Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (4): 79-85.doi: 10.6040/j.issn.1673-3770.0.2021.188

Previous Articles    

Forty cases of early glottic cancer treated by CO2 laser surgery combined with radiofrequency ablation

LI Lijie, TIAN Xiufen   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
  • Published:2022-07-11

PDF (PC)

180

Abstract: Objective To explore the clinical efficacy of endoscopic CO2 laser surgery combined with low-temperature plasma radiofrequency ablation(LTP-RFA). Methods We retrospectively analyzed the clinical data of 40 patients with early glottic cancer treated by endoscopic CO2 laser surgery combined with LTP-RFA. Results All patients initially underwent endoscopic CO2 laser surgery combined with LTP-RFA. The patients were followed up for 4.2-32.0(18.6)months; none were lost to follow-up. Three cases experienced recurrence once and two cases, twice. The recurrence rate was 12.5%. Total laryngectomy was performed in two cases, vertical partial laryngectomy in one case, selective neck dissection in one case, and combined surgery with tracheotomy in one case. One patient who experienced recurrence after total laryngectomy received chemoradiotherapy and interventional therapy, but the therapeutic effect was poor. One patient with recurrence after vertical partial laryngectomy, with an otherwise good general condition, opted for radiotherapy. The other three patients recovered well after their last surgery. Granulation tissue was observed in nine cases postoperatively and healed completely after 1-6 months. Mild vocal cord adhesion was observed in four patients. Postoperative vocal function was good in 36 patients, poor in 2 patients, and lost in 2 patients after total laryngectomy. Conclusion Endoscopic CO2 laser surgery combined with LTP-RFA for the treatment of early glottic cancer helps overcome the limitations of the two methods when used alone and helps improve surgical efficiency. It is an effective and feasible surgery.

Key words: Early glottic cancer, CO2 laser, Radiofrequency ablation, Endoscopic technique

CLC Number: 

