Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T06:09:16.188Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical significance of granulation tissue after transoral laser microsurgery for glottic cancer

Published online by Cambridge University Press:  03 March 2015

E Rioja ,
J-L Blanch ,
A Borés ,
M Bernal-Sprekelsen  and
I Vilaseca
E Rioja
Affiliation:
Department of Otorhinolaryngology, Althaia Xarxa Assistencial de Manresa, Barcelona, Spain
J-L Blanch
Affiliation:
ENT Surgical Oncology Section, Hospital Clínic, Barcelona, Spain
A Borés
Affiliation:
Department of Otorhinolaryngology, Hospital Universitari Josep Trueta, Girona, Spain
M Bernal-Sprekelsen
Affiliation:
Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain School of Medicine, Universitat de Barcelona, Spain
I Vilaseca*
Affiliation:
Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain School of Medicine, Universitat de Barcelona, Spain
*
Address for correspondence: Dr Isabel Vilaseca, Department of Otorhinolaryngology, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Granulation tissue after transoral laser microsurgery can make it difficult to distinguish between normal healing and tumour recurrence.

Materials and methods:

We carried out a retrospective analysis of 316 consecutive glottic carcinomas (Tis–T3). Presence of granulation tissue at one and six months was correlated with demographic and clinical data, tumour and surgical characteristics, and tumour relapse.

Results:

Granulation tissue appeared in 53.8 per cent of patients at month 1, resolving spontaneously in 41.8 per cent. Revision surgery was performed in 60.1 per cent and was effective in 41.1 per cent. At month 6, 14.9 per cent of patients presented with granulation tissue. In 74.5 per cent the tissue was surgically removed and was positive for malignancy in 62.9 per cent. Tumour relapse presented in 29.4 per cent with granulation tissue at month 1 and in 61.7 per cent at month 6 (p = 0.000). Granulation tissue at month 1 correlated with thyroid cartilage exposure and continued smoking. At month 6, granulation tissue correlated with thyroid cartilage exposure, the affected surgical margins and diabetes.

Conclusion:

Granulation tissue after transoral laser microsurgery is frequent. When it persists at six months, revision surgery is formally recommended.

