Ollivier Laccourreye’s research while affiliated with Université Paris Cité and other places

Objective To evaluate whether supracricoid partial laryngectomy (SCPL) may be a viable alternative to radiation therapy (RT) for patients with glottic cT3N0M0 squamous cell carcinoma (SCC) who are surgical candidates for total laryngectomy (TL) and respond well to platinum-based induction chemotherapy. Methods Retrospective case series review of 18 consecutive patients with cT3N0M0 glottic SCC, initially considered surgical candidates only for TL who showed a good response to platinum-based induction chemotherapy, managed at a French university teaching institution with either SCPL (n = 9) or RT (n = 9). The main endpoints were 10-year local control and laryngeal preservation. The secondary endpoints were 10-year survival, causes of death analysis, and univariate analysis of local control and survival. Results The 10-year actuarial local control, laryngeal preservation, survival rates were 77.8%, 88.9%, and 66.7% after SCPL, respectively, and 72.9%, 87.5%, and 33.3%, after RT without significant statistical differences. In univariate analysis none of the clinical variables under analysis were related to local control and survival. Conclusions Our data suggest that SCPL may warrant further consideration as a treatment option for glottic cT3N0M0 SCC patients who respond well to platinum-based induction chemotherapy. However, additional prospective research is warranted given the retrospective, nonrandomized nature of the presented case series.

Objectives The aim of this study was to document 10‐year outcomes after supracricoid partial laryngectomy (SCPL) in selected cT3M0 laryngeal squamous cell carcinoma (SCC) patients. Methods This real‐life retrospective observational study analyzed an inception cohort of 168 patients with isolated, untreated, selected cT3M0 laryngeal SCC, that were consecutively managed by SCPL during the period 1973–2013, and followed up until death or for a minimum of 10 years in 92% of cases at a single French academic and tertiary referral care center. Prior induction chemotherapy, arytenoid cartilage removal, level II–IV neck dissection, and postoperative radiation therapy were performed on 148, 77, 136, and 27 patients, respectively. The main objective was to determine 10‐year actuarial local control and laryngeal preservation estimates. Secondary objectives included 10‐year actuarial survival and cause‐of‐death analysis, and assessment of correlations between endpoints and clinical variables. The significance threshold was set at p < 0.005. Results Ten‐year actuarial local control, laryngeal preservation, and survival estimates were 90%, 85%, and 52%, respectively. Salvage treatment resulted in an overall 99% local control rate. Metachronous second primary cancer, intercurrent disease without evidence of SCC, SCPL‐related death, and uncontrolled local recurrence accounted for 31%, 26%, 7%, and 2% of causes of death. On univariate analysis, overall local recurrence and laryngeal preservation rates varied significantly, from 5% to 54% and 90% to 46% when resection margins were R0 and R1, respectively. Conclusion The present study highlighted successful 10‐year outcomes after SCPL, providing further evidence in favor of its integration into the conservative armamentarium for endolaryngeal cT3 SCC. Level of Evidence 4 Laryngoscope , 2024

Objectives To document the 10‐year results of transoral mandibular preservation surgery for patients with T1‐2 squamous cell carcinoma (SCC) arising from the lateral oropharynx. Methods This was a retrospective 30‐year review using STROBE guidelines at an academic, tertiary referral center. A total of 294 patients with T1‐2 SCC of the lateral oropharynx were reviewed. Only 19% of patients were never‐smokers, suggesting a predominantly HPV‐negative population. All patients had transoral mandibular preservation surgery. Follow‐up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and postoperative radiation therapy (31.6%) Local control, survival, and functional endpoints, as well as the consequences of local recurrence, were analyzed. Results The 10‐year local disease control was 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% local control rate. The overall 10‐year survival was 50%. Mortality was related to metachronous second primary cancer (MSPC) (29.2%), medical comorbidities (25.7%), uncontrolled local recurrence (10%), and complications following transoral resection (4.2%). In multivariate analysis, the development of an MSPC significantly increased ( p < 0.005) the risk of death. Overall, 95.2% of patients achieved mandibular preservation. However, gastrostomy and tracheostomy dependence occurred in 1% and 0.3% of cases, respectively. Conclusions For a patient population with a significant percentage of tobacco‐associated oropharyngeal cancer (OPC), transoral surgery was associated with long‐term minimal postoperative complications and a high rate of local control. MSPC was the main cause of death during the first 10 postoperative years. Such long‐term figures support transoral surgery as an effective first‐line treatment for early‐stage predominantly tobacco‐related OPC. Level of Evidence 4 Laryngoscope , 2024