  • R739.65
[1] 李京旻, 马衍, 向明亮. 早期喉癌腔镜外科手术及放疗治疗进展[J]. 国际耳鼻咽喉头颈外科杂志, 2018, 42(1): 32-36. doi:10.3760/cma.j.issn.1673-4106.2018.01.008. LI Jingmin, MA Yan, XIANG Mingliang. Progress in the treatment of early laryngeal cancer[J]. Int J Dermatol Venereol, 2018, 42(1): 32-36. doi:10.3760/cma.j.issn.1673-4106.2018.01.008.
[2] 严羽, 朱江. 早期喉癌及喉癌前病变诊断的研究进展[J]. 山东大学耳鼻喉眼学报, 2015,29(4): 80-85. doi:10.6040/j.issn.1673-3770.0.2015.007. YAN Yu, ZHU Jiang. Advances in the diagnosis of early laryngeal carcinoma and precancerous laryngeal lesions[J].J Otolaryngol Ophthalmol Shandong Univ, 2015,29(4): 80-85. doi:10.6040/j.issn.1673-3770.0.2015.007.
[3] David GP, Sharon S, David A. Head and Neck Cancers,Version 1.2021[EB/OL]. Natl Compr Canc Netw NCCN[2020-11-09] ,http://www.nccn.org.
[4] Tamaki A, Miles BA, Lango M, et al. AHNS Series: Do You know your guidelines? Review of current knowledge on laryngeal cancer[J]. Head Neck, 2018, 40(1): 170-181. doi:10.1002/hed.24862.
[5] 陈露, 万保罗, 臧艳姿, 等. 等离子结合支撑喉镜CO2激光治疗早期声门型喉癌的效果分析[J]. 中国实用医刊, 2019, 46(8): 74-76. doi:10.3760/cma.j.issn.1674-4756.2019.08.022. CHEN Lu, WAN Baoluo, ZANG Yanzi, et al. Analysis of diagnosis and treatment effect on plasma combined with laryngoscope CO2 laser on early glottic laryngeal carcinoma[J]. Chin J Pract Med, 2019, 46(8): 74-76. doi:10.3760/cma.j.issn.1674-4756.2019.08.022.
[6] 刘卫兴, 陈桂, 宋丽娟, 等. 早期声门型喉癌经低温等离子射频消融术和CO2激光治疗的Meta分析[J]. 中华生物医学工程杂志, 2020,26(1):15-16. doi:10.3760/cma.j.issn.1674-1927.2020.01.003. LIU Weixing, CHEN Gui, SONG Lijuan, et al. Low-temperature plasma radiofrequency a-blation and CO2 laser treatment for early glottic laryngeal cancer: a meta-analysis[J]. ChinJ Biomed Eng, 2020, 26(1):15-16. doi:10.3760/cma.j.issn.1674-1927.2020.01.003.
[7] Brierley JD, Gospodarowicz MK, Wittekind C. UICC TNM classification of malignant tumours[M]. Eighth ed. Chichester: Wiley, 2017:31-34.
[8] Iglesias Docampo LC, Arrazubi Arrula V, Baste Rotllan N, et al. SEOM clinical guidelines for the treatment of head and neck cancer(2017)[J]. Clin Transl Oncol, 2018, 20(1): 75-83. doi:10.1007/s12094-017-1776-1.
[9] 孔维佳, 周梁. 耳鼻咽喉头颈外科学[M]. 3版. 北京: 人民卫生出版社, 2015:502-508.
[10] 魏矿荣, 郑荣寿, 梁智恒, 等. 2014年中国喉癌发病与死亡分析[J]. 中华肿瘤杂志, 2018,40(10):736-743. doi:10.3760/cma.j.issn.0253-3766.2018.10.004. WEI Kuangrong, ZHENG Rongshou, LIANG Zhiheng, et al. Incidence and mortality of l-aryngeal cancer in China, 2014[J]. Chin J Oncol, 2018, 40(10):736-743. doi:10.3760/cma.j.issn.0253-3766.2018.10.004.
[11] Hans S, Crevier-Buchman L, Circiu M, et al. Oncological and surgical outcomes of patients treated by transoral CO2 laser cordectomy for early-stageglottic squamous cell carcinoma: a retrospective chart review[J]. Ear Nose Throat J, 2021, 100(1): 33S-37S. doi:10.1177/0145561320911486.
[12] Bayan S, Faquin WC, Zeitels SM. Glottic carcinoma in young patients[J]. Ann Otol Rhinol Laryngol, 2019, 128(3): 25S-32S. doi:10.1177/0003489418818852.
[13] Boffetta P, Hashibe M. Alcohol and cancer[J]. Lancet Oncol, 2006, 7(2): 149-156. doi:10.1016/s1470-2045(06)70577-0.
[14] Steuer CE, El-Deiry M, Parks JR, et al. An update on larynx cancer[J]. CA Cancer J Clin, 2017, 67(1): 31-50. doi:10.3322/caac.21386.
[15] 张晶晶, 张庆丰, 刘得龙. 等离子射频治疗早期声门型喉癌的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2017,31(14): 1127-1129. doi:10.13201/j.issn.1001-1781.2017.14.019. ZHANG Jingjing, ZHANG Qingfeng, LIU Delong. Efficacy analysis of transoral endoscopic radiofrequency coblation for early glottic cancer[J]. J Clin Otorhinolaryngol Head Neck Surg, 2017,31(14): 1127-1129. doi:10.13201/j.issn.1001-1781.2017.14.019.