Keywords

Laser TherapyGranulation TissueLaryngeal NeoplasmsWound Healingcarbon dioxide laser
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 4 , April 2015 , pp. 377 - 382
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Suárez, C, Rodrigo, JP. Transoral microsurgery for treatment of laryngeal and pharyngeal cancers. Curr Oncol Rep 2013;15:134–41Google Scholar
2Peretti, G, Piazza, C, Cocco, D, De Benedetto, L, Del Bon, F, Redaelli de Zinis, LO et al. Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients. Head Neck 2010;32:977–83Google Scholar
3Vilaseca, I, Bernal-Sprekelsen, M, Luis Blanch, J. Transoral laser microsurgery for T3 laryngeal tumors: prognostic factors. Head Neck 2010;32:929–38CrossRefGoogle ScholarPubMed
4López-Álvarez, F, Rodrigo, JP, Llorente-Pendás, JL, Suárez-Nieto, C. Transoral laser microsurgery in advanced carcinomas of larynx and pharynx [Spanish]. Acta Otorrinolaringol Esp 2011;62:95–102CrossRefGoogle ScholarPubMed
5Hartl, DM, de Monès, E, Hans, S, Janot, F, Brasnu, D. Treatment of early-stage glottic cancer by transoral laser resection. Ann Otol Rhinol Laryngol 2007;116:832–6Google Scholar
6Olthoff, A, Ewen, A, Wolff, HA, Hermann, RM, Vorkwerk, H, Hille, A et al. Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer. Strahlenther Onkol 2009;185:303–9Google Scholar
7Morosolli, AR, Veeck, EB, Niccoli-Filho, W, Gomes, MF, das Graças, V, Goulart, M. Healing process after surgical treatment with scalpel, electrocautery and laser radiation: histomorphologic and histomorphometric analysis. Lasers Med Sci 2010;25:93–100Google Scholar
8Lippert, BM, Teymoortash, A, Folz, BJ, Werner, JA. Wound healing after laser treatment of oral and oropharyngeal cancer. Lasers Med Sci 2003;18:36–42Google Scholar
9Hendrick, DA, Meyers, A. Wound healing after laser surgery. Otolaryngol Clin North Am 1995;28:969–86Google Scholar
10Michel, J, Fakhry, N, Duflo, S, Lagier, A, Mancini, J, Dessi, P et al. Prognostic value of the status of resection margins after endoscopic laser cordectomy for T1a glottic carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:297–300Google Scholar
11Sigston, E, de Mones, E, Babin, E, Hans, S, Hartl, DM, Clement, P et al. Early-stage glottic cancer: oncological results and margins in laser cordectomy. Arch Otolaryngol Head Neck Surg 2006;132:147–52CrossRefGoogle ScholarPubMed
12World Health Organization. Definition of an older or elderly person. In: http://www.who.int/healthinfo/survey/ageingdefnolder/en [9 February 2015]Google Scholar
13Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A. AJCC Cancer Staging Manual, 7th edn.New York: Springer, 2010Google Scholar
14Blanch, JL, Vilaseca, I, Bernal-Sprekelsen, M, Grau, JJ, Moragas, M, Traserra-Coderch, J et al. Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1–T4 pharyngo-laryngeal cancers. Eur Arch Otorhinolaryngol 2007;264:1045–51CrossRefGoogle ScholarPubMed
15Jeong, WJ, Kim, H, Ahn, JC, Sung, MW, Kim, KH, Ahn, SH. Serial endoscopic analysis of the glottis following laser cordectomy: from an oncological perspective. Lasers Med Sci 2012;27:1025–31CrossRefGoogle ScholarPubMed
16Blanch, JL, Vilaseca, I, Caballero, M, Moragas, M, Berenguer, J, Bernal-Sprekelsen, M. Outcome of transoral laser microsurgery for T2-T3 tumors growing in the laryngeal anterior commissure. Head Neck 2011;33:1252–9Google Scholar
17Guo, S, DiPietro, LA. Factors affecting wound healing. J Dent Res 2010;89:219–29Google Scholar
18Gosain, A, DiPietro, LA. Aging and wound healing. World J Surg 2004;28:321–6CrossRefGoogle ScholarPubMed
19Keylock, KT, Vieira, VJ, Wallig, MA, DiPietro, LA, Schrementi, M, Woods, JA. Exercise accelerates cutaneous wound healing and decreases wound inflammation in aged mice. Am J Physiol Regul Integr Comp Physiol 2008;294:R179–84Google Scholar
20Rinker, B. The evils of nicotine: an evidence-based guide to smoking and plastic surgery. Ann Plast Surg 2013;70:599–605Google Scholar
21Kean, J. The effects of smoking on the wound healing process. J Wound Care 2010;19:5–8Google Scholar
22Heijink, IH, Brandenburg, SM, Postma, DS, van Oosterhout, AJ. Cigarette smoke impairs airway epithelial barrier function and cell-cell contact recovery. Eur Respir J 2012;39:419–28Google Scholar
23Sørensen, LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 2012;255:1069–79CrossRefGoogle Scholar
24Ma, C, Martins-Green, M. Second-hand cigarette smoke inhibits wound healing of the cornea by stimulating inflammation that delays corneal reepithelialization. Wound Repair Regen 2009;17:387–96CrossRefGoogle ScholarPubMed
25Bernardi, S, Severini, GM, Zauli, G, Secchiero, P. Cell-based therapies for diabetic complications. Exp Diabetes Res 2012;2012:872504Google Scholar
26Lan, CC, Wu, CS, Huang, SM, Wu, IH, Chen, GS. High-glucose environment enhanced oxidative stress and increased interleukin-8 secretion from keratinocytes: new insights into impaired diabetic wound healing. Diabetes 2013;62:2530–8CrossRefGoogle ScholarPubMed
27Ministerio de Sanidad, Servicios Sociales e Igualdad. La Diabetes [Spanish]. In: http://www.msssi.gob.es/ciudadanos/enfLesiones/enfNoTransmisibles/diabetes/diabetes.htm [9 February 2015]Google Scholar
28Bueno, H, Hernáez, R, Hernández, AV. Diabetes mellitus type 2 and cardiovascular disease in Spain: a descriptive revision [Spanish]. Rev Esp Cardiol Supl 2008;8:53–61Google Scholar
29Pham, TA, De Freitas, R, Sigston, E, Vallance, N. Factors leading to the use of alternate treatment modalities following transoral laser excision of T1 and T2 glottic squamous cell carcinoma. ANZ J Surg 2012;82:720–3Google Scholar
30Jäckel, MC, Ambrosch, P, Martin, A, Steiner, W. Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope 2007;117:350–6Google Scholar
31Bernal-Sprekelsen, M, Blanch, JL, Caballero-Borrego, M, Vilaseca, I. The learning curve in transoral laser microsurgery for malignant tumours of the larynx and hypopharynx: parameters for a levelled surgical approach. Eur Arch Otorhinolaryngol 2013;270:623–8CrossRefGoogle ScholarPubMed