A comparison of histopathological results of conventional surgery and transoral radiofrequency ablation in early stage laryngeal carcinoma

Yıl 2013, Cilt: 23 Sayı: 6, 325 - 330, 25.12.2013

İbrahim Çukurova Murat Gümüşsoy Erdem Atalay Çetinkaya Ahmet Sabit Oğuz Orhan Gazi Yiğitbaşı Demet Etit

Öz

Objectives: This study aims to compare histopathological results of conventional surgery and transoral radiofrequency ablation in patients with early stage laryngeal carcinoma. Patients and Methods: Between January 2006 and May 2010, 36 patients 34 males, 2 females; mean age 61.6 years; range 43 to 77 years who underwent partial laryngectomy in our clinic were retrospectively analyzed. All patients were randomized to partial laryngectomy with radiofrequency ablation or conventional surgery. Hoarseness due to early stage T1 and selected T2N0 vocal cord lesions was an indication for surgery. Of 20 patients receiving conventional surgery, 14 underwent partial laryngectomy, while six patients underwent cordectomy for the excision of tumors. Tumors were excised by transoral radiofrequency ablation in 16 patients. Results: We observed thermal artifacts in four patients undergoing conventional surgery and in 13 patients undergoing transoral radiofrequency ablation. There was also hemorrhage in 16 patients undergoing conventional surgery and in seven patients undergoing transoral radiofrequency ablation. Histopathological examination revealed that the surgical margins were safe in 10 patients after radiofrequency ablation. The specimens obtained from six patients showed thermal artifacts which complicated histopathological examination. Sixteen 80% of 20 conventional surgery patients and nine 56% of 16 radiofrequency ablation patients had safe surgical margins. Conclusion: In radiofrequency ablation, the surgical zone must be larger than in conventional surgery due to the high risk of tissue damage and complicated histopathological examination.

Anahtar Kelimeler

Laryngeal carcinoma, partial laryngectomy, radiofrequency ablation, surgical zone, transora

Erken evre larenks karsinomunda konvansiyonel cerrahi ve transoral radyofrekans ablasyonunun histopatolojik sonuçlarının karşılaştırılması

Öz

Amaç: Bu çalışmada erken evre larenks karsinomlu hastalarda konvansiyonel cerrahi ve transoral radyofrekans ablasyonunun histopatolojik sonuçları karşılaştırıldı.Hastalar ve Yöntemler: Ocak 2006 - Mayıs 2010 tarihleri arasında kliniğimizde parsiyel larenjektomi yapılan 36 hasta 34 erkek, 2 kadın; ort. yaş: 61.6 yıl; dağılım: 43-77 yıl retrospektif olarak incelendi. Hastaların tümü radyofrekans ablasyonu ile birlikte parsiyel larenjektomiye veya konvansiyonel cerrahiye randomize edildi. Erken evre T1 ve seçilmiş T2N0vokal kord lezyonlarına bağlı ses kısıklığı, cerrahi endikasyonuydu. Konvansiyonel cerrahi uygulanan 20 hastanın 14’ünde parsiyel larenjektomi, altısında kordektomi ile tümörler eksize edildi. On altı hastada ise transoral radyofrekans ablasyon ile tümörler alındı.Bulgular: Konvansiyonel cerrahi yapılan dört hastada ve transoral radyofrekans ablasyon uygulanan 13 hastada termal artefaktlar gözlendi. Konvansiyonel cerrahi yapılan 16 hastada ve transoral radyofrekans ablasyon uygulanan yedi hastada ise kanama vardı. Histopatolojik incelemede radyofrekans ablasyonundan sonra 10 hastada cerrahi sınırların güvenli olduğu tespit edildi. Altı hastadan alınan örneklerde, histopatolojik incelemeyi güçleştiren termal artefaktlar izlendi. Konvansiyonel cerrahi yapılan 20 hastanın 16’sında 80% ve radyofrekans ablasyonu uygulanan 16 hastanın dokuzunda %56 cerrahi sınırlar güvenli bulundu.Sonuç: Yüksek doku hasarı ve zorlaşmış histopatolojik inceleme riski nedeniyle, radyofrekans ablasyonunda, konvansiyonel cerrahiye kıyasla, cerrahi alan daha geniş olmalıdır

Anahtar Kelimeler

Larenks karsinomu, parsiyel larenjektomi, radyofrekans ablasyonu, cerrahi alan, transoral

Kaynakça

• Shimm DS, Coulthard SW. Radiation therapy for squamous cell carcinoma of the supraglottic larynx. Am J Clin Oncol 1989;12:17-23.
• Spriano G, Antognoni P, Piantanida R, Varinelli D, Luraghi R, Cerizza L, et al. Conservative management of T1-T2N0 supraglottic cancer: a retrospective study. Am J Otolaryngol 1997;18:299-305.
• Looser KG, Shah JP, Strong EW. The significance of “positive” margins in surgically resected epidermoid carcinomas. Head Neck Surg 1978;1:107-11.
• Ho CM, Ng WF, Lam KH, Wei WI, Yuen AP. Radial clearance in resection of hypopharyngeal cancer: an independent prognostic factor. Head Neck 2002;24:181-90.
• Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society Member Survey. Head Neck 2005;27:952-8.
• Bäck LJ, Hytönen ML, Malmberg HO, Ylikoski JS. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment. Laryngoscope 2002;112:1806-12.
• Lee KC, Hwang PH, Kingdom TT. Surgical management of inferior turbinate hypertrophy in the office: three mucosal sparing techniques. Oper Tech Otolaryngol Head Neck Surg 2001;12:107-11.
• Cragle SP, Brandenburg JH. Laser cordectomy or radiotherapy: cure rates, communication, and cost. Otolaryngol Head Neck Surg 1993;108:648-54.
• Eckel HE, Thumfart WF. Laser surgery for the treatment of larynx carcinomas: indications, techniques, and preliminary results. Ann Otol Rhinol Laryngol 1992;101:49.
• Thumfart WF. Early cancer of the larynx: laser- surgery of larynx-carcinomas: indications, techniques and follow up. In: Johnson JT, Didolkar MS, editors. Head and neck cancer: proceedings of the Third International Conference on Head and Neck Cancer, San Francisco, July 26-30, 1992, Vol. 3. Amsterdam: Elsevier Science Publishing; 1993.
• Steiner W, Ambrosch P. The role of the phoniatrician in laser surgery of the larynx. In: Steiner W, Ambrosch P, editors. Endoscopic laser surgery of the upper aerodigestive tract. New York: Thieme; 2000. p. 124-9.
• Jazrawi LM, Chen A, Stein D, Heywood CS, Bernstein A, Steiner G, Rokito A. The effects of radiofrequency bipolar thermal energy on human meniscal tissue. Bull Hosp Jt Dis 2003;61:114-7.
• Chu PY, Hsu YB, Lee TL, Fu S, Wang LM, Kao YC. Longitudinal analysis of voice quality in patients with early glottic cancer after transoral laser microsurgery. Head Neck 2012;34:1294-8.