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Objectives The aim of this article was to describe the surgical technique and report the oncological and functional outcomes of the partial glottic-subglottic laryngectomy (GSL). Methods A retrospective review of the clinical charts of patients who underwent GSL for laryngeal cancer from 1989 to 2020 at the Otolaryngology Unit of the Vittorio Veneto Hospital, a referral center for laryngeal cancer treatment. Results The present article considered 36 patients who were submitted to GSL for laryngeal cancer. The pathological exam found squamous cell carcinoma (SCC) in 16 cases, adenoid-cystic carcinoma (ACC) in 9 cases, laryngeal chondrosarcoma in 8 cases, 1 giant cell carcinoma, 1 carcinosarcoma, and 1 metastasis of colon adenocarcinoma. Considering the 16 SCC cases we observed a recurrence rate of 31%, the overall survival (OS) and disease-specific survival (DSS) were 75%. The 9 ACC cases had a recurrence rate of 23% and OS/DSS of 88%. In the 8 chondrosarcomas no relapses were reported and the OS/DSS were 100%. Among the patients without recurrence of the disease, a definitive decannulation was achieved in 21 cases (75%). Conclusions The GSL represents a valid alternative to total laryngectomy in selected cases of laryngeal cancer involving the glottic and subglottic regions.

Lo spazio tiro-crico-aritenoideo (TCAS): implicazioni cliniche e prognostiche nel carcinoma laringeo.La recente letteratura riguardante la chirurgia oncologica laringea si sta sempre più focalizzando sul significato prognostico negativo del coinvolgimento da parte della neoplasia della porzione posteriore dello spazio paraglottico inferiore, che può essere definito spazio “tiro-crico-aritenoideo” (TCAS). Abbiamo valutato retrospettivamente il significato prognostico del coinvolgimento di tale sito anatomico in una coorte di 84 pazienti trattati con laringectomia parziale orizzontale open. È stato inoltre valutato mediante analisi univariata il significato prognostico dei parametri clinici e patologici. I casi con coinvolgimento del TCAS hanno avuto un maggior tasso di recidiva ed una minore sopravvivenza libera da malattia, rispetto ai casi senza coinvolgimento dello stesso. In conclusione, le neoplasie coinvolgenti questo sito laringeo dovrebbero essere considerate e trattate come tumori extra-laringei. I carcinomi glottici posteriori con invasione del TCAS hanno una prognosi peggiore quando gestiti mediante chirurgia conservativa. Nei casi di carcinoma glottico localmente avanzato con coinvolgimento del TCAS la laringectomia totale dovrebbe essere considerata il trattamento di scelta.The recent literature on laryngeal surgical oncology has increasingly focused on the negative prognostic impact of neoplastic involvement of the posterior portion of the inferior paraglottic space, which we refer to as the “thyro-cricoarytenoid space” (TCAS). We retrospectively considered the prognostic significance of TCAS involvement in a cohort of 84 patients treated with open partial horizontal laryngectomy for glottic squamous cell carcinoma. Univariate analysis was conducted on the prognostic value of several clinical and pathological parameters. Cases with TCAS involvement experienced a higher recurrence rate and shorter disease-free survival. Neoplasms involving the TCAS should be considered and treated as extralaryngeal malignancies. Posterior glottic tumours with TCAS invasion have worse prognosis when managed with conservative surgery. Total laryngectomy should be considered in cases of locally-advanced glottic carcinoma with TCAS involvement.

Background The involvement of the thyroarytenoid (TA) muscle by glottic cancer may be related to an impaired vocal cord mobility, which is classified as cT2 disease. The primary endpoint was to evaluate the prognostic significance of TA muscle involvement in early glottic cancer treated with transoral laser microsurgery (TLM). Methods A review was conducted on a cohort of 209 patients consecutively treated with TLM for early glottic carcinoma. Univariate analysis was used to examine the prognostic meaning of clinical and pathological parameters. Results The statistical analysis showed that TA muscle infiltration correlated significantly with a worse prognosis in terms of recurrence rate and disease-free survival, and this was confirmed even in the subcohort with pT1a glottic cancer. Conclusions Our preliminary findings suggest that it could be considered as a criterion for upstaging a glottic cancer from pT1 to pT2.