[16] Bajaj Y, Uppal S, Sharma RK, et al. Evaluation of voice and quality of life after transoral endoscopic laser resection of early glottic carcinoma[J]. J Laryngol Otol, 2011, 125(7): 706-713. doi:10.1017/S002221511100065X.
[17] Wang GY, Li GD, Wu JJ, et al. Analysis of prognostic factors for Tis-2N0M0 early glottic cancer with different treatment methods[J]. Braz J Otorhinolaryngol, 2022, 88(3):375-380. doi:10.1016/j.bjorl.2020.06.013.
[18] 刘鸣. 早期声门癌的内镜治疗[J]. 山东大学耳鼻喉眼学报, 2019,33(4): 6-9. doi:10.6040/j.issn.1673-3770.1.2019.037. LIU Ming. Transoral laser microsurgery for early glottic neoplasms[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019,33(4): 6-9. doi:10.6040/j.issn.1673-3770.1.2019.037.
[19] Remacle M, Ricci-Maccarini A, Matar N, et al. Reliability and efficacy of a new CO2 laser hollow fiber: a prospective study of 39 patients[J]. Eur Arch Otorhinolaryngol, 2012, 269(3): 917-921. doi:10.1007/s00405-011-1822-5.
[20] 李玉杰, 于敏, 赵春红, 等. CO2激光联合等离子射频消融术治疗早期声门型喉癌临床观察[J]. 中国耳鼻咽喉颅底外科杂志, 2014,20(4): 345-347. doi:10.11798/j.issn.1007-1520.201404015 LI Yujie, YU Min, ZHAO Chunhong, et al. Application of CO2 laser combined with plasma radiofrequency ablation to the treatment of early glottic carcinoma[J]. Chin JOtorhinolaryngol-Skull Base Surg, 2014,20(4): 345-347. doi:10.11798/j.issn.1007-1520.201404015.
[21] 袁玉刚, 韩德民. 内窥镜下CO2激光喉癌切除术研究进展[J]. 中国眼耳鼻喉科杂志, 2001,6(3):106-108. doi:10.3969/j.issn.1671-2420.2001.03.027. YUAN Yugang, HAN Demin. Progress in endoscopic CO2 laser resection of laryngeal car-cinoma[J]. Chin J Ophthalmol Otolaryngol, 2001,6(3):106-108. doi:10.3969/j.issn.1671-2420.2001.03.027.
[22] Jing J, Li L, Zheng L, et al. Research on the efficacy of laryngendoscopic low-temperature plasma ablation on early glottic cancer[J]. J BUON, 2020, 25(5): 2382-2388.
[23] Chu PY, Hsu YB, Lee TL, et al. Longitudinal analysis of voice quality in patients with early glottic cancer after transoral laser microsurgery[J]. Head Neck, 2012, 34(9): 1294-1298. doi:10.1002/hed.21914.
[24] Kayhan FT, Koc AK, Erdim I. Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery[J]. Auris Nasus Larynx, 2019, 46(2): 285-293. doi:10.1016/j.anl.2018.08.015.
[25] Zapater E, Frías S, Pérez A, et al. Comparative study on chronic tissue damage after cordectomies using either CO2 laser or microdissection electrodes[J]. Head Neck, 2009, 31(11): 1477-1481. doi:10.1002/hed.21115.
[26] 王琦, 徐霖, 汪文斌, 等. 早期声门型喉癌CO2激光术后创面的动态观察[J]. 中华耳鼻咽喉头颈外科杂志, 2016,51(4):289-293. doi:10.3760/cma.j.issn.1673-0860.2016.04.010. WANG Qi, XU Lin, WANG Wenbin, et al. Wound healing following laser cordectomy forearly glottic carcinoma[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(4):289-293. doi:10.3760/cma.j.issn.1673-0860.2016.04.010.
[27] 喻博, 任树北, 朱旭, 等. CO2激光联合低温等离子治疗声门型喉癌的优势及疗效[J]. 中国疗养医学, 2019,28(10):1075-1076. doi:10.13517/j.cnki.ccm.2019.10.025. YU Bo, REN Shubei, ZHU Xu, et al. Advantage and efficacy of CO2 laser combined with Low-temperature plasma in the treatment of glottic carcinoma[J]. Chin J Convalescent Med, 2019, 28(10):1075-1076. doi:10.13517/j.cnki.ccm.2019.10.025.
