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Endoscopic Supraglottic Laryngectomies. Results on 45 Cases
P50
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
Endoscopic Supraglottic Laryngectomies. Results on 45 Cases Marc J Remacle, MD, PhD (presenter); Georges Lawson, MD; Jacques Jamart, MD OBJECTIVE: The aim of this study was to evaluate long-term results of transoral CO2 laser-assisted surgery for supraglottic carcinoma. METHODS: From 1992 to 2004, 45 patients including 38 males and 7 females with a mean age of 62 years and showing a supraglottic squamous cell carcinoma (2 Tis, 9 T1N0, 27T2N0, 2T2N1, 1T2N2, 4 T3N0) underwent different types of endoscopic partial supraglottic laryngectomies according to the European Laryngological Society (ELS) proposal of classification (3 limited excision–type I; 29 medial without resection of the pre-epiglottic space-type II; 4 medial with resection of the pre-epiglottic space-type III; 11 lateral-type IV) in combination with neck dissection performed during the same session. Frozen sections were performed on the laryngeal margins after tumoral resection. No patient had tracheostomy perioperatively. RESULTS: Overall survival was 93 ⫾ 4% after 3 years and 89 ⫾6% after 5 years. The minimum follow-up was 3 years. Frozen sections were negative in 40 cases and presented only dysplasia in 5 cases. N0 nodes were positive in 8 cases (18%). Two postoperative bleedings were controlled by electrocautery. All of them relearned undisturbed deglutition within 5 days to 3 weeks from surgery. Two patients presented aspiration pneumonia. Mean duration of hospitalization was 12.5 days. CONCLUSIONS: Endoscopic partial laryngectomies according to the ELS proposal of classification for selected supraglottic SCC prove to be an excellent alternative to radiotherapy and open neck surgery for selected supraglottic carcinoma. Impact of Voice and Swallowing Problems in the Elderly Richard Turley, MD (presenter); Seth M Cohen, MD, MPH OBJECTIVE: 1) Evaluate the prevalence of and quality of life impact of voice and swallowing problems in the elderly. 2) Determine treatment trends and barriers to treatment. METHODS: Cross-sectional study of independent living residents in 2 retirement communities. Main outcome measures include prevalence of dysphonia and dysphagia, Voice Related Quality of Life (VRQOL), 7-point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES-D) scale, and barriers to treatment. Relationship between continuous variables were analyzed with Spearman correlation and between categorical and continuous variables with a t-test. RESULTS: 248 residents responded, with a mean age of 82.4 years. 19.8% had dysphonia, 13.7% dysphagia, and 6% both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL (p ⫽ 0.04, Spearman
correlation ⫽ -0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES-D score 15.5 versus 9.9, p ⫽ 0.008, t-test). While 75% of respondents with dysphonia were interested in treatment, only 20.4% and 2.1% had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options, and viewing voice and swallowing trouble as a normal part of aging, were the two most common reasons for not seeking treatment. CONCLUSIONS: Voice and swallowing problems are common in the elderly but they are not realizing potential treatment benefits. Improved health care services for voice and swallowing problems in the elderly are essential. p63 Expression in 127 Patients with Laryngeal Cancer Claudio R Cernea, MD (presenter); Marcus Antonio De Mello Borba; Fernando Luiz Dias, MD, PhD; Paulo Faria; Carlos Bacchi, MD; Andre´ Leonardo De Castro Costa, MS OBJECTIVE: (1) To evaluate the expression of p63 in laryngeal squamous cell carcinoma (2) To analyze its prognostic significance. METHODS: p63 expression was examined in 127 patients submitted to total laryngectomy between 1998 and 2000 (111 male/16 female; 69 Caucasian/58 non-Caucasian; 36- to 93years-old, median: 58 years). 19 tumors were glottic, 16 supraglottic and 92 transglottic(15%, 13% and 72%, respectively). Two cases were stage I(1.6%), 21 were stage II(16.5%), 82 were stage III(64.6%) and 22 were stage IV(17.3%). 96 patients(75.6%) received adjuvant radiotherapy. The immunohistochemical analysis of the expression of p63 included the following scores: 0: no immunostaining; 1: immunostaining in ⬍30% of neoplastics cells; 2: immunostaining in ⬎30% and ⬍70% of neoplastics cells; and 3: immunostaining in ⬎70% of neoplastics cells. RESULTS: 62 cases had score 3; 60 had score 2; 4 had score 1; and one case did not show any expression (48.8%, 47.2%, 3.1% and 0.8%). Overall survival was 73.9% at 24 months and 59.5% at 60 months. The disease-free survival was 77.2% and 75.1%, and the disease-specific survival was 79% and 67% at 24 and 60 months respectively. Uni and multivariate analysis identified that decreased immunoexpression of protein p63 and the involvement of the hypopharynx were statistically significant factors for the risk of recurrence and death by cancer. CONCLUSIONS: p63 expression was highly prevalent in laryngeal squamous cell carcinomas in the present study. Decreased p63 protein expression was statistically associated to the recurrence and death.
