Functional outcomes and complications after salvage total laryngectomy for residual, recurrent, and second primary squamous cell carcinoma of the larynx and hypopharynx : a multicenter retrospective cohort study

Background/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx after initial (chemo)radiation. Methods: Retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018. Prognostic factors for functional outcomes and complications were identified with uni- and multivariable analysis. Results: A total of 405 patients were included in the final analysis. STL was performed for residual tumor (40.2%), local recurrence (40.5%), or second primary laryngeal or hypopharyngeal SCC (19.4%). Early postoperative complications were experienced by 34.2% of patients: postoperative hemorrhage occurred in 5.4%, wound infection in 16.2%, and clinical pharyngocutaneous fistula (PCF) in 25.5% of patients. Early readmission proved necessary in 15.1% of cases, most often due to late PCF development (72.2%). Patients achieved total peroral intake in 94.2% of cases. However, subjective dysphagia was reported by 31.3% of patients during follow-up. Functional speech, defined as functional communication by speech without additional aids, was reported in 86.7% of cases and was most often achieved by tracheo-esophageal puncture (TEP) (94.1%). In a multivariable model, lower preoperative hemoglobin (<12.5 g/dl) was identified as an independent prognostic factor for higher overall complication rate. No risk factors were found significant for clinical fistula formation. Vascularized tissue augmentation did not significantly prevent clinical PCF. Patients with positive section margins, patients initially treated with surgery combined with adjuvant RT (vs. radiotherapy alone), and those developing PCF after STL were less likely to achieve total peroral intake. Postoperative dysphagia proved more likely in patients who developed a PCF postoperatively, and less likely in patients who underwent STL without partial pharyngectomy and in patients with myocutaneous pectoralis major (PM) flap reconstruction, compared to muscle onlay PM flap. Achieving postoperative functional speech proved most likely in patients with smaller tumors (lower pT classification) and free section margins. Conclusion: Substantial complication rates and favorable functional outcomes are reported after STL

Laryngeal reinnervation: from the accurate diagnosis to the accurate treatment

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Up-Front and Salvage Transoral Laser Microsurgery for Early Glottic Squamous Cell Carcinoma: A Single Centre Retrospective Case Series

Introduction/aimTransoral laser microsurgery (TLM) is a minimally invasive surgical alternative for radiotherapy (RT) in the primary management of early glottic cancer. More recently, TLM emerged also as a possible salvage treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM performed in a Belgian tertiary referral center.Patients and methodsA retrospective review of records from 142 consecutive patients who underwent TLM was performed. Oncologic outcomes were evaluated by means of descriptive statistics and Kaplan–Meier estimates. Variation of estimated outcomes between different subgroups was evaluated using Log-Rank analysis.ResultsOf 142 patients, 109 (76.8%) underwent TLM as a primary treatment and 33 (23.2%) were treated in a salvage setting for recurrent or second primary glottic cancer. cT classification in the up-front TLM group was cT1a in 72 (66.1%), cT1b in 11 (10.1%), and cT2 in 26 (23.9%) patients. In the salvage group, patients were cT/rT classified as cT1a–rT1a in 17 (51.5%), cT1b–rT1b in 1 (3.0%), cT2–rT2 in 14 (42.4%), and cT3–rT3 in 1 (3.0%) patients. All patients were cN0. Second-look TLM was performed in 28 patients (19.7%), and RT was associated as adjuvant therapy in 5 patients (3.5%). Mean follow-up was 51.6 months (SD = 38.4 months). Three-year overall survival (OS) was 94.1% (SE = 2.2%), 3-year disease-specific survival (DSS) 100%, 3-year disease-free survival (DFS) 80.1% (SE = 3.8%), 3-year local recurrence-free survival (RFS) 81.0% (SE = 3.7%), and 3-year ultimate local control rate with laser alone 89.2% (SE = 3.0%). Upon subgroup analysis, no differences in OS, DSS, and DFS were observed between the up-front and salvage group (log rank; p = 0.306, p = 0.298, and p = 0.061 respectively). However, local RFS and ultimate local control rate with laser alone were significantly higher in the primary treated TLM group (log rank, p = 0.014 and p = 0.012). Five-year laryngeal preservation rate was 89.7% (SE = 3.5%) in the total population, 100% in the upfront group, and 64.9% (SE = 9.8%) in the salvage group, a difference which proved statistically significant (Log-Rank, p &lt; 0.001).ConclusionThis retrospective study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer. In the salvage setting, TLM allows avoidance of total laryngectomy in the majority of cases

Thyroid Swelling: A Common Phenomenon in Art?

Representations of thyroid swelling, intended as an enlarged anterior neck region, in the artworks of various periods are sporadically reported in the scientific literature, and different intents may be hypothesized. A comprehensive review of the international literature was performed on PubMed, Embase, and ResearchGate with the aim to analyze the modalities of representation of thyroid swelling through the ages by different artistic movements. Thyroid swelling is frequently represented in the artworks of many stylistic periods and seems to be a known condition even by the earliest cultures. Thyroid swelling may be considered a common finding among forms of art distant in time and style. It is not always possible to define whether thyroid swelling is a realistic representation or a detail added by the author. Although the function of the gland was discovered only at the end of the 19th century, thanks to the artworks of authors in many cultures, it is nowadays possible to formulate hypotheses about the distribution of thyroid diseases over the centuries

Fotodynamische therapie in de behandeling van hoofd-halskanker

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Primary Treatment of T1-T2 Hypopharyngeal Cancer: Changing Paradigms.

There has been a general shift in the treatment of hypopharyngeal cancer from open surgical techniques (either radical or partial "organ" preserving) toward non-surgi cal "organ preserving" strategies (radiotherapy [RT] or chemoradiotherapy [CRT]) and minimally invasive transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Oncologic outcomes reported are comparable whatever modality is chosen, but better functional outcomes are observed in the RT/CRT and TLM/TORS-treated patients. Because of the high rate of second primary malignancies, which influences overall survival, one could favor an up-front transoral surgical procedure as a primary treatment modality for early hypoharyngeal carcinoma, leaving the (chemo)radiotherapeutic option open for treatment of a likely later emerging second primary. However, the TLM and TORS studies report a high rate of adjuvant irradiation-based treatment for close or positive margin excisions. Concerning post-treatment functionality, both RT/CRT and TLM/TORS yield satisfactory results, especially when compared to the open surgical procedures, but it remains unclear which of these options will result in the long-term best laryngopharyngeal functional outcome. There is a need for multi-institutional randomized controlled trials comparing the long term oncologic and functional outcomes of up-front minimal invasive transoral surgery with/without adjuvant treatment, to a primary non-surgical organ preservation treatment.status: publishe

Transoral Robotic Surgery (TORS) for malignant head and neck tumors: the University Hospitals Leuven experience

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Early experience in transoral robotic surgery (TORS) for non-oropharyngeal head and neck malignancies: a review of functional and oncologic outcomes

Early experience in transoral robotic surgery (TORS) for non-oropharyngeal head and neck malignancies: a review of functional and oncologic outcomes. Objective: To review and summarize functional and oncologic outcomes after transoral robotic surgery (TORS) for non-oropharyngeal head and neck malignancies. Data Sources: The MEDLINE database and bibliographies of relevant studies were searched through December 2014. Methods: Search strategy was ((transoral) AND surgery) AND robotics) OR TORS. Abstracts and titles were screened for relevance and full articles of the selected records were evaluated and critically appraised after inclusion. Data concerning functional and oncologic outcomes as well as adverse effects were collected. Results: 22 records were eventually included in the review. For TORS in the treatment of glottic, hypopharyngeal ands supraglottic cancer we retained 3 case series (26 patients), 5 case series (36 patients) and 6 case series (67 patients) respectively. 8 case reports/series (14 patients) assessing safety and feasibility of TORS for tumours in the parapharyngeal space, nasopharynx and skull base were also evaluated. In general, treatment of laryngeal and hypopharyngeal cancer by means of TORS seems to be feasible and safe with satisfying functional and short-term oncologic results. For treatment of malignant tumours in the parapharyngeal space, nasopharynx and skull base, the benefits of TORS, when compared to classic surgical techniques, are still uncertain and are particularly based on theoretical advantages. Conclusion: TORS offers an interesting new approach for treating non-oropharyngeal head and neck malignancies. However, long term results are still not reported and TORS should be directly compared to existing therapeutic options in randomized controlled trials. Until then, its use should be subject to critical appraisal.status: publishe

ASO Author Reflections: Salvage Total Laryngectomy, the Last Resort for Patients with Residual, Recurrent or Second Primary Laryngeal and Hypopharyngeal Cancer in Times of Nonsurgical Organ Preserving Treatment Strategies

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