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26-01-2012 | Surgery | Article

Laser cordectomy offers good outcomes in elderly glottic carcinoma patients


Free abstract

MedWire News: Endoscopic laser surgery is an effective and well-tolerated treatment for glottic carcinoma in elderly patients, study findings show.

The research was a retrospective analysis of 130 consecutive patients aged 65 years and older who were diagnosed with early-stage (cT1-T2 N0) glottic carcinoma. Their mean age was 73.3 years and 126 patients were male.

All were treated with carbon dioxide (CO2) laser endoscopic cordectomy. This represented primary treatment in 122 patients and a salvage procedure in eight cases where prior endoscopic surgery or radiotherapy had failed.

There were no intraoperative complications and just one instance of significant postoperative laryngeal bleeding. None of the patients needed a tracheotomy or developed dysphagia or neck pain but 24 developed postoperative granuloma and two patients suffered glottic synechia. The mean length of hospital stay was just 1.7 days.

The cohort was followed up for an average of 54.9 months. In all, 20 patients developed a local recurrence, one patient died from their disease, and 15 died from other causes, yielding overall and disease-specific survival rates of 87.7% and 99.2%, respectively.

Using univariate analysis, Marco Lucioni (Vittorio Veneto Hospital, Italy) and co-workers looked for baseline clinicopathologic features that predicted outcomes.

They found that a range of features - cT classification, involvement of other laryngeal regions (arytenoids, subglottis, vocal muscle, and ventricle), and excision margin status - predicted recurrence rates and/or disease-free survival.

In multivariate analysis, however, just one variable - surgical margin status - was a significant predictor for disease-free survival, at a hazard ratio of 6.04 for positive versus free or close margins.

Commenting on their results, Lucioni et al say that the importance of surgical margins in predicting outcomes may relate to the particular lymphatic drainage of the glottis, which generally requires a 1-mm free margin.

They conclude: "Our results confirm that endoscopic laser surgery is also an effective treatment for selected glottic carcinomas in elderly patients.

The reasons are fairly straightforward: very high local control rates are achieved with the laser alone, with a very low morbidity… as well as a good patient compliance, and a very short hospital stay (<2 days in our experience, and this is a particularly important issue for geriatric patients).

By Joanna Lyford

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