Second-look microlaryngoscopy to detect residual carcinoma in patients after laser surgery for T1 and T2 laryngeal cancer.
CONCLUSIONS
The presented concept of second-look microlaryngoscopy in patients treated with transoral laser surgery (TLS) for early glottic carcinoma is promising and warrants further studies to evaluate its benefits.


OBJECTIVE
Clear surgical margins at the primary site influence the course of the disease in patients with laryngeal carcinoma who undergo TLS. Several factors may lead to a reduced sensitivity in detecting tumor remnants at the time of the initial procedure. We therefore developed the concept of second-look microlaryngoscopies to enable a microscopic and histologic reassessment at the primary tumor site to exclude residual carcinoma.


METHODS
Patients were scheduled for two second-look microlaryngoscopies under general anesthesia at 8-10 weeks and 16-20 weeks after the initial TLS procedure. We analyzed the histopathologic findings of biopsies taken in the second-look microlaryngoscopies and the survival parameters of 181 patients treated with TLS for early laryngeal carcinoma.


RESULTS
Carcinoma at the primary site was found in 5.1% of all patients within the first and in 11.5% of all patients within the second second-look microlaryngoscopy, although the preoperative indirect laryngoscopy was inconspicuous in most cases. The survival analysis showed a 5-year and 10-year disease-free survival of 96.3% and 92.7%, respectively. The disease-free survival was significantly decreased when carcinoma was found in the second-look microlaryngoscopy (p=0.004).
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany. simon.preuss@uni-koeln.de
Simon Florian
SF
Preuss
Kirsten
K
Cramer
Uta
U
Drebber
Jens Peter
JP
Klussmann
Hans-Edmund
HE
Eckel
Orlando
O
Guntinas-Lichius
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult