Transoral videolaryngoscopic surgery for laryngeal and hypopharyngeal cancer — Technical updates and long-term results

Tomifuji, Masayuki; Araki, Koji; Uno, Keikichi; Kamide, Daisuke; Tanaka, Yuya; Suzuki, Hiroshi; Kimura, Eiko; Hirokawa, Shotaro; Taniai, Shinichi; Shiotani, Akiko

doi:10.1016/j.anl.2019.09.003

Cited by 21 publications

(33 citation statements)

References 11 publications

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“…It should also be noted that RT and CRT for pharyngeal cancer are accompanied by the risk of laryngopharyngeal dysfunction 3 and carotid artery stenosis/thrombus 4 as late adverse events. On the other hand, several recent reports 6 , 12 and the findings of the present study suggest that TOVS is a minimally invasive treatment with favorable postoperative laryngopharyngeal function and acceptable complications.…”

Section: Resultssupporting

confidence: 58%

“…The surgical field was sometimes limited, especially for PC and PW lesions, and we occasionally experienced difficulty in securing negative mucosal margins for these lesions. Recently, various surgical instruments have been developed for transoral laser microsurgery (TLM), 15 endoscopic laryngopharyngeal surgery (ELPS), 16 , 17 and transoral robotic surgery (TORS) 18 , 19 and the usefulness of a curved blade for the FKWO retractor 12 has been reported. To address this weakness, we recommend these instruments and techniques.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic factors after transoral resection of early hypopharyngeal cancer

Iritani

Mundo

Iwaki

et al. 2021

Laryngoscope Investig Oto

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Objective This study aimed to investigate risk factors predictive of local recurrence and/or lymph node metastasis after transoral resection of early hypopharyngeal cancer. Methods Forty‐nine consecutive patients who underwent transoral videolaryngoscopic surgery (TOVS) as an initial treatment for hypopharyngeal cancer were evaluated. On univariate and multivariate analysis, local recurrence rates were assessed respectively using log‐rank test and cox regression analysis according to the following parameters: subsite, pT, mucosal margin, lymphatic invasion, vessel invasion, tumor thickness (> 4 mm vs ≤4 mm), history of esophageal cancer, and multiple Lugol‐voiding lesions (LVLs) in the esophagus. Categorical variables were evaluated for their associations with lymph node metastasis using chi‐squared test or Fisher's exact test. Result The subsites of primary lesions were piriform sinus in 24 patients, posterior wall in 15 patients, and postcricoid in 10 patients. Thirty patients had esophageal cancer. Local recurrence occurred in 14 patients. Three patients had lymph node metastasis at the time of diagnosis and four patients developed lymph node metastasis after the initial treatment, resulting a total of seven patients having lymph node metastasis. While mucosal margin and LVLs showed significant associations with local recurrence on univariate analysis, only LVLs remained as a significant risk factor on multivariate analysis (P = .0395; hazard ratio = 8.897; 95% confidence interval, 1.113‐71.15). Most cases of local recurrence were satisfactorily controlled by repeated TOVS. While multivariate analysis could not be performed due to the small number of the patients with lymph node metastases, venous invasion (P = .0166) and tumor thickness (P = .0092) were significantly associated with lymph node metastasis on univariate analysis. Conclusions Local recurrence was more frequent in patients with LVLs, but most of them were salvaged by repeated TOVS. Patients with venous invasion and/or tumor thickness greater than 4 mm should be followed up with special attention to lymph node metastasis. Level of Evidence: 3.

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Section: Resultssupporting

confidence: 58%

Section: Resultsmentioning

confidence: 99%

Prognostic factors after transoral resection of early hypopharyngeal cancer

Iritani

Mundo

Iwaki

et al. 2021

Laryngoscope Investig Oto

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“…Thus, TOVS has many advantages as a minimally invasive surgery; however, there have only been a few reports on treatment outcomes and safety ( 8 , 9 ). Recently, Tomifuji et al reported the long-term treatment outcomes of 90 patients with hypopharyngeal cancer and 25 patients with supraglottic cancer who underwent TOVS, including advanced T3 or T4 lesions treated with neoadjuvant chemotherapy or before surgery or cases of failed radiation therapy, in their single institutional retrospective observational study ( 10 ). A total of 83 patients with fresh hypopharyngeal cancer (6 with Tis, 18 with T1, 45 with T2, 12 with T3, and 2 with T4) had a 5-year overall survival (OS) rate of 83.2%, 5-year disease-specific survival (DSS) rate of 94.3%, and 5-year larynx preservation rate (LPR) of 94.6%.…”

Section: Tovs In Japanmentioning

confidence: 99%

Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan

et al. 2021

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As the laryngopharynx is closely related to swallowing, speech, and phonation, it is necessary to consider not only disease control but also a minimally invasive approach for the treatment of laryngopharyngeal cancer. Transoral surgery has been reported to be a minimally invasive method for treating these diseases. Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan and recently emerged as treatments for patients with early stage pharyngeal and laryngeal cancers. However, securing an appropriate field of view and a narrow operating space during TOVS or ELPS are critical issues to be resolved for these surgeries. The clinical significance and safety of transoral robotic surgery (TORS) using the da Vinci Surgical System have been widely reported to provide surgeons with increased visualization and magnification, resulting in precise surgical margins and rapid functional recovery. In this context, a multi-institutional clinical study was conducted to evaluate the treatment outcomes of TORS for the treatment of laryngopharyngeal cancer in Japan, and the da Vinci Surgical System for oral robot-assisted surgery for these diseases was approved by the Pharmaceutical Affairs Agency in August 2018. This review provides an overview of the therapeutic effects of TOVS, ELPS, and TORS, with a particular focus on these therapeutic results in Japan.

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“…Transoral surgery (TOS) has been reported as useful for resecting Tis, T1, T2, and selected T3 stages of laryngopharyngeal cancer [4]. Moreover, it has been recently reported that TOS can resect lesions that underwent treatment failure after definitive radiation therapy (RT) or those that develop additional primary lesions within the RT field [5].…”

Section: Introductionmentioning

confidence: 99%

Swallowing function after transoral surgery for laryngopharyngeal cancer

et al. 2022

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Transoral surgery (TOS) has been widely used to treat laryngopharyngeal cancers. Although TOS is a minimally invasive procedure, postoperative complications, such as postoperative dysphagia, may occur, which can lead to a poor quality of life for patients undergoing TOS. This study aimed to investigate factors that may affect swallowing function in patients who underwent TOS for laryngopharyngeal cancers. Swallowing function of 84 patients who underwent endoscopic resection for oropharyngeal, hypopharyngeal, and supraglottic lesions was evaluated by the Functional Outcome Swallowing Scale, and predictors for postoperative dysphagia were identified. Multivariate analysis identified the following factors as independent predictors for postoperative dysphagia: Eastern Cooperative Oncology Group Performance Status (ECOG PS, p = 0.008), prior neck radiation therapy (p = 0.008), and operative time (p = 0.021). This study suggests that patients with poor ECOG PS or those who received prior neck radiation therapy should be fully assessed for preoperative swallowing function. In the future, we would like to clarify the criteria for preoperative swallowing evaluation to create a system that can identify patients suitable for TOS.

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Transoral videolaryngoscopic surgery for laryngeal and hypopharyngeal cancer — Technical updates and long-term results

Cited by 21 publications

References 11 publications

Prognostic factors after transoral resection of early hypopharyngeal cancer

Prognostic factors after transoral resection of early hypopharyngeal cancer

Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan

Swallowing function after transoral surgery for laryngopharyngeal cancer

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