[28] 戴俊, 怀德, 陈智斌. CO2激光联合低温等离子射频消融术治疗累及前联合早期声门型喉癌临床观察[J]. 中国肿瘤临床与康复, 2017,24(6): 670-672. doi:10.13455/j.cnki.cjcor.2017.06.09. DAI Jun, HUAI De, CHEN Zhibin. CO2 laser combined with plasma radiofrequency ablation at relatively low temperatures for early glottic cancer with anterior commissure involvement[J]. Chin J Clin Oncol Rehabilitation, 2017,24(6): 670-672. doi:10.13455/j.cnki.cjcor.2017.06.09.
[29] 章松林, 李建玲, 刘杰. CO2激光联合低温等离子治疗累及前联合早期声门型喉癌的远期预后及并发症观察[J]. 中国肿瘤临床与康复, 2019,26(11): 1200-1203. doi:10.13455/j.cnki.cjcor.2019.11.13. ZHANG Songlin, LI Jianling, LIU Jie. Long-term prognosis and complications in patients with glottic laryngeal carcinoma involving the anterior commissure treated by CO2 laser combined with low-temperature plasma therapy[J]. Chin J Clin Oncol Rehabilitation, 2019,26(11): 1200-1203. doi:10.13455/j.cnki.cjcor.2019.11.13.
[30] Rucci L, Romagnoli P, Scala J. CO2 laser therapy in Tis and T1 glottic cancer: indications and results[J]. Head Neck, 2010, 32(3): 392-398. doi:10.1002/hed.21200.
[31] Wu JH, Zhao J, Li ZH, et al. Comparison of CT and MRI in diagnosis of laryngeal carcinoma with anterior vocal commissure involvement[J]. Sci Rep, 2016, 6: 30353. doi:10.1038/srep30353.
[32] Ambrosch P. The role of laser microsurgery in the treatment of laryngeal cancer[J]. Curr Opin Otolaryngol Head Neck Surg, 2007, 15(2): 82-88. doi:10.1097/MOO.0b013e3280147336.
[33] 中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组, 中华医学会耳鼻咽喉头颈外科学分会头颈学组, 李晓明. 喉癌外科手术及综合治疗专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2014,49(8):620-626. doi:10.3760/cma.j.issn.1673-0860.2014.08.002. Editorial Board Head and Neck Surgery Group of Chinese Journal of OtorhinolaryngologyHead and Neck Surgery, Head and Neck Division of Otolaryngology Head and Neck Sur-gery Branch of Chinese Medical Association, LI Xiaoming. Expert consensus on laryngealcancer surgery and comprehensive treatment[J]. Chin J Otorhinolaryngol Head Neck Surg, 2014, 49(8):620-626. doi:10.3760/cma.j.issn.1673-0860.2014.08.002.
[34] Zhou J, Wen Q, Wang H, et al. Prognostic comparison of transoral laser microsurgery for early glottic cancer with or without anterior commissure involvement: a meta-analysis[J]. Am J Otolaryngol, 2021, 42(2): 102787. doi:10.1016/j.amjoto.2020.102787.
[35] 汪守峰, 戴俊, 怀德, 等. 声门型喉癌CO2激光显微手术治疗局部复发与前联合受侵犯对比分析[J]. 中华临床医师杂志(电子版), 2017,11(7): 1071-1074. WANG Shoufeng, DAI Jun, HUAI De, et al. Comparative analysis of CO2 laser microsurgery for the treatment of glottic carcinoma with local recurrence[J]. Chin J Clin Electron Ed, 2017, 11(7): 1071-1074.
[36] Rucci L, Ferlito A, Bradley PJ, et al. Can embryology influence clinicians concerning the “best therapy” for glottic cancer?[J]. Acta Otolaryngol, 2002, 122(7): 796-798. doi:10.1080/003655402_000028044.
[37] Peretti G, Piazza C, Cocco D, et al. Transoral CO2 laser treatment for Tis-T3 glottic cancer: The University of Brescia experience on 595 patients[J]. Head Neck, 2010, 32(8): 977-983. doi:10.1002/hed.21278.
[38] Wang CC, Liu SA, Wu SH, et al. Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports[J]. Head Neck, 2016, 38(6): 913-918. doi:10.1002/hed.24354.
[39] 李文明, 魏东敏, 钱晔, 等. 支撑喉镜下CO2激光治疗喉癌的疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 13-17. doi:10.6040/j.issn.1673-3770.1.2018.025. LI Wenming, WEI Dongmin, QIAN Ye, et al. Evaluate the curative effect of CO2 laser in treatment of laryngeal carcinoma[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(6): 13-17. doi: 10.6040/j.issn.1673-3770.1.2018.025.