Patterns di recidiva dopo intervento di laringectomia parziale orizzontale tipo II e III: analisi univariata e regressione logistica dei fattori di rischio.Nella scelta del trattamento chirurgico (laringectomia totale o parziale) in pazienti affetti da carcinoma laringeo, è ancora necessaria l’identificazione di una correlazione tra fattori prognostici e risultati oncologici. Una coorte multi-istituzionale di 819 pazienti affetti da carcinoma laringeo e sottoposti a laringectomia parziale orizzontale (OPHL) tipo II e tipo III dal 1995 al 2014 è stata suddivisa in base alla comparsa o meno di recidiva (108 vs 711) ed alla sede di ricomparsa di malattia (loco-regionale, locale, a distanza). Sono state analizzate, mediante analisi uni e multivariata, tredici variabili cliniche e istologiche nei due gruppi, in relazione agli esiti oncologici (OS, DFS, DSS, LSF, FFL). All’analisi multivariata quattro sono risultati i fattori determinanti rischio di recidiva: sede del tumore (maggiormente nei tumori sopraglottici), invasione cartilaginea (maggiormente se presente), invasione perineurale (maggiormente se presente) ed il tipo di OPHL (maggiormente in caso di OPHL tipo III). La conoscenza e la detezione dei fattori prognostici negativi per il rischio di recidiva (classificazione pN, interessamento cartilagineo, invasione perineurale e quindi trattamento chirurgico adottato) potrebbero aumentare le già note potenzialità delle OPHL nel trattare casi con indicazione certa dopo attenta discussione collegiale.In choosing the best surgical treatment (total or partial laryngectomy) for patients affected by laryngeal squamous cell carcinoma (SCC), it is still necessary to identify a link between prognostic factors and oncological outcomes. A retrospective analysis of clinical outcomes of 819 patients affected by laryngeal cancer who underwent OPHL type II and III between 1995 to 2014 was carried out. Focusing on recurrence and its site (local, regional or distant), our cohort has been divided in two groups: patients showing recurrence (n = 108) vs those without recurrence (n = 711). Thirteen clinical-pathological parameters have been studied by univariate and multivariate analysis to identify possible correlations between recurrence and oncological outcomes (overall survival (OS), disease free survival (DFS), disease specific survival (DSS), laryngectomy free survival (LSF), laryngectomy free freedom (FFL). In multivariate analysis, we found 4 negative prognostic factors for recurrence: site of tumour (supraglottic), cartilage invasion (if present), perineural invasion (if present) and type of OPHL (in OPHL type III). The knowledge and detection of negative prognostic factors for the risk of recurrence (pN classification, cartilage involvement, perineural invasion, and thus the type of surgical treatment adopted) could increase the already well-established potentiality of OPHLs in treating cases with a safe indication after careful discussion in the tumour board.

Background: The Prognostic Nutritional Index (PNI) is a parameter of nutritional and inflammation status related to toxicity in cancer treatment. Since data for head and neck cancer are scanty, this study aims to investigate the association between PNI and acute and late toxicity for this malignancy. Methods: A retrospective cohort of 179 head and neck cancer patients treated with definitive radiotherapy with induction/concurrent chemotherapy was followed-up (median follow-up: 38 months) for toxicity and vital status between 2010 and 2017. PNI was calculated according to Onodera formula and low/high PNI levels were defined according to median value. Odds ratio (OR) for acute toxicity were calculated through logistic regression model, hazard ratios (HR) for late toxicity and survival were calculated through the Cox proportional hazards model. Results: median PNI was 50.0 (interquartile range: 45.5–53.5). Low PNI was associated with higher risk of weight loss &gt, 10% during treatment (OR = 4.84, 95% CI: 1.73–13.53 for PNI &lt, 50 versus PNI ≥ 50), which was in turn significantly associated with worse overall survival, and higher risk of late mucositis (HR = 1.84, 95% CI:1.09–3.12). PNI predicts acute weight loss &gt, 10% and late mucositis. Conclusions: PNI could help clinicians to identify patients undergoing radiotherapy who are at high risk of acute and late toxicity.

This study prospectively assessed the 6-month prevalence of self-reported and psychophysically measured olfactory dysfunction in subjects with mild-to-moderate COVID-19. Self-reported smell or taste impairment was prospectively evaluated by SNOT-22 at diagnosis, 4-week, 8-week, and 6-month. At 6 months from the diagnosis, psychophysical evaluation of olfactory function was also performed using the 34-item culturally adapted University of Pennsylvania Smell Identification Test (CA-UPSIT). 145 completed both the 6-month subjective and psychophysical olfactory evaluation. According to CA-UPSIT, 87 subjects (60.0%) exhibited some smell dysfunction, with 10 patients being anosmic (6.9%) and seven being severely microsmic (4.8%). At the time CA-UPSIT was administered, a weak correlation was observed between the self-reported alteration of the sense of smell or taste and olfactory test scores (Spearman’s r = −0.26). Among 112 patients who self-reported normal sense of smell at last follow-up, CA-UPSIT revealed normal smell in 46 (41.1%), mild microsmia in 46 (41.1%), moderate microsmia in 11 (9.8%), severe microsmia in 3 (2.3%), and anosmia in 6 (5.4%) patients; however, of those patients self-reporting normal smell but who were found to have hypofunction on testing, 62 out of 66 had a self-reported reduction in sense of smell or taste at an earlier time point. Despite most patients report a subjectively normal sense of smell, we observed a high percentage of persistent smell dysfunction at 6 months from the diagnosis of syndrome coronavirus 2 (SARS-CoV-2) infection, with 11.7% of patients being anosmic or severely microsmic. These data highlight a significant long-term rate of smell alteration in patients with previous SARS-COV-2 infection.

To evaluate the functional and oncologic outcomes of adjuvant (chemo)radiation [(C)RT] after open partial horizontal laryngectomies (OPHLs). Multicenter retrospective evaluation of 130 patients (116 males, 14 females) submitted between 1995 and 2017 to OPHL Types II and III for laryngeal cancer and receiving adjuvant (C)RT for one or more of the following risk factors at histopathologic examination of the surgical specimen: pT4a and/or > pN2a categories, close/positive resection margins, or presence of both perineural (PNI) and lympho-vascular invasion (LVI). The primary study endpoints were evaluation of the presence of tracheostomy and/or gastrostomy at last follow-up, and calculation of laryngo-esophageal dysfunction-free survival (LEDFS). Mean age of the study cohort was 60.8 ± 8.9 years (median, 62; interquartile range [IQR], 13). Mean follow-up was 50.7 ± 39.4 months (range 24–188; median, 38; IQR, 51). Adjuvant therapy consisted of CRT in 53 (41%) patients, and RT alone in 77 (59%). Five-year LEDFS was 85%. Overall survival was 71.5%, while 13% of patients remained tracheostomy- and 3% gastrostomy-dependent at the last follow-up. The only significant variable in predicting survival (p = 0.020) was tracheostomy dependence: it was maintained in 7.5% of subjects after OPHL Type II and in 34% of those submitted to OHPL Type III (p