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
Endoscopic Supraglottic Laryngectomies. Results on 45 Cases Marc J Remacle, MD, PhD (presenter); Georges Lawson, MD; Jacques Jamart, MD OBJECTIVE: The aim of this study was to evaluate long-term results of transoral CO2 laser-assisted surgery for supraglottic carcinoma. METHODS: From 1992 to 2004, 45 patients including 38 males and 7 females with a mean age of 62 years and showing a supraglottic squamous cell carcinoma (2 Tis, 9 T1N0, 27T2N0, 2T2N1, 1T2N2, 4 T3N0) underwent different types of endoscopic partial supraglottic laryngectomies according to the European Laryngological Society (ELS) proposal of classification (3 limited excision–type I; 29 medial without resection of the pre-epiglottic space-type II; 4 medial with resection of the pre-epiglottic space-type III; 11 lateral-type IV) in combination with neck dissection performed during the same session. Frozen sections were performed on the laryngeal margins after tumoral resection. No patient had tracheostomy perioperatively. RESULTS: Overall survival was 93 ⫾ 4% after 3 years and 89 ⫾6% after 5 years. The minimum follow-up was 3 years. Frozen sections were negative in 40 cases and presented only dysplasia in 5 cases. N0 nodes were positive in 8 cases (18%). Two postoperative bleedings were controlled by electrocautery. All of them relearned undisturbed deglutition within 5 days to 3 weeks from surgery. Two patients presented aspiration pneumonia. Mean duration of hospitalization was 12.5 days. CONCLUSIONS: Endoscopic partial laryngectomies according to the ELS proposal of classification for selected supraglottic SCC prove to be an excellent alternative to radiotherapy and open neck surgery for selected supraglottic carcinoma. Impact of Voice and Swallowing Problems in the Elderly Richard Turley, MD (presenter); Seth M Cohen, MD, MPH OBJECTIVE: 1) Evaluate the prevalence of and quality of life impact of voice and swallowing problems in the elderly. 2) Determine treatment trends and barriers to treatment. METHODS: Cross-sectional study of independent living residents in 2 retirement communities. Main outcome measures include prevalence of dysphonia and dysphagia, Voice Related Quality of Life (VRQOL), 7-point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES-D) scale, and barriers to treatment. Relationship between continuous variables were analyzed with Spearman correlation and between categorical and continuous variables with a t-test. RESULTS: 248 residents responded, with a mean age of 82.4 years. 19.8% had dysphonia, 13.7% dysphagia, and 6% both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL (p ⫽ 0.04, Spearman
correlation ⫽ -0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES-D score 15.5 versus 9.9, p ⫽ 0.008, t-test). While 75% of respondents with dysphonia were interested in treatment, only 20.4% and 2.1% had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options, and viewing voice and swallowing trouble as a normal part of aging, were the two most common reasons for not seeking treatment. CONCLUSIONS: Voice and swallowing problems are common in the elderly but they are not realizing potential treatment benefits. Improved health care services for voice and swallowing problems in the elderly are essential. p63 Expression in 127 Patients with Laryngeal Cancer Claudio R Cernea, MD (presenter); Marcus Antonio De Mello Borba; Fernando Luiz Dias, MD, PhD; Paulo Faria; Carlos Bacchi, MD; Andre´ Leonardo De Castro Costa, MS OBJECTIVE: (1) To evaluate the expression of p63 in laryngeal squamous cell carcinoma (2) To analyze its prognostic significance. METHODS: p63 expression was examined in 127 patients submitted to total laryngectomy between 1998 and 2000 (111 male/16 female; 69 Caucasian/58 non-Caucasian; 36- to 93years-old, median: 58 years). 19 tumors were glottic, 16 supraglottic and 92 transglottic(15%, 13% and 72%, respectively). Two cases were stage I(1.6%), 21 were stage II(16.5%), 82 were stage III(64.6%) and 22 were stage IV(17.3%). 96 patients(75.6%) received adjuvant radiotherapy. The immunohistochemical analysis of the expression of p63 included the following scores: 0: no immunostaining; 1: immunostaining in ⬍30% of neoplastics cells; 2: immunostaining in ⬎30% and ⬍70% of neoplastics cells; and 3: immunostaining in ⬎70% of neoplastics cells. RESULTS: 62 cases had score 3; 60 had score 2; 4 had score 1; and one case did not show any expression (48.8%, 47.2%, 3.1% and 0.8%). Overall survival was 73.9% at 24 months and 59.5% at 60 months. The disease-free survival was 77.2% and 75.1%, and the disease-specific survival was 79% and 67% at 24 and 60 months respectively. Uni and multivariate analysis identified that decreased immunoexpression of protein p63 and the involvement of the hypopharynx were statistically significant factors for the risk of recurrence and death by cancer. CONCLUSIONS: p63 expression was highly prevalent in laryngeal squamous cell carcinomas in the present study. Decreased p63 protein expression was statistically associated to the recurrence and death.