Gian Peppino Ledda

Lobular capillary hemangioma of the nasal cavity : A retrospective study on 40 patients

Background Nasal lobular capillary hemangioma (LCH) is a benign lesion of unknown etiology that must be included in the differential diagnosis of vascular lesions. Based on a large cohort of LCH patients, we retrospectively analyzed the clinical presentation, histological and radiological findings, and the treatment strategy. Methods Clinical records of 40 patients affected by LCH, treated in a 10-year period at two university hospitals, were reviewed. Data concerning symptoms, possible etiologic factors, endoscopic findings, imaging studies, and treatment were collected. Results Previous nasal trauma and pregnancy were identified as possible causes in six (15%) and two (5%) patients, respectively. The main symptoms were unilateral epistaxis (95%) and nasal obstruction (35%). Lesions ranged in size from 1 to 8 cm and mainly involved the nasal septum (45%) and the nasal vestibule (17.5%). In the four (10%) patients with a large lesion, radiological evaluation was helpful not only in assessing the extent, but also in suggesting the possible nature of the lesion. All patients underwent endoscopic resection under local (72.5%) or general (27.5%) anesthesia. At mean follow-up time of 53 months, no recurrence has been observed. Conclusion To the best of our knowledge, this is the largest series of patients with nasal LCH. When the mass is considerable in size, differentiation from other hypervascularized lesions may be intriguing. Under these circumstances, information obtained with imaging may sometimes suggest a correct diagnosis without resorting to biopsy. Endoscopic surgery is the treatment of choice even for large lesions, that do not require preoperative embolization.

Functional outcomes after CO2 laser treatment of early glottic carcinoma.

Objectives: To analyze vocal outcome after endoscopic CO2 laser treatment of early glottic carcinoma by perceptive and objective assessment.

Carbon dioxide laser microsurgery for early glottic carcinoma.

OBJECTIVES: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma. METHODS: A retrospective study of 103 patients with glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2) treated from October 1993 to June 2001. Surgical treatment included endoscopic CO2 laser cordectomies according to the classification of the European Laryngological Society. RESULTS: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 5 years after primary surgery alone was 100% for the Tis, 96.05% for the T1, and 100% for the T2. Local control at 5 years after exclusive CO2 laser salvage surgery was 98.03%. The probability of remaining free of local recurrence 5 years after any type of salvage surgery was 100%. Laryngeal preservation was achieved in 100% of the cases. CONCLUSIONS: According to the present series, endoscopic CO2 laser surgery is an effective treatment for early glottic cancer.

Carbon dioxide laser salvage surgery after radiotherapy failure in T1 and T2 glottic carcinoma.

OBJECTIVES: Recurrent glottic carcinoma after radiotherapy (RT) may be managed by open neck or endoscopic surgery. The impact of endoscopic treatment with CO2 laser for recurrent glottic carcinoma after RT is reported. METHODS: We present the oncologic and vocal outcomes of a retrospective study based on a series of 16 patients with rT1 and rT2 glottic carcinoma who were endoscopically managed between February 1995 and December 1999 after RT failure. All patients were males with a mean age of 68.7 years (range, 50 to 87 years). Before RT, the lesions had been staged as T1 N0 in 11 patients and T2 N0 in 5, and after RT as rT1 N0 in 12 and rT2 N0 in 4. According to the European Laryngological Society classification, a total of 9 transmuscular, 3 total, and 4 extended cordectomies were performed. Mean follow-up was 45 months (range, 9 to 79 months). RESULTS: Endoscopic salvage surgery was successful in 14 patients. One of them developed a second recurrence and was definitively cured with an additional endoscopic procedure. Two of the 16 patients had recurrent disease after salvage laser surgery and died due to progression of disease. Ultimate local control with laser alone at 3 years was 87.1%, according to the Kaplan-Meier method. Laryngeal preservation was obtained in all survivors after endoscopic rescue surgery. Voice analysis showed a clear correlation between the amount of vocal cord tissue resected and decrease of the vocal outcome. CONCLUSIONS: The present series indicates that selected recurrences after primary RT for T1 and T2 glottic carcinoma are eligible for endoscopic salvage surgery with oncologic results comparable to those with open neck procedures but with a lower complication rate and a favorable functional outcome.

Surgical therapy of T1 and selected cases of T2 glottic carcinoma: cordectomy, horizontal glottectomy and CO2 laser endoscopic resection.

