Abstract
Objective
In the present study, the voice and functional outcomes of radiofrequency ablation (RFA) and CO 2 laser for early glottic cancer were evaluated.
Methods
One hundred sixty eight patients with early glottic cancer from October 2007 to June 2015 were included. Ninety-seven patients underwent RFA and seventy-one patients underwent CO 2 laser. The operation time and score of visual analog scale (VAS) for pain on the second day after surgery were recorded. The electronic laryngoscopy was performed at one week, one month and three months of postoperation.
Results
The operation time in RFA was shorter than that in CO 2 laser (8.52 ± 1.43 min vs. 11.76 ± 1.67 min, P < 0.05). There was no statistical difference in VAS scores between two operation methods (2.86 ± 0.52 vs. 2.89 ± 0.68, P > 0.05). One month after operation, the mucosal recovery in RFA group was better than that in CO 2 laser group ( P < 0.05). The alterations of acoustic parameters Jitter, Shimmer and HNR at three time points after operation showed statistical significances in both RFA and CO 2 laser groups ( P < 0.05). The significant differences in acoustic parameters between two groups were also observed ( P < 0.05). There were no differences in three-year survival rate, local recurrence rate, recurrence rate with anterior commissure involvement and postoperative adhesion rate with anterior commissure between the patients with RFA and CO 2 laser ( P > 0.05). No patient underwent tracheotomy and had symptoms of bucking, dyspnea, severe pain, hemoptysis and other serious complications.
Conclusion
Both RFA and CO 2 laser are safe and effective for the treatment of early glottic cancer. RFA has the advantage of quick voice recovery, low mucosa injury and short operation time, which is worthy for wide clinical application.
1
Introduction
In recent years, minimally invasive surgery, including radiofrequency ablation (RFA) and CO 2 laser, is widely applied in the treatment of early glottic cancer . These technologies not only completely remove the lesions but also retain the phonatory function of throat to the maximum degree, largely improving the living quality of patients. In the present study, 168 patients with early glottic laryngeal cancer (T is , T 1a , T 1b ) who underwent RFA or CO 2 laser were reviewed.
2
Materials and methods
2.1
Subjects
In this report, 168 patients (142 male and 26 female) with early-stage glottic cancer were included from October 2007 to June 2015, and randomly selected for RFA or CO 2 laser. There were 97 cases that underwent RFA and 71 cases that underwent CO 2 laser. The stage of cancer was identified according to the UICC (2002). All patients were pathologically diagnosed as squamous cell carcinoma. Color Doppler sonography and enhanced-scanning CT in neck were used to evaluate the lymph node metastasis. No patient with lymph node metastasis was observed. The patients with surgery radiotherapy and/or chemotherapy were excluded in this study. The general characteristics were shown in Table 1 . The study was approved by the ethics committee of the Second Hospital of Tianjin Medical University, and written informed consent was obtained from all patients.
| Radiofrequency ablation | CO 2 laser | P value | |
|---|---|---|---|
| Cases | 97 | 71 | |
| Age (years) | 54.2 ± 7.3 | 51.5 ± 8.9 | > 0.05 |
| Gender (male/female) | 82/15 | 60/11 | > 0.05 |
| Tumor stage | > 0.05 | ||
| T is | 22 (22.6%) | 12 (16.9%) | |
| T 1a N 0 M 0 | 57 (58.8%) | 39 (54.9%) | |
| T 1b N 0 M 0 | 18 (18.6%) | 20 (28.2%) | |
| Cancer cell differentiation | > 0.05 | ||
| Well differentiated | 84 (86.6%) | 55 (77.5%) | |
| Moderately differentiated | 13 (13.4%) | 16 (22.5%) | |
| Anterior commissure involvement | > 0.05 | ||
| Involvement | 32 (33.0%) | 20 (28.2%) | |
| Non-involvement | 65 (67.0%) | 51 (71.8%) |
2.2
Surgical equipment
The surgical instruments were used as follows: C-MAC video laryngoscope system (Karl Storz, Germany), microsurgical instruments set, surgery microscope (Carl-Zeiss, Germany), Coblator II surgery system (ArthroCare, USA), self-regulating electrocoagulator, and Sharplan 30C CO 2 laser (Sharplan lasers Inc., Israel).
