excellent absolute survival also after 10 years follow-up. Since both the CO2 laser and supracricoid partial laryngectomy show similar local control and survival rates we can't determine with certainty the best therapeutic approach as claimed by a great number of literature studies.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia , Prega Vocal/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/fisiopatologia , Laringectomia/efeitos adversos , Laringectomia/instrumentação , Laringectomia/métodos , Laringectomia/mortalidade , Terapia a Laser/instrumentação , Lasers de Gás/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/patologia , Prega Vocal/fisiopatologiaRESUMO
Advanced laryngeal and hypopharyngeal carcinomas are associated with a poor prognosis and a pronounced loss of quality of life due to impairment of the swallowing and voice function. The fundamental therapeutic challenge is successful tumor control with concomitant rehabilitation of swallowing and voice functions. Further objectives are a low complications rate (fistula, aspiration) and prompt transfer to the adjuvant radio-oncologic therapy. With these factors in mind, the microvascular anastomosed jejunum speech siphon with a biventer rein has proven to be an effective method of reconstruction following extensive circular laryngopharyngeal resections. In this case report, a typical operative and postoperative course is presented, as are the functional results.
Assuntos
Neoplasias Hipofaríngeas/cirurgia , Jejuno/transplante , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Faringectomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Humanos , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Laríngeas/diagnóstico , Laringectomia/instrumentação , Masculino , Pessoa de Meia-Idade , Faringectomia/instrumentação , Desenho de Prótese , Procedimentos de Cirurgia Plástica/instrumentação , Resultado do TratamentoRESUMO
OBJECTIVES: The 585-nm pulsed-dye laser (PDL) is used for in-office treatment of recurrent respiratory papillomatosis (RRP), premalignant/early malignant lesions, vascular lesions, and proliferative lesions of the larynx. Reported advantages of this technique include avoidance of general anesthesia, improved efficiency, lower overall cost, and treatment of the anterior commissure with minimal web formation. Our objective was to review our experience with office-based PDL procedures for laryngeal lesions. STUDY DESIGN: Retrospective review. METHODS: A chart review of patients undergoing office-based PDL procedures of laryngeal lesions from the years 2005 to 2012. RESULTS: Of 33 patients, 32 (97%) tolerated the procedure without complication. One patient experienced an anxiety attack and the procedure was aborted. There were no complications. The following pathologies were treated: vascular lesions (n = 10), RRP (n = 8), granuloma (n = 5), premalignant lesions (n = 5), benign mass (n = 2), amyloidosis (n = 1), and anterior web (n = 1). Six (19%) patients, all with vascular lesions, were treated successfully with the in-office PDL and no operating room (OR) procedures. All six patients reported complete resolution of symptoms at 6 months posttreatment. Twenty-six (81%) patients were treated with a combination of in-office PDL and OR procedures, most commonly for RRP (n = 8). Seventeen patients had complete resolution of their symptoms with in-office PDL and OR procedures. CONCLUSIONS: PDL treatment is a safe, well-tolerated, effective, adjunctive therapy and may function as monotherapy in the treatment of selected laryngeal lesions.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/instrumentação , Doenças da Laringe/cirurgia , Laringectomia/instrumentação , Terapia a Laser/instrumentação , Lasers de Corante , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Humanos , Doenças da Laringe/diagnóstico , Laringectomia/efeitos adversos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Endoscopic transoral surgical techniques have developed, adapted to forms of early stage larynx cancer. A total laryngectomy remains the only treatment for patients suffering from an advanced stage cancer which is not receptive to organ preservation strategies. For all these patients, nurse surveillance combines technical and relational care.