Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynx

Abstract

Background. CO 2 -laser surgery is a relatively new treatment for selected carcinomas of the upper aerodigestive tract. The purpose of our study was to evaluate prospectively the functional results for swallowing after C0 2 -laser resections.Methods. The sample was composed of 210 consecutive patients with malignancies of the larynx and hypopharynx treated with CO 2 laser between February 1998 and January 2002. Endoscopic resections included all T1 and T2 tumors and selected T3 and T4 tumors. T1 glottic tumors were not included in the analysis. We assessed the need for a feeding tube and the period the tube remained in place, aspiration pneumonia, tracheotomy secondary to aspiration, the need for a permanent or temporary gastrostomy, and total laryngectomy secondary to aspiration.Results. The nasogastric feeding tube was used in 23.2% of small tumors (2.5 F 8.04 days) and in 63% of locally advanced tumors (13.95 F 22.55 days). Frequency and period of storage of the feeding tube were higher in locally advanced tumors (p = .0001). Twelve patients (5.7%) had postoperative pneumonia and 59 (28.1%) had temporary postoperative cough during oral intake. Aspiration symptoms correlated with location (p = .001) and locally advanced tumors (p = .016). Eight patients (3.8%) needed a postoperative tracheotomy for severe swallowing difficulties; six (2.9%) of them were definitive and two (0.95%) temporary. Thirteen gastrostomies (6.2%) were performed to avoid severe aspirations; five of them were definitive. The need for gastrostomy correlated significantly with location (p = .002), pT3 and pT4 tumors (p = .002), age (p = .02), and postoperative radiotherapy (p = .04). No correlation was found with the period of feeding tube (p = .38), or aspiration pneumonia (p = .24).Conclusions. Endoscopic resection of laryngeal and hypopharyngeal tumors is associated with good recovery of deglutition. Many tracheotomies are avoided, the need for a feeding tube is usually reduced, and organ preservation is often feasible even in locally advanced tumors.

Outcomes in Patients With Early-Stage Hypopharyngeal Cancer Treated With Radiotherapy

“…However, endoscopy techniques (i.e., endoscopic laser resection) have been used only in a few institutions, and the indication for these treatments is unclear (9,11). Although Shimizu et al (9) performed endoscopic submucosal dissection in 4 patients with early-stage HPC and reported no local recurrences, no distant metastasis, and no early or late complications, Bernal-Sprekelsen et al (11) performed endoscopic resection using a CO 2 laser and reported the need for a nasogastric feeding tube in 23.2% of the patients with small tumors, postoperative pneumonia in 5.7%, temporary postoperative coughing during oral intake in 28.1%, and severe swallowing difficulties in 3.8%. Thus, the factors associated with the occurrence and severity of various complications after endoscopic resection remain to be clarified (9).…”

Current management strategy of hypopharyngeal carcinoma

“…In attempt to decrease the treatment-related morbidities and to increase post-operative quality of life, minimally invasive surgery such as transoral LASER microsurgery has been investigated for its potential use in hypopharyngeal cancer [59][60][61]. With the recent advancement and increasing use of robotic assisted surgery in otolaryngology [62][63][64][65], there are reports on the potential value of transoral robotic surgery (TORS) for the management of tumors of the upper aerodigestive tract [66][67][68].…”

The learning curve in transoral laser microsurgery for malignant tumors of the larynx and hypopharynx: parameters for a levelled surgical approach

“…Aspiration pneumonia is related to the extension of tissue resection [23]. In a recent study on complications linked to TLM, the rate of severe bleedings (needing either, revision surgery, intensive care unit observation, and/or blood transfusion) was found to be of 8 % in the first series and of 5.9 % after a longer period of experience with TLM [17].…”