Objectives To evaluate and compare the oncological and functional outcomes of total laryngectomies (TL) performed as first line treatment or for salvage after failure of conservative approaches for treating advanced laryngeal carcinoma (LSCC). Study design A retrospective cohort study. Methods A cohort of 217 patients who underwent TL was divided according to whether the procedure was for primary treatment of their LSCC (101 patients) or for recurrences after conservative surgery or chemo-radiotherapy (116 patients). Results The overall survival rate and disease-specific survival rate were significantly higher in the primary TL group than in the salvage TL group (P = .04 and P = .01, respectively). The recurrence rate was significantly higher and the disease-free survival (in months) was shorter for patients who had salvage TL than for those who had primary TL (P = .00 and P = .01, respectively). The salvage TL group also included significantly more cases of postoperative pharyngo-cutaneous fistula needing salivary stent positioning, and experienced significantly longer hospital stays than the primary TL group (P = .04 and P = .03, respectively). Conclusion Oncological and functional outcomes of primary TL were significantly better than after salvage TL. If salvage TL was performed after conservative surgery had failed, the oncological and functional results were better than after the failure of organ-preserving protocols. This could justify a first attempt at conservative surgery for intermediate-advanced LSCC in selected cases, reserving chemo-radiotherapy only for patients unsuitable for surgery. Level of evidence 4 Laryngoscope, 131:E569-E575, 2021.

Background Major pharyngeal defects after total pharyngolaryngectomy for hypopharyngeal squamous cell carcinoma (SCC) frequently demand reconstruction strategies that include myocutaneous pedicled flaps, such as the pectoralis major flap. Methods We retrospectively reviewed the clinical charts of 24 patients with hypopharyngeal SCC treated with Bocca's hemipharyngo-total laryngectomy (HPTL) at our Institution. Results Eighteen patients (80%) experienced no disease recurrence after primary surgery and were alive with no evidence of disease after a mean follow-up of 43 months. The 2-year overall survival (OS) and disease-specific survival (DSS) rates in our sample were 69% and 82%, respectively. Conclusion Bocca's HPTL enables an immediate neopharyngeal reconstruction, and is indicated in selected patients with intermediate to advanced hypopharyngeal tumors.

Purpose The present paper describes our experience in surgical treatment of laryngeal ACC, and discuss the effectiveness of conservative surgery. Methods We retrospectively reviewed the clinical charts of 17 patients with laryngeal ACC treated surgically at the Otolaryngology Unit of Vittorio Veneto Hospital (Italy) from November 1989 to April 2020. Results Fourteen patients underwent partial laryngectomy, and three had a total laryngectomy. Five patients (29%) experienced a laryngeal ACC relapse after a disease-free survival of 66.6 ± 50.1 months. The distant metastasis rate was 17%. At latest follow-up, two patients had died of distant metastatic disease after 156 and 243 months. Conclusions Radical surgery for laryngeal ACC does not warrant free margins and even cases with positive deep margins rarely experience any relapsing disease. We recommend that surgical treatment for laryngeal ACC be as conservative as possible.

Objectives To evaluate the effect of preepiglottic space (PES) dissection in the endoscopic supraglottic laryngectomy (ESL). Study Design A retrospective cohort study. Methods We retrospectively compared 15 patients who underwent ESL with 15 patients matched for clinical stage who underwent open partial horizontal laryngectomy (OPHL). The functional outcomes were assessed in terms of hospital stay; need for nasal feeding tube (NFT) and tracheostomy, as well as duration of their use; postoperative complications; aspiration pneumonia rates; voice quality; and dysphagia. Results Among the ESL cases, combined dissection of the epiglottis and PES (type III) had a negative impact on functional outcomes. ESL patients experienced shorter hospital stays, as well as shorter use of NFT and tracheostomy, than patients who had OPHL. Conclusion Combined dissection of the epiglottis and PES (ESL type III) negatively affected functional outcome in patients undergoing ESL, a procedure generally related to significantly better functional outcomes than OPHL type I. Level of Evidence 4. Laryngoscope, 2017

Background The purpose of this study was to present our findings on the involvement of paratracheal lymph nodes in laryngeal squamous cell carcinoma (SCC) with subglottis extension, which is controversial. Methods We assessed 196 patients with laryngeal SCC involving the subglottis, treated with open laryngeal surgery with or without paratracheal neck dissection (PTND). The relationship of the paratracheal lymph node metastatic pattern with laterocervical nodal status and tumor location within different subglottic subsites was analyzed. The influence of PTND on regional disease control was assessed. Results Paratracheal lymph nodes were affected in 12.2% of cases. An increased frequency (P = .064) of paratracheal metastasis was noticed in case of anterior subglottis extension with respect to other subsites. A correlation (P

