Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery

Piazza, Cesare; Paderno, Alberto; Grazioli, Paola; Bon, Francesca Del; Montalto, Nausica; Perotti, Pietro; Morello, Riccardo; Filauro, Marta; Nicolai, Piero; Peretti, Giorgio

doi:10.1002/lary.26861

Cited by 43 publications

(23 citation statements)

References 19 publications

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“…The AC is the laryngeal subsite closest to this interface, and so this might lead to a poorer coverage of the prescribed dose in that subsite . As for TLM, laryngeal exposure is one of the most important factors affecting the outcomes of glottic cancer . In other words, the worse the exposure, the greater the risk of negative outcomes.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta‐analysis

Tulli

Bondi

et al. 2019

The Laryngoscope

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Objective The anterior commissure is considered a laryngeal subsite, but it is not taken into account in the current T‐staging system. The impact of anterior commissure involvement (ACI) on the oncologic outcomes of T1 glottic tumors has not been well defined and remains controversial. The aim of this study was to assess the influence of ACI in the prognosis of T1 glottic tumors. Methods A systematic review and meta‐analysis of observational studies was performed by including studies published up to July 2019. Studies were selected if they had investigated the local control rate (LCR) at 5 years of clinical stage I (T1 and N0) glottic squamous cell carcinoma with and without ACI. The difference in LCR at 5 years between T1 glottic tumors without and with ACI was evaluated. Results The meta‐analysis showed that the difference in LCR at 5 years between T1 glottic tumors without and with ACI is 12% (95% confidence interval: 8%‐16%, p < 0,0001, I2 = 34.81%). Conclusions Our study pointed out that the anterior commissure involvement is a negative prognostic factor in LCR at 5 years for T1 glottic tumors. Our results suggest the need to consider ACI in the T staging of glottic tumors. Laryngoscope, 130:1932–1940, 2020

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Section: Discussionmentioning

confidence: 99%

The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta‐analysis

Tulli

Bondi

et al. 2019

The Laryngoscope

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“…Moreover, its systematic application to the preoperative assessment of patients to be submitted to TLM was shown to be important in avoiding inadequate surgical margins after such a surgical approach. In fact, when considering glottic cancer, surgical outcomes were shown to be poorer in patients with suboptimal exposure than in those having good visualization of the target itself . In particular, Piazza et al demonstrated a significantly increased rate of positive surgical margins (47.4% vs. 19.2%, P = 0.001) in patients with class II to III exposure rather than with class 0 to I when treated by TLM for early‐intermediate glottic cancer.…”

Section: Discussionmentioning

confidence: 99%

Glottic exposure for transoral laser microsurgery: Proposal of a mini‐version of the laryngoscore

et al. 2018

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Objectives: Good laryngeal exposure (GLE) is typically regarded as an essential prerequisite for transoral laser microsurgery (TLM). The Laryngoscore is a preoperative scoring system aimed at predicting glottic visualization through the laryngoscope using easy patient-derived parameters. However, the presence of subjective variables may hamper its reliability and reproducibility. The aim of the present study was to provide a validation of the Laryngoscore and to develop a revised mini-version of the same, called mini-Laryngoscore (mLS), which could allow even quicker, yet sufficiently accurate, preoperative prediction of GLE.Study Design: Prospective cohort study. Methods: We prospectively evaluated 310 consecutive patients submitted to TLM between 2014 and 2017, grading each patient according to the variables considered in the Laryngoscore.Results: Among the 11 variables of the previous Laryngoscore, three were confirmed as statistically significant at validation: interincisors gap, thyromental distance, and upper jaw dental status. We chose these three variables as part of the revised mLS (ranging from 0 to 4). In our cohort, 30% of the patients obtained a score of 0, 57% a score of 1, 11% a score of 2, and 2% a score of ≥3. GLE was achieved in 97%, 85%, 65%, and 20% of cases, respectively.Conclusion: Our validation confirmed the predictive ability of the Laryngoscore. Furthermore, although composed of only three clinical parameters, the mLS was still able to convey useful information regarding the possibility of obtaining GLE.

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“…The degree of exposure guides the surgeon's decision to propose a transoral or external approach. The basis for performing a safe transoral surgery is adequate exposure of the area to be treated to minimize the risk of damage to surrounding tissue or incomplete resection, which is especially important in oncologic surgery. For transoral robotic surgery, some authors have proposed preoperative anatomic variables or cephalometric measures taken from the imaging to help select patients suitable for the procedure and to reduce the risk of intraoperative conversion to open surgery.…”

Section: Discussionmentioning

confidence: 99%

Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore

Tirelli¹,

Gatto²,

Fortunati³

et al. 2018

The Laryngoscope

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Objectives Optimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement. Study Design Prospective validation study. Methods A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ2 and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded. Results The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus. Conclusion The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy. Level of Evidence 2b Laryngoscope, 129:1438–1443, 2019

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Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery

Abstract: 2b. Laryngoscope, 128:1146-1151, 2018.

Cited by 43 publications

References 19 publications

The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta‐analysis

The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta‐analysis

Glottic exposure for transoral laser microsurgery: Proposal of a mini‐version of the laryngoscore

Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore

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