Organ Preservation Surgery For Laryngeal Cancer

Organ Preservation Surgery for Laryngeal Cancer Following Failed Radiation Therapy Hedyeh Javidnia January 14 th , 2008 Grand Rounds University of Ottawa Department of Otolaryngology and Head and Neck Surgery

Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case of Mr. L ,[object Object],[object Object],[object Object],[object Object]

Case of Mr. L ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What constitutes laryngeal organ preservation surgery? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Principles of Organ Preservation Surgery 1 ,[object Object],[object Object],[object Object],[object Object],1. Tufano R. et. al. Organ preservation surgery for laryngeal cancer. Otolaryngol Clin N Am. 2008; 41: 741-755

Radiation failure & Total Laryngectomy ,[object Object],[object Object],2. Grisen O et. al. Consecutive series of patients with laryngeal carcinoma treated by primary irradiation. Acta Oncol 1997; 36:279-282 3. Hawkins NV et al. The treatment of glottic carcinoma: an analysis of 800 cases. Laryngoscope 1975; 85:1485-93

First step is identification: Challenges ,[object Object],[object Object],4. Zbaren P. et. al. Pretherapeutic staging of recurrent laryngeal carcinoma: clinical findings and imaging studies compared with histopathology. Otolaryngol Head and Neck Surg. 2007; 137:487-491. 5. De Bree R, et. al. A randomized trial of PET scanning to improve diagonostic yield of direct laryngoscopy in pateints with suspicion of recurrent laryngeal carcinoma after radiotherapy. Contemp Clin Trials 2007; 28:705-712

Diagnostic steps: Clinical ,[object Object],[object Object],[object Object],[object Object],[object Object],6. Marioni et. al. Current opinion in diagnosis and treatment of laryngeal carcinoma. Cancer Treatment Rev. 2006; 32:504-515

Diagnostic steps: Radiographic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],7. Becker M. Neoplastic invasion of laryngeal cartilage: radiologic diagnosis and therapeutic implications. Eur J Radiol 2000; 33:216-229.

TNM Definitions AJCC 6 th Ed. 2002 ,[object Object],[object Object],[object Object],[object Object]

Supraglottis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Glottis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Subglottis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Regional lymph nodes (N) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Distant metastasis (M) ,[object Object],[object Object],[object Object]

AJCC Stage Groupings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stage IVA T4a, N0, M0 T4a, N1, M0 T1, N2, M0 T2, N2, M0 T3, N2, M0 T4a, N2, M0 Stage IVB T4b, any N, M0 Any T, N3, M0 Stage IVC Any T, any N, M1

Back to Case of Mr. L ,[object Object],[object Object],[object Object],[object Object],[object Object]

Transoral Laser Surgery: Inclusion Criteria 8 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],8. Motamed M, et. al. Salvage conservation laryngeal surgery after irradiation failure for early laryngeal cancer. Laryngoscope 2006; 116:451-455

Transoral Laser Surgery: Reported advantages 9 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9. Piazza C, et. al. Salvage surgery after radiotherapy for laryngeal cancer: from endoscopic resections to open-neck partial and total laryngectomies. Arch Otolaryngol Head and Neck Surg 2007; 133:1037-1043

Transoral Laser Surgery: Operative considerations 10 ,[object Object],[object Object],[object Object],[object Object],10. Bradley PJ, et. al. Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma. Eur Arch Otorhinolaryngol 2006; 263:889-894

Transoral Laser Surgery: Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transoral Laser Surgery: Outcomes Steiner W, et. al. 11 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Transoral Laser Surgery: Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transoral Laser Surgery: Complications 8 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Vertical Partial Laryngectomy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vertical Partial Laryngectomy: Contraindications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vertical Partial Laryngectomy: Operative Considerations ,[object Object],[object Object],[object Object],[object Object],12. Sewnaik A. et. al. Partial Laryngectomy for recurrent glottic carcinoma after radiotherapy. Head and Neck 2005; 27:101-107.

Vertical Partial Laryngectomy: Outcomes 13 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],13. Yotakis et. al. Partial laryngectomy after irradiation failure. Otolaryngol Head and Neck Surg. 2003; 128: 200-209

Vertical Partial Laryngectomy: Outcomes 13 ,[object Object],[object Object],[object Object]

Vertical Partial Laryngectomy: Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Supracricoid Laryngectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Supracricoid Laryngectomy: Contraindications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Makeieff et. al. 14 Laryngoscope 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pellini et. al. 15 Head and Neck 2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Supracricoid Laryngectomy: Outcomes 16 ,[object Object],[object Object],[object Object],[object Object],16. Marioni G, et. al. The role of supracricoid partial laryngectomy for glottic carcinoma recurrence after radiotherapy failure: A critical review. Acta Otolaryngol 2006; 126:1245-1251

Supracricoid Laryngectomy: Complications 16 ,[object Object],[object Object],[object Object],[object Object]

Overall Review ,[object Object]

Motamed et. al. 8 Laryngoscope 2006 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Motamed et. al. Laryngoscope 2006 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Motamed et. al. Laryngoscope 2006 ,[object Object],[object Object],[object Object],[object Object]

Horizontal Partial Laryngectomy ,[object Object],[object Object],[object Object]

Complications of partial laryngectomies exacerbated by previous radiation ,[object Object],[object Object]

Neck Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

Back to Case of Mr. L ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Canadian Perspective ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusion ,[object Object],[object Object],[object Object],[object Object]

Organ Preservation Surgery For Laryngeal Cancer

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Organ Preservation Surgery For Laryngeal Cancer