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Literature Review: A Roundup of Important Recent Studies

TLM Safe Salvage Option for T1a and T1b Glottic Cancers

What is the role of transoral laser microsurgery (TLM) for salvage in radiation failures for selected glottic cancers?

Background: TLM has replaced open laryngeal surgery for managing early glottic cancer, while preserving organ and function. It is also easily repeated for local recurrences, with better functional outcomes and shorter hospitalizations. This study was conducted to address TLM in the management of recurrent glottic cancer after failure of definitive radiation.

Study design: Retrospective analysis of medical records of 18 patients with recurrent T1 and T2 of the glottis after receiving radiation therapy. Records between 2002 and 2007 were examined.

Setting: Academic medical center in South Korea.

Synopsis: Only patients with recurrent glottic cancers were included in this study. All had received primary radiation and were re-staged at the time of recurrence with CT scans, endoscopy and biopsies due to a tendency to understage these recurrences initially. Only recurrent T1 and T2 cancers with adequate exposure were selected for TLM. A vestibulectomy was performed, followed by a CO2 laser en bloc or piecemeal excision. Frozen section of the margins was performed, and no patients underwent a neck dissection. The three- and five-year local control rates after TLM were 65 percent and 40 percent, respectively. Local control rates were much lower for those with anterior commissure involvement. Six of the 18 patients underwent salvage laryngectomies. There was a 90 percent disease-specific five-year survival after either salvage surgery or TLM.

Bottom line: Although the sample size was small, this retrospective study demonstrates that TLM is a relatively safe salvage option for recurrent T1a and T1b glottic cancers. For T2 and anterior commissure cancers, the high local recurrence rate makes TLM a less feasible option.

Reference: Han YJ, Lee SH, Kim SW, et al. Transoral laser microsurgery of recurrent early glottis cancer after radiation therapy: clinical feasibility and limitations. Ann Otol Rhinol Laryngol. 2012;121:375-382.

—Reviewed by Natasha Mirza, MD

Post-Operative Pain and Bleeding Risk Following Tonsillectomy

What is the association of post-operative pain and risk of hemorrhage after tonsillectomy?

Background: Tonsillectomies are among the most common medical procedures performed in the U.S., and their most common serious complication is post-operative hemorrhage. A high proportion of patients also suffer various degrees of post-operative pain. This study sought to investigate the association of post-operative pain behavior with post-operative hemorrhage.