[40] Ansarin M, Santoro L, Cattaneo A, et al. Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation[J]. Arch Otolaryngol Head Neck Surg, 2009, 135(4): 385-390. doi:10.1001/archoto.2009.10.
[41] 王恩彤. 早期声门型喉癌治疗方式的评价与选择[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(6):477-480. doi:10.3760/j.issn:1673-0860.2007.06.025. WANG Entong. Management of early glottic cancer[J]. Chin J Otorhinolaryngol Head Ne-ck Surg, 2007, 42(6):477-480. doi:10.3760/j.issn:1673-0860.2007.06.025.
[1] CHEN Guoping, FU Minyi, YE Fei, XU Jianhui. Comparative study of holmium and CO2 laser surgeries for early glottic carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 8-11.
[2] NIU Zijie, XIAO YangOverview,WANG Jun,MA LijinngGuidance. Progress in the surgical treatment of recurrent laryngeal papillomatosis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 96-100.
[3] ZHOU En, XIAO Yu, XIAO Xuping. Application progress of radiofrequency ablation technology in the treatment of early glottic carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 9-15.
[4] DOU Qianwen, TIAN Xiufen. Clinical analysis of 216 cases of congenital pyriform sinus fistula treated by radiofrequency ablation [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 43-49.
[5] XIAO Xuping, ZHOU En, XIAO Yu. Application of radiofrequency ablation with plasma spot excitation in early glottic carcinoma(Tis-T1b) [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 60-66.
[6] TIAN Tianjie, ZHANG Zixion, YANG Fei, ZHOU Yi. Effects of palatal arch suturing on postoperative hemorrhage after tonsillectomy [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 82-85.
[7] TAN Fengwu, DENG Yaping, LI Kehua. The therapeutic effects of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic carcinoma: a Meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 63-71.
[8] XU Jinjing, HU Jinghua, WU Yuanqing, DENG Yi, YU Weiwei. Applications of CO2 laser microsurgery on laryngeal precancerous lesions and early glottic laryngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 129-133.
[9] SHEN Min, QU Jining, JIANG Yidao. Evaluation the efficacy of a CO2 laser and traditional exfoliation in the treatment of vocal cord leukoplakia by using objective voice analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 67-70.
[10] XU Xia, DENG Wenting, HUANG Chengzhi, CHEN Yongting, WANG Jian. Curative effect analysis of endoscopic laryngeal surgery with plasma radiofrequency ablation versus open surgery to treat early glottic cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 81-85.
[11] Zhigang HUANG. Treatment of throat tumors with CO2 laser [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 1-3.
[12] Ming LIU. Treatment of epiglottic carcinoma by transoral laser microsurgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 4-7.
[13] Wenbin LEI,Qihong LIU. Progress in the treatment of recurrent respiratory papillomatosis using a CO2 laser [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 8-12.
[14] Wenming LI,Dongmin WEI,Ye QIAN,Shengda CAO,Ya XU,Dayu LIU,Xinliang PAN,Dapeng LEI. Evaluate the curative effect of CO2 laser in treatment of laryngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 13-17.
[15] Dayu LIU,Ruijie SUN,Xuexin LI,Zhen JIANG,Jianlin YUE,Yun LIN,Dapeng LEI,Xinliang PAN. Therapeutic effect of partial laryngectomy with CO2 laser in the treatment of bilateral vocal cord paralysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 18-21.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd