Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy.

OBJECTIVES: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. METHODS: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). RESULTS: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. CONCLUSIONS: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.

Narrow band imaging for detecting superficial oral squamous cell carcinoma: a report of two cases.

We present two cases of superficial squamous cell carcinoma of the floor of the mouth, which were coincidentally detected by narrow band imaging (NBI) combined with magnifying gastrointestinal endoscopy (GIE) during gastrointestinal evaluation. We successfully removed the lesions using laser assisted with NBI combined with magnifying GIE. Because NBI combined with magnifying GIE shows a well-demarcated brownish area and scattered foci of microvascular proliferation, it may play an important role in the management of superficial squamous cell carcinoma in the oral cavity.

Treatment effects in patients with squamous cell carcinoma of the oral cavity.

A total of 221 patients (155 males, 66 females; stage I, n = 55: stage II, n = 58; stage III, n = 57; stage IV, n = 51) with squamous cell carcinoma of the oral cavity were studied. Tumor localization was as follows: cancer of the tongue, n = 161; cancer of the oral floor, n = 28; cancer of the hard palate, n = 12; cancer of the buccal mucosa, n = 11; and cancer of the gingiva, n = 9. In order to compare the effect of different treatments, three major treatment groups were defined, namely a surgery group, a radiotherapy group and a combination treatment group. Five-year cumulative survival rates showed significant differences between stage classifications (stage I = 91%, stage II = 73%, stage III = 63%, stage IV = 47%; p < 0.01) but not between tumor sites. The 5-year cumulative survival rate was highest for oral floor cancer (80%). In the early-cancer group, the 5-year cumulative survival rate for the surgery group (92%) was significantly higher (p < 0.05) than those for both the radiation (69%) and combination (71%) groups. In the advanced-cancer group, the 5-year cumulative survival rate for the surgery group (74%) was significantly higher (p < 0.05) than those for both the radiation (37%) and combination (51%) groups. No significant difference in regional control rates was observed between the treatment groups. Five-year regional control rates were 86% for cervical untreated patients with T1N0 tumors and 60% for cervical untreated patients with T2N0 tumors. Fourteen N0 cases were treated with neck dissection. Cervical metastasis was found pathologically in 2/14 (14%) of these cases. The 5-year survival rate for patients with cervical recurrences after primary tumor resection was 70% (n = 15). In contrast, the 5-year survival rate for patients with both primary tumor resection and neck dissection was 74% (n = 14) but no significant difference was observed between these 2 groups.