Surgery for early-intermediate oropharyngeal squamous cell carcinoma (OPSCC) may involve using transoral endoscopic approaches or open surgical procedures. "Lateral pharyngotomy" (LP) is an open surgical approach that improves exposure of the oropharyngeal region, while avoiding mandibulotomy. The aim of the present study was to retrospectively analyze our experience with the surgical treatment of early-intermediate OPSCC using the LP approach, and to investigate the potentially prognostic clinical and/or pathological factors that might identify patients at higher risk of recurrence after primary surgery. Sixty-four patients with previously untreated early-intermediate (pT1-T2-T3) OPSCC consecutively underwent partial pharyngectomy using a LP approach, performed by the same surgical team at a tertiary head and neck oncology center (Otolaryngology Unit, Vittorio Veneto Hospital, Italy). The 2-year disease-specific survival rates were 86% for stage I-II and 77% for stage III-IV disease. All patients who experienced locoregional or distant metastases died of their disease, while no patients died of any complications of the treatment. Postoperative complications occurred in 25 patients (39%), the most common being pharyngocutaneous fistula. All but one of the patients experienced a complete recovery of oral food intake. In conclusion, the LP approach to oropharyngeal cancer could be a valid open surgical alternative to oropharyngectomy with mandibulotomy for: (a) patients with early-intermediate OPSCC in whom oropharyngeal exposure proves difficult, and/or who are not eligible for transoral endoscopic surgery; (b) HPV-negative OPSCCs; and

A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter- and intra-rater agreement was assessed using unweighted Cohen’s kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter- and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.

BACKGROUND Given the relevance of any tumor invasion of the arytenoid cartilage or crico-arytenoid unit to the planning open partial horizontal laryngectomy (OPHL) for laryngeal squamous cell carcinoma (LSCC), it is important to have a reliable radiological test to assess impairments of these structures. METHODS We retrospectively compared the endoscopic, radiological, and pathological findings in patients with glottic LSCC who underwent OPHL. RESULTS The endoscopic finding of a reduced (impaired or absent) vocal cord motility proved more sensitive, with better positive and negative predictive values, but less specific than the radiological finding of complete arytenoid sclerosis in detecting histologically assessable infiltration of the arytenoid cartilage. CONCLUSIONS Endoscopy retains a key role in the preoperative workup for glottic LSCC. CT evidence of complete sclerosis of the arytenoid cartilage is related to a dangerous contiguity of the tumor to the cartilage.

Background The purpose of this retrospective study was to identify subcategories in cT3 to cT4a supraglottic/glottic cancers, describing their different spreading patterns, and local and locoregional recurrence modes. Methods Four hundred eighty-nine patients who underwent open partial horizontal laryngectomies (OPHLs) were retrospectively classified as: subcategory I (anterior pT3 with normal arytenoid mobility); subcategory II (posterior pT3 with impaired/absent mobility); subcategory III (anterior pT4 with normal mobility); and subcategory IV (posterior pT4 with impaired/absent mobility). Results Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional, local control, freedom from laryngectomy, and laryngectomy-free survival were significantly better in anterior tumors (subcategories I and III) when compared with the corresponding posterior ones (subcategories II and IV). Conclusion Anterior cT3 tumors are manageable by OPHL, and this approach could also be proposed in the treatment of early anterior cT4aN0. Despite promising results, OPHLs should be considered under investigation in posterior cT3 tumors due to clinical and biological behavior similar to cT4a tumors.

Several studies have previously analyzed the relationship between QOL and signs of dysphagia in patients treated for head and neck cancer and have reported heterogeneous findings. To the best of our knowledge, no study has previously investigated this relationship among patients who underwent open partial horizontal laryngectomy (OPHL). The aim of the study is to determine if patient-reported swallowing-related QOL can discriminate between safe and unsafe swallowing in OPHL patients. 92 type I, type II, and type III OPHL patients at least 6 months postoperatively were recruited. Fiberoptic endoscopic evaluation of swallowing (FEES) was conducted using liquids, semisolids, and solids. FEES recordings were assessed through the penetration–aspiration scale, the pooling score and the dysphagia outcome and severity scale. All patients completed the MD Anderson dysphagia inventory (MDADI). Kruskal–Wallis test and post-hoc Mann Whitney U test were performed to compare MDADI scores among different level of airway invasion, post-swallow pharyngeal residue’s degree and overall dysphagia severity. ROC curves were generated to determine diagnostic accuracy of the MDADI. Statistically significant differences in MDADI scores were found between level of airway invasion with semisolids and solids, degree of pharyngeal residue with solids, and severity of dysphagia. MDADI showed significant diagnostic accuracy only in the detection of moderate/severe pharyngeal residue and severe dysphagia; however, sensitivity and specificity were low. Investigating patients’ perception of swallowing impairment and swallowing-related QOL is not sufficient to discriminate safe and unsafe swallowing in OPHL patients.

The aim of the present paper was to investigate the oncological safety of two-stage bilateral cordectomy for the treatment of cT1b glottic SCC, and to compare its oncological outcome and synechia development rate with those of single-stage procedures.A retrospective cohort study was performed at the Otolaryngology Unit of Vittorio Veneto Laryngeal Cancer Center (Italy). The prognostic significance of clinical, pathological and surgical factors was also investigated, in terms of recurrence rate and disease-free survival, in a univariate statistical setting.Our results indicate that patients treated with primary two-stage bilateral cordectomy achieved local control in 96% of cases, with 95% disease-specific and 88% overall survival rates, and a 95% organ preservation rate, with anterior synechiae developing in 1 case. Involvement of the deep surgical margins correlated with a worse prognosis. Patients developed anterior synechiae less frequently after two-stage bilateral cordectomy, and experienced no higher recurrence rate or shorter disease-free survival than patients treated with a single-stage procedure.Two-stage bilateral cordectomy is a safe and effective procedure. In selected patients it could be considered the primary approach for the treatment of early glottic cT1b carcinomas.

Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Among therapeutic options, open partial horizontal laryngectomy is proposed as a function-sparing surgical technique.We analyzed the clinical outcomes of 555 patients with laryngeal cancer staged pT3 to pT4a who underwent open partial horizontal laryngectomy.Five-year overall survival (OS), disease-free survival (DFS), locoregional control, local control, laryngectomy-free survival, and laryngeal function preservation rates were 84.6%, 84.2%, 86.3%, 90.6%, 93.3%, and 91.2%, respectively. DFS, locoregional control, and laryngeal function preservation rates were significantly affected by pT4a staging (68.1%, 71.7%, and 78.0%, respectively), whereas pN+ influenced only DFS (≤72.6%) and locoregional control (≤79.6%).Open partial horizontal laryngectomy with a modular approach can be considered effective in terms of prognostic and functional results in intermediate-stage and selected advanced-stage laryngeal cancers, even with subglottic extension. © 2015 Wiley Periodicals, Inc. Head Neck 38: E649-E657, 2016.

Background. There are limited data on the role of laser- assisted surgery for early glottic cancer in elderly patients. Methods. This retrospective study was conducted on a series of 130 consecutive cases of early glottic carcinoma occurring in elderly patients (>65 years old) treated with CO2 laser surgery. Results. The overall and disease-specific survival rates were 87.7% and 99.2%, respectively. The rates of local disease control after primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 84.6%, 93.8%, and 96.9%, respectively. A shorter disease-free survival (DFS) was associated with the involvement of 1 or more specific laryngeal regions (arytenoids, ventricle, anterior commissure, vocal muscle, subglottis) (p ¼ .01) and the status of the surgical margins (p ¼ .002); on multivariate analysis, only the latter remained prognostically significant vis-� the DFS (p ¼ .002). Conclusions. Even in elderly patients with early glottic carcinoma, endoscopic laser surgery is an effective treatment. V C 2012 Wiley Periodicals, Inc. Head Neck 34: 1804-1809, 2012

Assess the impact of surgical margin CO2 laser photocoagulation (LPC) on disease local control in patients submitted to endoscopic surgery for early glottic cancer in comparison with subjects treated with laser cordectomy without borders LPC.Historical cohort study.Regional referral cancer center.A total 281 patients with early glottic cancer (T1a, T1b, T2) were treated with endoscopic laser cordectomy according to the European Laryngological Society Classification between 1999 and 2006. Among the patients, 123 (treated between 2003 and 2006) were submitted to postresection LPC of surgical margins (group 1), whereas 158 (operated between 1999 and 2002) underwent laser cordectomy without margin LPC (group 2). Median follow-up was 51 months (range, 36-101 months).Local recurrence was found in 43 of 281 (15.30%) subjects (18 with T1a, 13 with T1b, 12 with T2). A significant difference in recurrence rate was found among patients treated with margin LPC in comparison with group 2 (P = .022). In particular, a lower recurrence rate in LPC patients was noticed in case of close (≤ 1 mm), nondefinable, and positive margins with infiltration of the superficial border. No significant difference was noticed in the case of negative edges (1 mm) or involvement of either deep margin or both superficial and deep edges.Surgical margin LPC increases disease local control in the case of close and superficial margin positivity. In such cases, no further treatment (surgical revision or radiotherapy) seems to be required in LPC patients. In case of deep border involvement, surgical revision or radiotherapy should be performed.

MASPIN, a member of serpin superfamily, has multifaceted biological functions and an unique tumour suppressing activity. Experimental evidences showed that MASPIN suppresses tumour growth, angiogenesis, invasion and metastasis. Only a very limited number of studies considered MASPIN expression in the upper aero-digestive tract carcinomas. It was recently found that nuclear localization of MASPIN was significantly associated with lower recurrence rate and longer disease-free interval in laryngeal carcinoma. The present study investigated the biological and prognostic role of MASPIN in relation to its subcellular localization in oral carcinoma. Sub-cellular pattern of distribution of MASPIN, nuclear and cytoplasmic MASPIN expressions were immunohistochemically determined in 56 consecutive cases of oral carcinoma. Statistical analysis found a significant association between pN-stage and recurrence of disease (P = 0.032) and a significantly longer disease-free interval in pN0 patients than in pN+ ones (P = 0.038). None of the subcellular expressions of MASPIN was significantly correlated with recurrence of disease and disease-free interval in our series of oral carcinomas. Sixty-one percent of pN0 cases was strongly MASPIN-positive in the cytoplasm of primary carcinoma cells, 33% of the pN+ cases was MASPIN-positive in the cytoplasm. Statistical analysis found a significant association between MASPIN cytoplasmic expression and pN-stage (P = 0.032). Negative MASPIN immunoreactivity in carcinoma cells cytoplasm may be useful to identify patients at risk of disease disseminating to neck lymph nodes. Further investigations are necessary to understand the biological role of cytoplasmic MASPIN localization in oral carcinoma.

Treatment for local glottic cancer recurrences after primary transoral laser microsurgery (TLM) has not been standardized.In 33 consecutive cases of salvage TLM after laser surgery for early glottic carcinoma failed, we retrospectively considered the potential clinicopathological prognostic factors in univariate statistical setting.Patient age65 years and pathological involvement of the deep margins were associated with a higher second recurrence rate and shorter disease-free survival.The age of the patient and the pathological status of surgical margins after salvage TLM could be useful for planning a closer endoscopic/radiological follow-up in selected patients at high risk of recurrence. Other appropriately designed studies are needed to see if an open surgical approach should be considered for younger patients (65 years old) with recurrent glottic carcinoma after primary TLM. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1043-1049, 2016.

