title: Distant metastases after transoral laser microsurgery for laryngeal and hypopharyngeal squamous cell carcinoma.
abstract: BACKGROUND
  Transoral CO(2) laser microsurgery (TLM) resection of laryngeal-hypopharyngeal squamous cell carcinomas has become a standard procedure. The objective was to evaluate whether there is a relationship between TLM and a higher incidence of distant metastases.
  
  
  METHODS
  We conducted a retrospective analysis of 340 consecutive patients with laryngeal or hypopharyngeal squamous cell carcinoma treated with TLM.
  
  
  RESULTS
  Distant metastases occurred in 24 of 340 (7.1%) patients. The mean time of distant metastases diagnosis was 19.1 months (range, 1-41) postsurgery. Univariate study demonstrated an association with alcoholism (p = .008), tumor site (p<.001), grade of differentiation (p = .032), stage (p<.001), tumor classification (T; p = .001), node involvement (N; p<.001), extracapsular node spread (p<.001), and positive surgical margin (p = .004). In multivariate logistic regression analysis, location (sinus piriform: OR = 15.37, p = .025), node involvement (N2: OR = 7.36, p = .003; N3: OR = 19.28, p = .027), and the affected surgical margin (OR 5.32; p = .005) predicted an increased likelihood of distant metastases.
  
  
  CONCLUSIONS
  Development of distant metastases after TLM in patients with squamous cell carcinoma depends mainly on the tumor site, the presence of metastatic lymph node disease, and the margin status after resection.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain. mcaba@clinic.ub.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Caballero
authors.forename: Isabel
authors.initials: I
authors.lastname: Vilaseca
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
authors.forename: Jose M
authors.initials: JM
authors.lastname: Guilemany
authors.forename: Miguel
authors.initials: M
authors.lastname: Moragas
authors.forename: Jose Luís
authors.initials: JL
authors.lastname: Blanch
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors