Francesca Del Bon

Transoral CO2 laser treatment for Tis–T3 glottic cancer: The University of Brescia experience on 595 patients

Transoral CO2 laser surgery has been accepted as a valuable therapeutic option for glottic cancer.

Narrow band imaging and high definition television in the assessment of laryngeal cancer: a prospective study on 279 patients

Narrow band imaging (NBI) is an optical technique in which a filtered light reveals superficial carcinomas in view of their neoangiogenic pattern. The accuracy of NBI is implemented by combining it with a high definition television (HDTV) camera. The aim of this study was to prospectively evaluate the diagnostic gain of NBI and HDTV in the assessment of laryngeal squamous cell carcinoma (LSCC). Between April 2007 and December 2008, we analyzed by NBI with or without HDTV 279 patients divided in two groups: Group A included 96 patients affected by LSCC and Group B included 183 subjects under follow-up after treatment for the same disease. Overall, 50 of 279 patients (18%) showed “suspicious” NBI findings histologically confirmed as neoplastic. The sensitivity, specificity, accuracy, positive and negative predictive rates of flexible NBI, HDTV with white light, and HDTV with NBI in both groups confirmed the value of these two technologies. In the pre- and intraoperative settings, NBI with or without HDTV provided better definition of tumor staging and surgical margins. NBI has also a role in the postoperative setting, due to its ability in early detection of persistences, recurrences, and metachronous tumors.

Intraoperative Narrow Band Imaging Better Delineates Superficial Resection Margins During Transoral Laser Microsurgery for Early Glottic Cancer

Objective: The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM. Methods: Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test. Results: At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort (P < .001). Conclusion: Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer.

Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore.

To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.

Quantitative analysis of videokymography in normal and pathological vocal folds: a preliminary study

Videokymography (VKG) captures high-speed images of the vocal folds independently of the periodicity of the acoustic signal. The aim of this study was to preliminarily assess a software package that can objectively measure specific parameters of vocal fold vibration. From August 2009 until December 2010, we prospectively evaluated 40 subjects (Group A, 18 normal subjects; Group B, 14 patients with benign lesions of the middle third of the vocal fold, such as polyps and cysts; Group C, 8 patients treated by endoscopic excision of vocal fold benign lesions) by videoendoscopy, videolaryngostroboscopy, and VKG. A VKG camera was coupled to a 70° telescope and video was recorded during phonation. Images were objectively analyzed by a post-processing software tool (VKG-Analyser) with a user-friendly interface developed by our group. Different parameters were considered, including the ratio between the amplitude of the vibration of one vocal fold with respect to the contralateral (Ramp), the ratio between the period of one vocal fold vibration and the opposite one (Rper), and the ratio between the duration of the open and closed phase within a glottal cycle (Roc). Mean values for Ramp, Rper, and Roc in Group A were 1.05, 1.04, and 1.35, respectively; in Group B were 1.63, 0.92, and 0.97, respectively; and in Group C were 1.13, 0.91, and 1.85, respectively. Quantitative analysis of videokymograms by the herein presented tool, named VKG-Analyser, is useful for objective evaluation of the vibratory pattern in normal and pathologic vocal folds. Important future developments of this tool for the study of both physiologic and pathologic patterns of vocal fold vibration can be expected.

'Biologic endoscopy': optimization of upper aerodigestive tract cancer evaluation.

Purpose of reviewEndoscopy is the first-line examination and most reliable way to get precise bidimensional assessment of the superficial extent of a squamous cell cancer arising within the upper aerodigestive tract (UADT). Its role as the cornerstone at each diagnostic step in the evaluation of head and neck cancer patients, in both treatment and follow-up, cannot be overemphasized. A number of technological improvements have been introduced to enhance conventional white light endoscopy of the UADT, in order to provide deeper insight into the specific biological properties of observed lesions. The purpose of this review is to summarize the most recent trends in ‘biologic endoscopy’ techniques. Recent findingsStarting from the use of toluidine blue up to the most recent light-based detection systems such as autofluorescence and narrow band imaging, researchers have devoted substantial efforts to the identification of specific biological properties of neoplastic tissues that can be targeted by new endoscopic tools. These aids attempt to assist the surgeon in achieving a more reliable distinction between normal and neoplastic or precancerous mucosa, within a wide range of inflammatory and iatrogenic modifications. SummaryEven though direct comparison of the efficacy of these techniques is seldom feasible due to their site-specific application, different advantages and disadvantages, economic considerations, and limited diffusion in daily practice, it is nevertheless clear that the future of endoscopy of the UADT will be strongly influenced by these new technologies.

Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

T3 laryngeal cancer encompasses heterogeneous lesions whose treatment is still debated. The purpose of this study was to evaluate transoral laser microsurgery (TLM) in management of selected T3 glottic and supraglottic cancers.

Organ preservation surgery for low‐ and intermediate‐grade laryngeal chondrosarcomas: Analysis of 16 cases

To demonstrate that endoscopic resection (ER), open partial laryngectomies, and cricotracheal resection and anastomosis (CTRA) achieve a good balance between oncologic radicality and organ preservation for laryngeal low‐grade chondrosarcoma (LCS) and intermediate‐grade chondrosarcoma (ICS).

Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

Objective: This study aimed to evaluate complications and success rates of tracheal resection and anastomosis (TRA) and cricotracheal resection and anastomosis (CTRA) in patients treated in 2 academic institutions. Methods: Retrospective charts review of 137 patients submitted to TRA/CTRA. Fifty (36.5%) had neoplastic (group A) and 87 (63.5%) benign (group B) stenoses. Using univariate analysis, age, medical comorbidities, previous radiotherapy, type of TRA/CTRA, association with neck dissection and thyroidectomy, length of resected airway, and preoperative tracheotomy were evaluated to identify factors predictive of complications and outcomes. Results: The mean length of resected airway was 2.7 and 3 cm in groups A and B, respectively. Overall decannulation and complication rates for group A were 96% and 36%, and 99% and 46% for group B, respectively. Length of airway resected and presence of preoperative tracheotomy had a statistically significant effect on major surgical complications. Age older than 70 and cardiovascular and pulmonary comorbidities were significantly associated with the incidence of major medical complications. No statistically significant difference was found considering the complication rates of group A versus group B. Conclusion: Even though the overall success rate of TRA/CTRA is high, it should always be regarded as a major surgical procedure with a non-negligible incidence of complications.

Functional outcomes after different types of transoral supraglottic laryngectomy

To seek a correlation between the four types of transoral supraglottic laryngectomies (TSLs) according to the European Laryngological Society (ELS) and postoperative morbidity.