Supracricoid laryngectomies (SCLs) are conservative organ-sparing surgical techniques for the treatment of selected T2-T4 laryngeal carcinomas. Although these procedures allow preserving the larynx and its functions, in several countries SCLs are not adopted in oncological protocols. One of the possible reasons to account for this choice is the complexity of post-surgical in-hospital management and the variability in functional results. The aim of this review is to analyse the literature on functional results after SCLs as knowledge on functional results will help in focusing on what is needed in the future to reach more standardized post-surgical procedures and homogeneous outcomes. The analysis of the length of hospital stay, feeding-tube removal time and time to eventual tracheotomy decannulation showed a marked variability across authors and centres. Several factors may come into play, including health-system organizations in different countries. In most studies in-depth description of the criteria applied for discharge, tracheotomy tube removal and commencement of oral feeding were not reported. Moreover, the review on swallowing functional outcomes showed marked variability, as well as a lack of consensus on how to assess swallowing after SCLs. The analysis of voice functional outcomes also revealed a marked variability; surprisingly, the tools applied in the assessments were very often not adequate for substitution voice. Literature review showed that voice- and swallowing-related quality of life are often satisfactory but the variability among centres is still too large. Therefore, there is a need for clearer clinical recommendations on early post-surgical management, tracheal-cannula and feeding-tube removal criteria, voice- and swallowing-assessment protocol, rehabilitation need and timing.

Total laryngectomy (TL) is often still recommended as a salvage approach for recurrent laryngeal squamous cell carcinoma (LSCC). Considering LSCC recurrences after the failure of primary transoral laser microsurgery (TLM), open partial horizontal laryngectomy (OPHL) could be a valid alternative to TL in selected patients. The aim of the present study was to analyze retrospectively the oncological outcome of a consecutive series of 17 patients treated at the Otolaryngology Unit of Vittorio Veneto Hospital (Italy) with OPHL after primary TLM had failed. Nine patients (53 %) had no further recurrences after salvage OPHL. Eight patients had a second recurrence of LSCC after OPHL, and five of them were cured by further salvage treatment, while the other three died of their disease. We found an overall and disease-specific survival both of 82 % and a loco-regional control rate and an ultimate organ preservation rate of 82 and 70 %, respectively. Patients who underwent two-stage bilateral cordectomy for primary glottic carcinoma showed a trend towards a higher rate of second recurrences, a lower ultimate organ preservation rate and a shorter disease-free survival after salvage OPHL. Further studies on larger cohorts of patients are needed to identify potential clinical and/or pathological prognostic parameters capable of pinpointing patients at higher risk of second recurrences after salvage OPHL in cases where TLM has failed. A salvage TL might be reasonably proposed as a first salvage choice in such cases.

The purpose of this study was to report preliminary long-term outcomes after supratracheal laryngectomy (STL).Twenty-two male patients who underwent STL were involved in this study. Swallowing skills, neoglottis motility, and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic, voice-related, and swallowing-related quality of life (QOL) were assessed.Aspiration was found in 10, 2, and 5 patients, respectively, for liquids, semisolids, and solids. Neoglottis motility was generally preserved, whereas vibration was impaired. Aerodynamic measures showed a poor performance. Perceptual assessment revealed highly dysphonic voices. In only 8 patients, a harmonic structure was visible in the spectrograms. Aspiration pneumonia occurred in 2 patients. Preoperative weight was maintained in 16 patients. Generic, voice-related, and swallowing-related QOL revealed satisfied patients.After STL, swallowing was sufficiently restored and QOL was satisfactory, whereas the voice was severely impaired even if oral communication was well preserved.

Background and aims: Immunosenes-cence, the age-related decline in immunologic function in healthy individuals, seems to contribute to increased susceptibility to bacterial infections in the elderly population. The present study describes elderly patients’ susceptibility to deep neck infection and prognosis. Methods: Between January 2000 and March 2004, 103 patients were admitted to the Department of Otolaryngology, University of Padova for deep neck infection. Twenty-four patients (23%) were over 65 (elderly patients). The remaining 79 patients (77%) aged ≤65 years (adult non-elderly patients) were also studied. Presentation modalities, origin of infection, site of deep neck infection, radiological investigations, bacteriology, treatment and outcome were all studied. Results: Hypertension and diabetes mellitus were the most commonly associated systemic diseases in both elderly and non-elderly patients. The number of patients with associated systemic diseases was significantly higher in the elderly group. The most common cause of deep neck infection was dental infection in both age groups. In the elderly group, salivary gland origin had the same incidence as dental origin. Twenty-two patients (6 elderly patients) were treated only with intravenous antibiotic therapy and intravenous steroids. Overall, in 81 cases (78.6%) (18 elderly patients) medical plus surgical procedures were indicated. None of the treated patients died of deep neck infection or its complications. Conclusions: Although the incidence of associated systemic diseases and complications of deep neck infections were higher in the elderly group, our medical or medical plus surgical approaches to deep neck infections, based on clinical and radiological evidence, were successful in all patients treated.

Laryngeal cancer management should pursue function-sparing therapeutic options. Even though demolitive surgery provides better control of disease at intermediate to advanced stages when compared to chemoradiotherapy, it does not preserve laryngeal function. Supratracheal partial laryngectomy has been described as a function-sparing surgical technique for laryngeal cancer with subglottic extension.In this retrospective study, we analyzed the clinical outcomes of 115 patients who underwent supratracheal partial laryngectomy.At 5 years, overall survival (OS), disease-free survival (DFS), and locoregional control rates were 78.9%, 68.5%, and 69.6%, respectively; DFS and locoregional control prevalences were greatly affected by pT4a classification (49.0% and 51.4%, respectively); and laryngeal function preservation was maintained in 78.3% of patients despite being affected by pT4a classification (59.3%) and age ≥65 (64.6%).For cases with glottic tumors and with subglottic extension, the choice of supratracheal partial laryngectomy versus chemoradiotherapy can be considered to be effective in terms of prognostic and functional results.