2.3
Surgical methods
The surgery was conducted under general anesthesia by oral trachea cannula. The vocal cords was fully exposed through oral adjustable support laryngoscope. The operative field amplification was adjusted to be clearly observed. For undergoing RFA, the initial energy level was coblation-7 (plasma setting). For undergoing CO 2 laser, the endotracheal intubation gasbag was covered by wet gauze strip for preventing burns, which are possibly caused by laser. CO 2 laser was set in a continuous wave mode (6–16 W, 270 μm spot size). For both RFA and CO 2 laser, the tumor was entirely removed from tumor margin (3–5 mm) and the operation time was recorded. The tumor tissue from the cutting edge was collected and underwent pathological examination with fast frozen sections. Operation could be finished if the pathological result is negative, and it should be continued if the result is positive. All patients underwent tumor resection under self-retaining laryngoscope and received antibiotic therapy for three to five days before operation. No case underwent preventive tracheotomy before operation. One week, one month and three months after operation, acoustic analysis was performed in return visit.
2.4
Pain assessment
The pain was assessed by visual analog scale (VAS) of 1–10 where 0 means no pain and 10 means excruciating unbearable pain : 1) 1–3 – mild pain; 2) 4–6 – moderate pain; 3) 7–10 – severe pain. The pain was graded one day after operation, which was measured by the same person.
2.5
Mucosal recovery determination
Vocal mucosa recovery was examined by laryngoscopy before operation and one month after operation. The mucosal hyperplasia induced granulation, pseudomembranous and cicatrix were recorded as non-smooth.
2.6
Voice acoustic analysis
Acoustic parameter measurements were detected one week, one month and three months after operation by XION acoustic analysis software (Germany). Patient sat in a quiet examination room with environmental noise less than 45 dB, and pronounced the letter “a” for longer than three seconds. The distance between mouth and voice tube was 0.3 m. Then, acoustic parameters (Jitter, Shimmer and HNR ) were recorded.
2.7
Statistical analysis
SPSS17.0 statistical software was used to perform all statistical analysis. The t test, chi-square test and Fisher’s exact test were used to compare the difference between two means. P -value less than 0.05 was considered to be statistical significance.
2
Materials and methods
2.1
Subjects
In this report, 168 patients (142 male and 26 female) with early-stage glottic cancer were included from October 2007 to June 2015, and randomly selected for RFA or CO 2 laser. There were 97 cases that underwent RFA and 71 cases that underwent CO 2 laser. The stage of cancer was identified according to the UICC (2002). All patients were pathologically diagnosed as squamous cell carcinoma. Color Doppler sonography and enhanced-scanning CT in neck were used to evaluate the lymph node metastasis. No patient with lymph node metastasis was observed. The patients with surgery radiotherapy and/or chemotherapy were excluded in this study. The general characteristics were shown in Table 1 . The study was approved by the ethics committee of the Second Hospital of Tianjin Medical University, and written informed consent was obtained from all patients.
| Radiofrequency ablation | CO 2 laser | P value | |
|---|---|---|---|
| Cases | 97 | 71 | |
| Age (years) | 54.2 ± 7.3 | 51.5 ± 8.9 | > 0.05 |
| Gender (male/female) | 82/15 | 60/11 | > 0.05 |
| Tumor stage | > 0.05 | ||
| T is | 22 (22.6%) | 12 (16.9%) | |
| T 1a N 0 M 0 | 57 (58.8%) | 39 (54.9%) | |
| T 1b N 0 M 0 | 18 (18.6%) | 20 (28.2%) | |
| Cancer cell differentiation | > 0.05 | ||
| Well differentiated | 84 (86.6%) | 55 (77.5%) | |
| Moderately differentiated | 13 (13.4%) | 16 (22.5%) | |
| Anterior commissure involvement | > 0.05 | ||
| Involvement | 32 (33.0%) | 20 (28.2%) | |
| Non-involvement | 65 (67.0%) | 51 (71.8%) |
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