Aims and background Among the different laryngeal neoplasms, glottic carcinoma is known to be one of the most suitable for functional management. Nevertheless, the best treatment for T1 and T2 glottic carcinoma, whether an open neck procedure, endoscopy or radiotherapy, with reference to recurrence, survival, and functional results, has long been debated. Study design From February 1983 to September 1997, 83 patients with well to undifferentiated glottic carcinoma (48 pT1a, 14 pT1b, and 21 selected cases of pT2 with impairment of vocal cord mobility) were submitted to surgery at the Otorhinolaryngologic Section of the Department of Surgical Sciences and Organ Transplantations of Cagliari University. Surgical treatment included 30 laryngofissures with simple or enlarged cordectomy, 22 horizontal glottectomies and 31 endoscopic laser resections. A retrospective review of the records of the patients was performed in order to obtain a better understanding of the outcome of the three different surgical procedures in our institution. Results According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 0.90 for the T1 group and 0.85 for the T2 group. The distribution of recurrences for cordectomy, glottectomy and CO2 laser at 3 years showed a cumulative probability of remaining free of disease after primary surgery of 0.86, 0.85 and 0.88. The probability of remaining free of local recurrence 3 years after salvage surgery was 0.96 for the T1 group and 0.95 for the T2 group. Analyzing the phenomena for type of surgical procedure, local control at 3 years after salvage surgery for cordectomy, glottectomy and exclusive CO2 laser was 0.93, 0.90 and 0.92, respectively. In the endoscopic group, local control rate after any type of salvage therapy modified the percentage at 3 years to 100%. Anterior commissure spread (AC1-AC2) resulted in a difference (not statistically significant) in local control between the group of patients without and with anterior commissure involvement. Laryngeal preservation was achieved in 93.7% (45/48) of patients who survived after salvage surgery following open neck procedures and in 100% of patients originally submitted to the endoscopic approach. Conclusions In our experience, although open laryngeal procedures can be still considered a valid option in the treatment of T1 and selected cases of T2 glottic carcinoma, endoscopic laser excision offered an oncologically adequate alternative to the traditional techniques, with minimum discomfort for the patient and satisfactory preliminary functional results.

Thyroarytenoid muscle invasion in T1 glottic carcinoma

We report the prevalence of thyroarytenoid (TA) muscle invasion in 109 consecutive patients with T1 glottic carcinoma submitted to endoscopic laser cordectomy between February 1997 and January 2006, in order to evaluate if routine resection of the TA is necessary. A total of 109 patients staged as T1 underwent endoscopic treatment with carbon dioxide laser (CO2), 36 cases were treated with type I or II cordectomies, and 73 patients underwent type III, IV or V cordectomies, with resection of all or part of the TA. Over a total of 109 patients, 6 (5.5%) cases staged as pT1 showed TA invasion. The endoscopic treatment of T1 glottic cancer should be as conservative as possible in terms of TA resection, since muscle invasion is rare. In many cases, type III and IV cordectomies can be regarded as excessive treatment. Muscle invasion found histologically after type II cordectomy can be managed by further excision.

CO2 Laser Microsurgery for Tis, T1, and Selected Cases of T2 Glottic Carcinoma

Objectives: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma. Methods: Retrospective study of 103 patients with well to undifferentiated glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2 with impairment of vocal cord mobility) were treated from October 1993 to June 2001 at the Section of Otorhinolaryngology at the Department of Surgical Sciences and Organ Transplantations of Cagliari University, Italy. Mean follow-up was 3.9 years. Surgical treatment included endoscopic CO2 laser cordectomies from type I to type Vc, according to the classification proposed by the European Laryngological Society in 2000. Results: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 100% for the Tis group, 93.4% for the T1 group (SE 3.85%) and 100% for the T2 group. Local control at 3 years after exclusive CO2 laser salvage surgery was 94.95% (SE 3.54%). The probability of remaining free of local recurrence 3 years after any type of salvage surgery was 100% for all the classes. Laryngeal preservation was achieved in 100% of the cases. Anterior commissure spread resulted in a not statistically significant difference in local control (P = 0.6), between the group of patients without (96.54%; SE 2.43%) and with anterior commissure involvement (87.5%; SE 11.69%). Conclusions: According to our experience, endoscopic CO2 laser surgery is an efficacious treatment for early stage glottic cancer.