Functional and Oncologic Outcomes of Octogenarians Undergoing Transoral Laser Microsurgery for Laryngeal Cancer

Objective To evaluate the oncologic and functional outcomes of transoral laser microsurgery (TLM) for glottic cancers in patients ≥80 years. Study Design Prospectively collected case series. Setting QEII Health Sciences Centre, Halifax, Canada. Methods This case series used a prospectively collected glottic cancer database to examine consecutive elderly patients (≥80 years old) undergoing TLM. Kaplan-Meier analysis was used to evaluate rates of disease-free, disease-specific, and overall survival as the primary end points of oncologic control. Secondary functional outcomes included voice function, length of hospital stay, and time to readmission. Results From 2005 to 2017, 17 octogenarian patients underwent TLM for glottic cancer. Median follow-up was 4.19 years (interquartile range, 0.71-6.95). Kaplan-Meier estimates of 5-year survival were 78.4% (disease free), 92.9% (disease specific), and 81.9% (overall). The median length of hospital stay was 1 day (range, 0-8). There was only 1 readmission within 30 days of surgery. No patients in this study developed significant surgical or postoperative complications requiring unplanned readmissions. Patient-perceived voice function improved to normal after treatment in 62.5% of patients. Conclusion The results of this study suggest that TLM is a safe and effective treatment modality for glottic cancer in patients aged ≥80 years, providing good oncologic control and satisfactory functional outcomes.

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Transoral laser microsurgery outcomes with early glottic cancer: the Dalhousie University experience

The Journal of Laryngology & Otology ◽

10.1017/s002221511000304x ◽

2011 ◽

Vol 125 (5) ◽

pp. 509-512 ◽

Cited By ~ 11

Author(s):

S E Lester ◽

M H Rigby ◽

S M Taylor

Keyword(s):

Overall Survival ◽

Disease Free Survival ◽

Glottic Cancer ◽

Transoral Laser Microsurgery ◽

Laser Microsurgery ◽

Free Survival ◽

Early Glottic Cancer ◽

Kaplan Meier ◽

Disease Free

AbstractObjective:To report the results of transoral laser microsurgery for the treatment of early glottic cancer at our institution.Design:Cohort study. Retrospective review of charts of patients diagnosed with tumour stage 1 or 2 (early stage; no nodes or metastases), previously untreated, primary glottic cancer, treated with transoral laser microsurgery at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. The minimum follow-up period was two years.Setting:Tertiary care head and neck cancer centre.Participants:Fifty-three patients treated between January 2002 and November 2007.Outcome measure:Kaplan–Meier survival analysis for disease-free survival, overall survival and laryngectomy-free survival, at five years.Results:The group comprised 46 men and seven women, with a mean age of 66 years (range 30–84 years). Mean follow up was 40 months (range 12–89 months). There were four cases of complications (7.5 per cent). Kaplan–Meier survival analysis revealed a five-year disease-free survival (including salvage) of 96.2 per cent, a five-year overall survival (all causes) of 88.8 per cent and a five-year laryngectomy-free survival of 98.1 per cent.Conclusion:Transoral laser microsurgery is a safe and effective initial treatment for early laryngeal cancer, and has high rates of laryngeal preservation and disease-free survival.

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Outcomes of transoral laser microsurgical management of T1b stage glottic cancer

The Journal of Laryngology & Otology ◽

10.1017/s0022215117000329 ◽

2017 ◽

Vol 131 (5) ◽

pp. 433-441 ◽

Cited By ~ 1

Author(s):

J A Song ◽

M H Rigby ◽

J Trites ◽

R D Hart ◽

S M Taylor

Keyword(s):

