Clinicopathological Analyses of Fifty Supracricoid Laryngectomized Specimens: Evidence Base Supporting Minimal Margins

Nakayama, Meijin; Holsinger, Christopher; Okamoto, Makito; Seino, Yutomo; Miyamoto, Shunsuke; Takeda, Masahiko; Yokobori, Satoru; Masaki, Takashi; Hayashi, Seiichi

doi:10.1159/000261836

Cited by 23 publications

(13 citation statements)

References 17 publications

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“…Among the three goals, continuous oncological control is by far the most important for the success of SCL-CHEP. Better oncological control essentially relies on better local and regional control (14)(15)(16). Local recurrence of SCL-CHEP has been reported at rates of 5-8% (3,4,8-11), compared with 18-31% in conventional partial laryngectomies (12,13).…”

Section: Discussionmentioning

confidence: 99%

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One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control?

Nakayama

Miyamoto

Seino

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: Supracricoid laryngectomy with cricohyoidoepiglottopexy has been known to be able to cope with tumor excisions with minimal margins. Extended resection may result in a limited margin and may impair the prognosis. We conducted a clinicopathologic analysis of local recurrence in supracricoid laryngectomy with cricohyoidoepiglottopexy patients. Methods: Between 1997 and 2013, 100 patients with glottic cancers underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. The clinicopathologic findings were evaluated. We also analyzed: (i) cancer-specific and overall survival rates, (ii) the correlation between locoregional recurrence and overall survival, (iii) T staging and larynx preservation rates and (iv) previous radiation history and larynx preservation rates. Results: Local recurrence was recognized in eight of the 100 patients (8%); all were initially staged as T3 or T4. Recurrence was identified in the submucosal regions of the ipsilateral arytenoid and/or infraglottis. Six patients were salvaged by completion total laryngectomy except two. Cancer-specific survival at 5 years was 93%; overall survival at 5 years was 89%. There was no significant difference between overall survival and locoregional recurrence. There was a significant difference between larynx preservation in T1-2 and T3-4 patients. There was no significant difference between larynx preservation and the previous radiation therapy status. Conclusions: Our experience convinced us of the clinical potential of supracricoid laryngectomy with cricohyoidoepiglottopexy as one of the effective options for functional larynx preservation. Supracricoid laryngectomy with cricohyoidoepiglottopexy is the most suitable for unfavorable T2 and T3a cases and is applicable for appropriately selected radiation-failed patients. Thorough preoperative evaluation, proper surgical techniques and careful follow-up are prerequisites for the success of supracricoid laryngectomy with cricohyoidoepiglottopexy.

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Section: Discussionmentioning

confidence: 99%

“…The surgical potential of SCL-CHEP has been confirmed to be able to cope with tumor excisions with margins of a few millimeters at the anterior, posterior and superior glottis except for the inferior glottis (14). An intraoperative margin study was reported to be useful for ensuring the validity of SCL-CHEP (15).…”

Section: Introductionmentioning

confidence: 93%

One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control?

Nakayama

Miyamoto

Seino

et al. 2015

Jpn. J. Clin. Oncol.

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“…When treating early glottis cancer with TLM, a 1–2 mm free margin from the tumor line is sufficient to guarantee a complete resection 11,15,16. In order to obtain good functional results the resection is tailored to the clinical appearance of the tumor, sparing as much tissue as possible of the vocal cord.…”

Section: Assessment Of Margins In Endoscopic Surgery—glottic Cancermentioning

confidence: 99%

Assessment of Margins in Transoral Laser and Robotic Surgery

Hamzany¹,

Brasnu²,

Shpitzer³

et al. 2014

Rambam Maimonides Med J

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The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Free margin status is being approached differently in vocal cord cancer (1–2 mm) compared with other sites in the upper aerodigestive tract (2–5 mm). Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon’s judgment with regard to the completeness of tumor resection.

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“…After introducing SCPL to our institute in 1997, the number of surgical cases increased as we gained experience; after 2003, the number of SCPL performed annually surpassed the number of total laryngectomies [9,10]. Postoperative complications, especially wound infection, were frequently encountered in our early stage patients.…”

Section: Discussionmentioning

confidence: 96%

Delayed wound infection after supracricoid partial laryngectomy following failure of high dose radiation

Nakayama

Okamoto

Seino

et al. 2010

Eur Arch Otorhinolaryngol

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Past radiation therapy is known as a major risk factor promoting post-supracricoid partial laryngectomy (SCPL) complications. Risk of post-SCPL complications may further increase following failure of high dose radiation; in these patients, wound infection may become evident more than 1 month after an uneventful post-surgical course. By defining this complication as "Delayed Wound Infection" and reviewing the clinical features, we intended to elucidate the mechanism, risk factors, and management of this post-SCPL complication. Between 1997 and 2009, 60 patients received SCPL. The incidence of post-SCPL wound infection was analyzed in reflect to radiation status, radiation dose, and medical histories. Of 60 patients, delayed wound infection was identified in 4 (7%); radiation doses were 65, 68, 70, and 76.8 Gy (avg. 70 Gy). Blood data including white blood cell and C-reactive protein showed slight elevation before the delayed infection became evident. Patients with high dose radiation (≥ 65 Gy) accompanied by histories of diabetes and renal insufficiency are considered a high risk group. Delayed re-epithelialization of the inner surface of the cricohyoido gap was presumed to be the main pathogenesis. Early initiation of antibiotics and hyperbaric oxygen therapy are effective for rapid recovery. "Delayed Wound Infection" was treatable and patients undergoing surgery after failure of high dose radiation should be managed with extra precaution, but should not be excluded from the indications for SCPL.

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Clinicopathological Analyses of Fifty Supracricoid Laryngectomized Specimens: Evidence Base Supporting Minimal Margins

Cited by 23 publications

References 17 publications

One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control?

One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control?

Assessment of Margins in Transoral Laser and Robotic Surgery

Delayed wound infection after supracricoid partial laryngectomy following failure of high dose radiation

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