The aim of the present investigation was to analyze the oncological results of a series of early stage glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery. We focused on prognosis factors with significant impact on local control and disease-free survival (DFS). This retrospective study was conducted on a series of 177 consecutive patients with pT1-T2 glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery in the period 2000-2007. All considered patients had at least a 24-month follow-up period (mean follow-up 49.1 ± 23.0 months). The overall survival and the disease-specific survival rates were respectively 90.8 and 98.8%. The rates of local control with primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 86.3, 94.3, and 97.7%, respectively. Arytenoids (p = 0.006) and limited subglottic involvements (p = 0.0002) have a significant impact on DFS. Endoscopic laser surgery is the gold standard in the treatment of early glottic carcinoma because of high local control rates with laser alone, day surgery modality, very low morbility, good post-operative voice quality in most of the cases, and low costs.

Despite advances in laryngeal squamous cell carcinoma (LSCC) treatment, patient survival has not improved in the last two decades. Novel, more effective strategies should be based on receptor-mediated LSCC-targeted therapy. The epidermal growth factor receptor (EGFR) is the most widely studied molecular target. MASPIN multifaceted anti-tumor effects have been rarely evaluated in LSCC. The aims of this study were to investigate EGFR and MASPIN expression and the role of sub-cellular MASPIN localization in LSSC. MASPIN and EGFR expression and the sub-cellular localization of MASPIN were assessed using a computerized image analysis system in 108 consecutive cases of operable LSCC. The rates of occurrence of lymph node metastases and recurrent disease were lower in patients with a nuclear pattern of MASPIN expression (p = 0.004, p = 0.0028). As expected, the loco-regional recurrence rate was lower in N0 patients (p = 0.009), but the disease recurrence rate was even lower in N0 patients with a nuclear localization of MASPIN (p = 0.020). Disease-free survival was longer in cases of LSCC with a nuclear MASPIN pattern (p = 0.003). The intensity of EGFR reactivity and the EGFR area fraction were unrelated to the clinico-pathological and prognostic parameters in LSCC. A nuclear MASPIN pattern is a promising prognostic indicator in LSCC, but further evidence is needed before elective neck dissection can be considered for cN0 LSCCs with a non-nuclear MASPIN pattern. Although a better understanding of the mechanisms behind sub-cellular MASPIN localization is mandatory, re-activating nuclear MASPIN in association with specific chemotherapeutic agents may be an important goal in the treatment of LSCC.

Our very preliminary results support the hypothesis that MASPIN expression in primary head and neck squamous cell carcinoma (HNSCC) may be a valuable parameter for predicting patients' responses to a treatment based on carboplatin plus vinorelbine combined with radiotherapy.The roles of induction chemotherapy and combined chemoradiotherapy in the treatment of locally advanced unresectable HNSCCs have evolved rapidly. MASPIN has a unique tumour-suppressing activity. Experimental evidence has shown that MASPIN suppresses tumour growth, angiogenesis, invasion and metastasis. We investigated the potential prognostic roles of MASPIN and p53 in a series of HNSCCs treated with carboplatin plus vinorelbine combined with radiotherapy.Nineteen consecutive stage III or IV HNSCC patients were recruited. The treatment plan consisted of the administration of carboplatin on day 1 and vinorelbine on days 1 and 8. Four weeks later, carboplatin was administered concomitantly with radiation therapy. Expression of MASPIN and p53 was determined immunohistochemically in HNSCC diagnostic biopsies.A significant inverse relation was found between MASPIN expression and cN staging (p = 0.003). From a prognostic viewpoint, MASPIN expression was directly correlated with chemoradiotherapy response (p = 0.041). Moreover, the log-rank test showed a significant relationship between higher MASPIN expression and longer disease-free survival (p = 0.03), overall survival (p = 0.006) and disease-specific survival (p = 0.007).

Diagnostic work-up should include contrast-enhanced computed tomography (CT) and mandible orthopantogram. When a dental origin of deep neck infection is suspected, the intravenous antibiotic regimen has to be active against gram-positive bacteria, both aerobes and anaerobes. Surgical exploration and drainage may be mandatory at presentation, or in cases not responding to medical therapy within the first 24 h.Deep neck infections are still associated with significant morbidity and mortality rates when complications occur. Despite worldwide improvement in dental care and oral hygiene, a significant prevalence of deep neck infections caused by dental infections has been described recently (40%).We analysed retrospectively 85 cases of deep neck infection with dental origin out of 206 consecutive cases of deep neck infection diagnosed in our institution between 2000 and 2006.The most frequent dental source was a periapical infection of the first mandibular molar, followed by second and third molar, respectively. Submandibular space infection involvement was diagnosed in 73 of 85 patients (85.9%), masticatory space infection in 28 (32.9%); in 56 patients (65.9%) the infection involved more than one space. Twenty-four patients (28.2%) were treated only with intravenous antibiotic therapy; 61 patients (71.8%) required both medical and surgical procedures.