Overall Survival ◽

Cancer Patients ◽

Local Control ◽

Glottic Cancer ◽

Transoral Laser Microsurgery ◽

Disease Specific Survival ◽

Laser Microsurgery ◽

Kaplan Meier ◽

One Year ◽

Disease Specific

AbstractObjective:This study aimed to evaluate the oncological and voice outcomes of transoral laser microsurgery for tumour stage T1b stage glottic cancer patients.Methods:A prospective cohort study in a tertiary care head and neck cancer centre included tumour–node–metastasis stage T1bN0M0 glottic cancer patients scheduled to undergo transoral laser microsurgery from January 2002 until June 2014. Kaplan–Meier five-year analyses of local control, overall survival, disease-specific survival and laryngeal preservation were performed. Voice Handicap Index-10 scores and maximum phonation times were also recorded.Results:Twenty-one participants with a mean age of 66.8 years were enrolled. The mean follow up was 56.5 months. Kaplan–Meier 5-year survival analysis illustrated a local control rate of 82 per cent, overall survival of 88 per cent, disease-specific survival of 100 per cent, and laryngeal preservation of 100 per cent. The pre-operative Voice Handicap Index-10 score was 19.1 ± 9.47 (mean ± standard deviation (SD)) and the post-operative scores were 13.5 ± 9.29 at three months, 10.44 ± 9.70 at one year and 5.83 ± 4.91 at two years. The pre-operative maximum phonation time was 16.23 ± 5.46 seconds (mean ± SD) and the post-operative values were 14.44 ± 6.73 seconds at three months, 15.27 ± 5.71 seconds at one year and 14.33 ± 6.44 seconds at two years.Conclusion:Transoral laser microsurgery yields relatively high rates of oncological control and acceptable voice outcomes, and thus shows utility as a primary treatment modality for T1b glottic cancer.

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Voice and Functional Outcomes of Transoral Laser Microsurgery for Early Glottic Cancer: Ventricular Fold Resection as a Surrogate

Journal of Clinical Medicine Research ◽

10.14740/jocmr2216w ◽

2015 ◽

Vol 7 (8) ◽

pp. 632-636 ◽

Cited By ~ 2

Author(s):

Ilyes Berania ◽

Christophe Dagenais ◽

Sami P. Moubayed ◽

Tareck Ayad ◽

Marie-Jo Olivier ◽

...

Keyword(s):

Functional Outcomes ◽

Glottic Cancer ◽

Transoral Laser Microsurgery ◽

Laser Microsurgery ◽

Early Glottic Cancer

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Transoral Laser Microsurgery for Untreated Glottic Carcinoma

Otolaryngology ◽

10.1016/j.otohns.2007.05.064 ◽

2007 ◽

Vol 137 (3) ◽

pp. 482-486 ◽

Cited By ~ 37

Author(s):

David G. Grant ◽

John R. Salassa ◽

Michael L. Hinni ◽

Bruce W. Pearson ◽

Richard E. Hayden ◽

...

Keyword(s):

Therapeutic Option ◽

Case Series ◽

Glottic Carcinoma ◽

Transoral Laser Microsurgery ◽

Laser Microsurgery ◽

Average Hospital ◽

Kaplan Meier ◽

Prospective Case Series ◽

Preservation Rate

OBJECTIVES: To report the oncology and functional outcomes of transoral laser microsurgery (TLM) for untreated glottic carcinoma. STUDY DESIGN: A 2 center prospective case series analysis. SETTING: Academic, tertiary referral centers. RESULTS: Seventy-six patients underwent TLM. Pathologic T stages were: T1, 45 (59%); T2, 21 (28%); T3, 5 (7%); and T4, 5 (7%). Five (7%) patients had neck dissections. Five (7%) patients received adjuvant radiotherapy. Mean follow-up was 42 months. Respective T1 and T2 5-year Kaplan-Meier estimates were: local control, 90% and 93%; loco-regional control, 90% and 93%; disease specific survival, 90% and 93%; and overall survival, 94% and 93%. The average hospital stay was 2 days. Two (3%) patients experienced major complications. The overall laryngeal preservation rate was 95% (72 of 76). CONCLUSIONS: TLM is a safe and effective treatment in select carcinoma of the glottic larynx. Low morbidity and mortality and short periods of hospitalization make TLM an attractive therapeutic option. SIGNIFICANCE: TLM is an emerging strategy in the treatment of laryngeal cancer.

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Survival Analysis Based on the Siddha Body Constitution of Asymptomatic SARS-CoV-2 Patients Under Integrative Management of Hydroxychloroquine (HCQ) and Kaba Sura Kudineer (KSK): A Retrospective, Cross-Sectional, Case Series in Tirupati

Current Traditional Medicine ◽

10.2174/2215083807666210810113120 ◽

2021 ◽

Vol 07 ◽

Author(s):

Samraj Karunanithi ◽

Sreenivasa Rao P ◽

Nandhagopal K ◽

Manoj Kumar D. ◽

Vinod N.P. ◽

...

