Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure?
| Autor: | Giandomenico Maggiore, Costanza Giannini, Cecilia Taverna, Massimo Squadrelli Saraceno, Oreste Gallo, Maria Silvia Lazio, Alberto Vallin |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Glottis medicine.medical_specialty Endoscopic Mucosal Resection Voice Quality Biopsy Laryngectomy Therapeutic Procedure Vocal Cords Dissection (medical) Free Tissue Flaps Disease-Free Survival Resection 03 medical and health sciences Postoperative Complications 0302 clinical medicine medicine Humans 030212 general & internal medicine Laryngeal Neoplasms Aged Retrospective Studies Leukoplakia Aged 80 and over business.industry Patient Selection Infusion technique Carcinoma Margins of Excision General Medicine Middle Aged medicine.disease Italy Otorhinolaryngology 030220 oncology & carcinogenesis Vocal function Lasers Gas Female Radiology business Precancerous Conditions |
| Zdroj: | Annals of Otology, Rhinology & Laryngology. 128:277-285 |
| ISSN: | 1943-572X 0003-4894 |
| DOI: | 10.1177/0003489418819544 |
| Popis: | Objectives: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. Methods: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. Results: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). Conclusion: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy. |
| Databáze: | OpenAIRE |
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