Prospective analysis of functional swallowing outcome after resection of T2 glottic carcinoma using transoral laser surgery and external vertical hemilaryngectomy.
56 patients affected by T2 glottic carcinoma were treated in two institutes using transoral laser microsurgery (TLM) in 40 cases and vertical hemilaryngectomy in 16 cases between September 2012 and September 2015. In the TLM group, different subtypes of type V cordectomy were used according to the extent of tumor. In the vertical hemilaryngectomy group, classical operation was used in most of the cases and the resection was extended in few cases. Analysis of post-operative swallowing function was done using videofluoroscopy (VFS), functional endoscopic evaluation of swallowing, and subjectively using MD Anderson dysphagia inventory. Objective evaluation of swallowing has been made by obtaining different measures from VFS (pharyngeal transit time, pharyngeal constriction ratio, and hyoid displacement for example). Analysis also included the need and duration of tracheostomy and nasogastric tube, ICU admission, and hospitalization time. Statistical analysis was performed with the Mann-Whitney U and Pearson Chi-square tests. Comparison of incidence of aspiration and swallowing outcome showed significantly better results in the laser group than in the vertical group (p < 0.001). The duration of ICU, tracheostomy, nasogastric tube, and hospital stay was also significantly shorter in the laser group (p < 0.001). This study shows that TLM had significantly better overall postoperative outcome than vertical hemilaryngectomy. It was associated with significantly shorter hospital stay and less need for tracheostomy, nasogastric tube, and ICU admission). Measures obtained from VFS are useful for detection and follow-up of postoperative aspiration, because it is a definitive technique for anatomical and physiological study of swallowing.
Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. dr_haniosama@yahoo.com.
Hani Osama
HO
Nasef
Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Hossam
H
Thabet
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Brescia, Brescia, Italy.
Cesare
C
Piazza
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Brescia, Brescia, Italy.
Francesca
F
Del Bon
Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Mohamed
M
Eid
Department of Phoniatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Manal El
ME
Banna
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Brescia, Brescia, Italy.
Piero
P
Nicolai
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005931:Glottis / Q000601:surgery; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011446:Prospective Studies; D063466:Respiratory Aspiration of Gastric Contents / Q000209:etiology; D018709:Statistics, Nonparametric; D014139:Tracheostomy / Q000706:statistics & numerical data; D016896:Treatment Outcome
Conservative laryngeal surgery; Functional outcomes; Swallowing; Transoral laser surgery