Keyword(s):

Survival Analysis ◽

Hospital Stay ◽

Case Series ◽

Length Of Hospital Stay ◽

Case Report Form ◽

Retrospective Case ◽

Cross Sectional ◽

Body Constitution ◽

Kaplan Meier ◽

Integrated Medical Care

Objective: To analyse the duration of hospital stay of asymptomatic COVID-19 patients in Integrated Medical care of Hydroxychloroquine and Kaba Sura Kudineer (Herbal decoction). Design: A retrospective case series of 19 asymptomatic confirmed SARS-Cov-2 patients from District COVID Care Centre, Tirupati, India, between 23rd May to 7th June 2020. Method: Clinical data were collected using a standardised case report form containing demographic information, length of hospital stays and Siddha Yakkai Ilakkanam (Body Constitution) from the records. The association between length of hospital stay, age, gender, and Siddha YI after admissions for confirmed patients was compared and analysed by Kaplan Meier survival analysis method. Result: Patients in Aiyam group take at least 9 days of hospital stay, 80% take 10 or more days to cure the disease. 71.4% take more than 4 days and 3 days of hospital stay in Azhal and Vali groups, respectively. 75% of females take 9 days or more of hospital stay. 73.3% of males take 9 days or more of hospital stay. The age group, 19-40 years, has a minimum and maximum hospital stay varies from 2-15 days. Conclusion: This study explores the significance of integration of Siddha Medicine with Western medicine in the management of SARS Cov-2 infection. It recorded an overall median of 9 days in the length of stay and 8.5 days in overall mean survival time. This study emphasised higher speedy relief comparing Vietnam and China studies. Comparing those studies, the patient taking integrative treatment have savings of 9 days.

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Oncological and functional outcomes after repeat transoral laser microsurgery for the treatment of recurrent early glottic cancer

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000407 ◽

2020 ◽

Vol 134 (2) ◽

pp. 169-173 ◽

Cited By ~ 2

Author(s):

D Forner ◽

M H Rigby ◽

M Corsten ◽

J R Trites ◽

J Pyne ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Survival Rate ◽

Cell Carcinoma ◽

Squamous Cell ◽

Functional Outcomes ◽

Additional Treatment ◽

Glottic Cancer ◽

Transoral Laser Microsurgery ◽

Laser Microsurgery ◽

Safe Alternative

AbstractBackgroundTransoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures.MethodA retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018.ResultsTwenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373).ConclusionRepeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.

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Audit of transoral laser-assisted microsurgical resection of early laryngeal cancer

The Journal of Laryngology & Otology ◽

10.1017/s0022215115000626 ◽

2015 ◽

Vol 129 (4) ◽

pp. 372-376

Author(s):

I Amir ◽

G A Vernham

Keyword(s):

Survival Rates ◽

Disease Free Survival ◽

Oncological Outcome ◽

Glottic Cancer ◽

Transoral Laser Microsurgery ◽

Laser Microsurgery ◽

Free Survival ◽

Early Glottic Cancer ◽

Kaplan Meier ◽

Microsurgical Resection

AbstractObjective:This study aimed to report our current practice of transoral laser microsurgery for early glottic cancer against the standards outlined by the ENT UK Head and Neck Group and assess the oncological outcome.Method:A retrospective review of case notes of patients diagnosed with early glottic cancer (tumour stages Tis, T1 and T2) who underwent transoral laser microsurgery as a primary curative treatment. The minimum follow-up period was two years.Results:Thirty-one patients had transoral laser microsurgery for early glottic cancer during the study period. Eighty-four per cent of cases were discussed by a multidisciplinary team prior to transoral laser microsurgery. Complete circumferential excision was achieved in 77 per cent of cases. Sixty-five per cent of specimens were subjected to histological analysis; they complied with standard pathology reporting for margins. Within 12 months of transoral laser microsurgery, there were 10 residual cases and 2 recurrences. Kaplan–Meier survival analysis gave disease-free survival rates of 96.8 per cent at 18 months and 93.5 per cent at 24 months. The laryngectomy-free survival rate was 96.8 per cent at two years.Conclusion:The findings of this audit are encouraging and have highlighted areas for further discussions, recommendations, training and education.

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T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO2-Laser Microsurgery Using the VEM

Journal of Clinical Medicine ◽

10.3390/jcm10061250 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1250

Author(s):

Wen Song ◽

Felix Caffier ◽

Tadeus Nawka ◽

Tatiana Ermakova ◽

Alexios Martin ◽

...

Keyword(s):

Function Analysis ◽

Survival Rates ◽

Severity Index ◽

Glottic Cancer ◽

Vocal Performance ◽

Laser Microsurgery ◽

Kaplan Meier ◽

Objective Parameter ◽

Oncological Results ◽

Perceptual Assessment

Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO2 transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan–Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.

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Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab040 ◽

2021 ◽

Author(s):

Jonathan P Scoville ◽

Evan Joyce ◽

Joshua Hunsaker ◽

Jared Reese ◽

Herschel Wilde ◽

...

Keyword(s):

Hospital Stay ◽

Chart Review ◽

Statistical Tests ◽

Case Series ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Opioid Use ◽

Pain Scores ◽

Surgical Methods ◽

Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

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