Transoral Laser Microsurgery for Glottic Cancer in Patients Over 75 Years Old

Alberto Paderno, Davide Lancini, Paolo Bosio, Francesca Del Bon, Milena Fior, Giulia Berretti, Marco Alparone, Alberto Deganello, Giorgio Peretti, Cesare Piazza

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives/Hypothesis: Laryngeal squamous cell carcinoma (LSCC) has a non-negligible incidence in elderly patients. However, there is still no clear indication on the ideal treatment for early-intermediate glottic LSCC in this specific age group. Both surgical and nonsurgical approaches may be burdened by complications and sequelae that negatively impact patient's health. In this setting, carbon dioxide transoral laser microsurgery (CO2 TOLMS) is a promising minimally invasive treatment option. Study Design: Retrospective case series in a single tertiary academic institution. Methods: Patients who underwent CO2 TOLMS for Tis-T3 glottic LSCC from 1997 to 2017 were reviewed. Demographic, clinical, and tumor characteristics, as well as postoperative complications were recorded. Overall (OS), disease-specific (DSS), recurrence-free (RFS), laryngo-esophageal dysfunction free survivals (LEDFS), and organ preservation (OP) were calculated. Results: A total of 134 patients (mean age, 80 ± 4 years; median, 79; range, 75–93) were included in the study. Seven lesions were classified as pTis, 65 as pT1a, 22 as pT1b, 35 as pT2, and 5 as pT3. No treatment-related death was observed. Twenty-eight (20.9%) patients reported 10 surgical and 19 medical complications. Five-year OS, DSS, RFS, LEDFS, and OP were 68.9%, 95.4%, 79.5%, 66%, and 92.5%, respectively. Age and comorbidities were associated with OS and LEDFS. Advanced T categories were negatively correlated with OS, DSS, RFS, LEDFS, and OP. Age and comorbidities were not significant risk factors for complications. Conclusions: CO2 TOLMS can be considered a valuable therapeutic approach for selected Tis-T3 glottic LSCC even in the elderly given its favorable oncologic outcomes and minimal aggressiveness. Level of Evidence: 4 Laryngoscope, 2021.

Original languageEnglish
JournalLaryngoscope
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • complication
  • elderly
  • glottis
  • Laryngeal cancer
  • laser
  • oncologic outcome
  • transoral surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

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