Objectif: Les preuves s'accumulent pour confirmer que la proteine p27 joue un role de modulateur negatif dans le cycle de la cellule a partir de G1 a la phase S et est donc consideree un suppresseur de tumeur. La diminution du nombre de recepteurs p27 a ete demontree dans plusieurs tumeurs malignes. Seulement quelques etudes examinent le role du p27 comme marqueur potentiel de pronostic du carcinome epidermoide du larynx. Le but de la presente etude est de determiner la pertinence pronostique du p27 dans une cohorte de patients avec un carcinome epidermoide du larynx, tres homogene du point de vue therapeutique pour eviter les influences possibles de la modalite sur les resultats: tous les patients n'ont subi qu'une laryngectomie partiel sur les lesions primaires. Nous avons simultanement investigue l'expression du MIB-1. Devis et methodes: Nous avons evalue un total de 22 cas de carcinome epidermoide du larynx ayant subi une laryngectomie supracricoide ou supraglottique avec ou sans curage ganglionnaire au department d'oto-rhino-laryngologie de l'universite Padova. Nous avons aussi teste la reactivite immunohistochimique de la p27 et du MIB-1 dans ces cancers en utilisant un systeme d'analyse de l'image. Variable evaluee: Une lesion est consideree positive pour la p27 lorsque plus de 18.56% des cellules tumorales montrent une coloration diffuse tres forte. Des echantillons avec un pourcentage de coloration de >20.24% des cellules est considere positif pour le MIB-1. Resultats: L'expression moyenne de la p27 est de 17% et 22% chez les patients avec ou sans rechute respectivement. Une expression faible de la p27 est statistiquement associee avec le retour de la maladie (p-=0.045). D'autre part, un taux eleve de MIB-1 est associe avec une recidive tumorale post-traitement. Conclusion: Les intervalles de confiance des analyses montrent une relation plus forte entre le MIB-1 que le p27 pour predire le retour de la maladie chez une cohorte de patients traites uniquement avec une laryngectomie partielle.

Aims Laryngeal verrucous squamous cell carcinoma (VSCC) is a highly differentiated carcinoma (SCC) whose histological diagnosis has many pitfalls in particular considering small biopsies: multiple glottic biopsies may be necessary to conclude for a malignant or benign lesion (papillary hyperplasia). Survivin is a member of the inhibitor of apoptosis protein family. Survivin over-expression has been demonstrated in laryngeal SCCs. The aims of the present study have been to evaluate for the first time survivin expression in glottic VSCC and investigate the potential role of survivin expression in the differential diagnosis of laryngeal VSCC. Methods Survivin expression was determined in 11 consecutive cases of glottic VSCC, in 24 cases of glottic papillary hyperplasia, and in 23 cases of SCC. Results Nuclear survivin reaction predominated in laryngeal VSCCs, papillary hyperplasias, and SCCs. Mean survivin expressions in the VSCC basal layer, hyper-proliferative areas of laryngeal papillary hyperplasia, and SCC were 62.7 %, 68.3 %, and 70.0 %, respectively. Mean survivin expression was 15.6 % in VSCC parakeratosis and 1.5 % in papillary hyperplasia parakeratosis ( p Conclusions Survivin expression was significantly higher in parakeratosis areas of laryngeal VSCC than in parakeratosis areas of laryngeal papillary hyperplasia. Immunohistochemical determination of survivin expression in parakeratosis areas may be a promising tool to substantiate differential diagnosis between glottic VSCC and papillary hyperplasia.

Nuclear expression of survivin should be studied as a promising marker of higher-risk laryngeal basaloid squamous cell carcinomas (BSCCs), which can then be treated more aggressively and followed more closely.BSCC is an uncommon bimorphic variant of SCC. The hypothesized greater aggressiveness and poorer prognosis of head and neck BSCC compared to SCC are still under debate. The regulation of apoptotic cell death has a profound effect on the pathogenesis and progression of malignancies. Survivin is the smallest member of the inhibitor of apoptosis gene family. The aim of this study was to investigate for the first time the expression of the inhibitor of apoptosis protein survivin in laryngeal BSCCs and their neck lymph node metastases and to compare the results with those obtained with conventional SCCs.Immunoreactivity to survivin was determined in nine laryngeal BSCCs and nine site- and stage-matched SCCs.A nuclear subcellular localization of survivin dominated in both primary laryngeal BSCCs and SCCs and in their lymph node metastases. There was no significant difference in mean survivin expression between primary laryngeal BSCCs (25.1%) and SCCs (25.6%) (p=0.86). Nuclear survivin expression was significantly higher in BSCCs associated with disease recurrence and poor prognosis (p=0.02).

The preliminary results reported here suggest that survivin expression in primary oral and oropharyngeal squamous cell carcinomas (SCCs) may identify patients at risk of disease disseminating to neck lymph nodes. If these results are confirmed in larger series of patients it may imply that elective neck dissection should be considered in clinically N0 patients with oral and oropharyngeal SCCs who show high expression of survivin.To investigate the expression of survivin, a member of the inhibitor of apoptosis proteins family, in patients with primary oral and oropharyngeal SCCs with and without neck lymph node metastases.We considered 13 consecutive cases of oral and oropharyngeal SCCs with lymph node metastases (pN + ) and 13 cases of pN0 oral and oropharyngeal SCCs. The survivin reactivity of primary SCCs and lymph node metastases was evaluated immunohistochemically. A lesion was considered positive if9.5% of the tumour cells showed diffuse strong staining.Sporadic groups of normal basal and parabasal epithelial cells showed weak survivin staining. In SCCs, a nuclear reaction predominated. Eight primary pN+ SCCs were survivin-positive (mean expression 34.7%), compared to 5 primary pN0 SCCs (mean expression 12.3%; p=0.017). Statistical analysis disclosed significantly higher survivin expression in primary oral and oropharyngeal SCCs that developed distant non-lymphatic metastases (p=0.012).