Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery

Abstract

The aim of this study is to evaluate the treatment outcome and analyze the associated factors of postoperative recurrence in patients who received transoral laser microsurgery for vocal cord leukoplakia. The demographic, histopathological data were retrospectively reviewed and the factors associated with recurrence of vocal leukoplakia after surgery were analyzed statistically. A total of 44 patients, including 36 males and 8 females, with a mean age of 50.4 ± 13.4 years, were enrolled. All the patients received excision of the vocal leukoplakia by carbon dioxide laser (2-4 Watt, ultrapulse mode) under general anesthesia. No patients had malignant transformation after surgery. Postoperative recurrence occurred in 10 patients (22.7 %). Univariate analysis showed that patients who had the habit of cigarette smoking, alcohol drinking, and presence of gastroesophageal reflux disease tended to recur. Among these risk factors, presence of gastroesophageal reflux disease (odds ratio 8.43) was the independent prognostic factor for recurrence using multivariate logistic regression analysis. Carbon dioxide laser excision is effective for treating vocal leukoplakia that is still confined to dysplasia of any degree, with acceptable morbidity. This study suggests that the presence of gastroesophageal reflux disease is the prognostic indicator for postoperative recurrence of vocal leukoplakia. Aggressive treatment of reflux disease for those who have received surgical excision for vocal leukoplakia is indicated.

Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review

“…From these, 64 were related to VF granuloma, 129 to laryngotracheal stenosis, 100 to laryngeal infections, and 48 to leukoplakia. Among these articles, 31 met our inclusion criteria and were kept for analysis ( Figure 1 ): 8 related to VF granuloma ( Table 1 ), 20-27 4 to laryngeal infections ( Table 1 ), 28-31 5 to leukoplakia ( Table 2 ), 7,32-35 and 10 to laryngotracheal stenosis ( Table 3 ). 36-45 Four additional basic research studies were identified concerning the relationship between reflux and the development of laryngotracheal stenosis.…”

“…This potential association was indirectly supported by Yang et al and Sezen Goktas et al in their recent studies. 7,34 Yang et al identified LPR symptoms and esophagitis in 31.8% of patients with leukoplakia, but they included patients with a history of smoking, oropharyngeal cancer, or head and neck radiation. 34 Sezen Goktas et al observed a leukoplakia regression in 29% of patients treated by PPI therapy.…”

“…7,34 Yang et al identified LPR symptoms and esophagitis in 31.8% of patients with leukoplakia, but they included patients with a history of smoking, oropharyngeal cancer, or head and neck radiation. 34 Sezen Goktas et al observed a leukoplakia regression in 29% of patients treated by PPI therapy. 7 However, neither author group 7,34 confirmed the LPR diagnosis through HEMII-pH or MII-pH, with the use of pepsin detection not currently a gold standard.…”

“…7,24-27,29,32,33,37-39,42,45 Among these studies, some authors considered GERD symptoms for the diagnosis without considering LPR-associated complaints. 7,32,39,42,45 The objective approaches used for the reflux diagnosis included x-ray 20 ; gastrointestinal endoscopy findings 20,34 ; single-probe, 20,43 dual-probe, 21-23,28 triple-probe, 36,40 or oropharyngeal 41 pH monitoring; manometry 20 ; and pepsin detection. 30,31,35 Impedance pH was used in 1 study, but the authors did not consider the nonacid data.…”

The Variation of Peripheral Inflammatory Markers in Vocal Leukoplakia before and after Recurrence and Canceration

“…The prevalence of VFL is 10.2 for men and 2.1 for women per 100000 persons [ 1 ], and the reason it really draws otolaryngologists' attentions is the recurrence and canceration tendency in clinical practice. Minimally invasive surgery with employment of carbon dioxide (CO 2 ) laser is a common strategy for leukoplakia, which still contains 16% to 22.7% of recurrence rate [ 2 , 3 ]. Pathological diagnosis has predicted the value of the potential malignant event in clinic [ 4 ]; however, effective presurgical markers to indicate the future behaviors of VFL are still lacking.…”