experience with endoscopic management of laryngeal cancer...
TRANSCRIPT
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Experience with endoscopic managementof laryngeal Cancer and CO-2 Laser
Prof. Dr. Steffen MauneDepartment of Oto-Rhino-Laryngology, Head and Neck Surgery
Municipal Hospital of CologneMember of the Faculty of the University of Kiel
Germany
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Endoscopic Management ofLaryngeal Cancer
Is it oncologically safe?
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Local controll
Neck Met´s
Distant Metastases
Prognostic factors
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Korrosionspräparat der A. carotisund der A. subclavia
Gefäßversorgung von Larynx undHypopharynx
Prof. B. Tillmann, Institut für Anatomie, Universität Kiel
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Focus and Effect
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Laryngoskop n.Weerda mod. n. Rudert
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Endoscopic Techique
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Laser SurgeryManagement of Safety
Laser SurgeryManagement of Safety
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Resection
„blockwise Resection
• Good overview
• Controll of infiltration
• Identification of tissueCartilage, Bone, Soft Tissue
• Individual Resectionse
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T3 Glottic Cancer
Postoperative Status
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Glottic T 1a left
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Postoperative StatusGlottic Synechia
Problem Synechien
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Mitomycin intraoperativ
Lokale Nachsorge zur Synechieprophylaxe
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Postoperative StatusPosterior glottic Stenosis
Postoperative Stenosis
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Supraglottic Resections
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Supraglottic Resection
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Supraglottic Carcinoma
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Hypopharynx
Prof. B. Tillmann, Inst.f.Anatomie Kiel
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Transorale Laserchirurgische Resektion
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Endoscopic Laser Surgery for supraglottic Carcinoma
Author Number Local IndikationPatients Controll
Davis 1990 14 8/8 T1, T24/6 T3
Zeitels 1994 22 100% T123 83% T2, T3
Rudert 1995 30 97% T1-T3
Ambrosch 1997 99 92% Stadium I, II81% Stadium III, IV
Ambrosch 1998 48 92% T1, T2
Iro 1998 141 84% Stadium I-IV
Rudert 2000 56 77% T1-T4
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Tumor MarkerHPV Mellin et al. 2000
p53 AAK Gottschlich et al. 2000
VEGF Smith et al. 2000
EGF-R Smith et al. 2001
HER-2 Xia et al. 2001
Cyclin D1 Akervall et al. 2001
p53 Vielba et al. 2003
NoConsequences
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Needs for an intelligent Therapy
selective Tumorrecognition(Diagnostics PT, Metastasen)
Precise, functional Resection techniques
Support of Immunsystem
Reproducibilaty
Less Side Effects
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Diagnostic
Endoscopy (90° Optik, flexibles Endoskop) Larynx/ Pharynx
Ultrasound of the Neck
Panendoscopy
CT/ MRT/PET
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Imaging
Ultrasound CT/MRT/PET
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Laryngeal Cancer: Minimal invasive StepcourseStufe 1 Laser Surgery, Phono
Stufe 2 Laser Surgery, selective Neck dissectionPhono/ Swallow
Stufe 3 Laser Surgery, Neck dissection,Radio-Chemoherapy, Phono/ Swallow
Stufe 4 Laryngopharyngectomy, Rekonstruction,Neck Dissection, Radio-Chemoth.,Surgery of distant Met`s, Voice prothesis,Phon-Swallow therapy
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Limits
Extensive Infiltration of the Thyroid orNeck tissue
Unzureichende Exposition des TumorsHohes Risiko schwerer postoperativerfunktioneller Störung: Aspiration oder Stenose
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Maximal Chirurgische Therapie Primärtumor
Laryngo-Pharyngektomie ggf. Rekonstruktion
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Lymphknotenmetastasen
N + selektive oder modifiziert-radikale ND
N 0 experimentell „Sentinel“ Exstirpation
Höft et al., J Nucl Med 2002)
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Tumorzelle + Dendritische Zelle
Tumor FITC-konjugiertes anti-HEA
DC R-PE-konjugiertes anti-HLA-DR
Hybridome
(Weise et al., Anticancer Research2003)
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Laser Surgery Summary
same onkologic Outcome
Functional Advantages
Higher Quality of Life
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Summary II
Diagnostic Endoskopisch, Ultraschall, CT, MRT, PET
Therapy 4 Step ConceptResektion (Transoral/ von aussen), Neck Dissektion,Strahlentherapie, Chemotherapie, Fernmetastasenchirurgie
Outlook Immunological Approachesmay be ???
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Thanks toProf. Heinrich RudertProf. Petra Ambrosch
Prof. B. Tillmann (Anatomy)
Kiel, Germany