Objectives To document 10‐year oncologic outcome of primary total laryngectomy (TL) for patients with cT3‐4M0 endolaryngeal squamous cell carcinoma (SCC). Study Design Observational inception cohort of 531 patients with isolated untreated endolaryngeal cT3‐4M0 SCC review over 40 years using STROBE guideline. 94% of patients were followed until death or for a minimum of 10 years. Setting Academic tertiary referral care center. Methods All patients underwent primary TL. Prior tracheotomy, induction chemotherapy, thyroid gland resection, level II‐IV neck dissection, level VI dissection, and postoperative radiation therapy were associated in 6%, 40%, 43%, 89%, 47%, and 74% of cases, respectively: The main objective was to determine the 10‐year actuarial local control estimate. Accessory objectives comprised screening for clinical variables increasing the risk of local recurrence, and analysis of long‐term oncologic consequences of local recurrence. Results The 10‐year actuarial local control estimate was 89.7%. Local recurrence was salvaged in 11% of cases, resulting in 92% overall local control. On multivariate analysis, none of the study variables correlated with local recurrence. Local recurrence resulted in significantly reduced nodal control, distant metastasis control, and survival. Postoperative complications, persistent index SCC, intercurrent disease, and metachronous second primary cancer accounted for respectively 3%, 37%, 33%, and 28% of the 334 deaths noted during the 10 years following TL. Conclusion The present study underscored the long‐term oncologic efficacy of primary TL, the dangers of local recurrence, the key role of local control for survival, and the importance of a long‐term oncologic watch policy. Level of Evidence 3 Laryngoscope , 2023

Objectives: although unilateral laryngeal immobility (ULI) can results from paralysis or ankylosis of the cricoarytenoid joint, no comparative study exist to date. Aim of this study was to compare clinical features, etiologies, spontaneous recovery, and evolution after surgical treatment of ULI according to its mechanism. Design: longitudinal observational cohort study between 1992 and 2017. Setting: tertiary care referral center and university teaching hospital. Participants: adult patients with isolated ULI. Main outcome measures: presenting symptoms and demographic data were recorded at baseline. During follow-up, natural recovery and, if a surgical treatment was performed, treatment failure rate were noted. Results: 994 patients were included, 56.4% of male and with a mean age of 58 years. Overall, 91% had paralysis and 9% had ankylosis. Dysphonia was the main symptom in both groups (>96%). Dyspnea was more frequent in patients with ankylosis (26.1% versus 4.2% in those with paralysis) whereas dysphagia was more frequent in those with paralysis (31.1% versus 20% in those with ankylosis). With a mean follow-up of 2.3 years (±5.1), spontaneous recovery did not differ according to ULI's etiology (hazard ratio 1.43, 95% confidence interval 0.85 - 2.40). Overall, 37.1% underwent a surgical treatment, and paralysis was associated with a lower odd of treatment failure (hazard ratio 0.27, 95% confidence interval 0.10 - 0.70) over a mean follow-up of 3.1years (±4.1). Conclusion: ULI resulting from paralysis or ankylosis differ in their symptoms and responses to surgical treatment, whereas natural evolution was similar.

Résumé Objectif: Analyse des trachéotomies post intubation pour SARS-Cov-2 réalisées par les otorhinolaryngologistes de 7 centres universitaires d’Ile de France (23/03-23/04/2020). Matériel et Méthodes: Etude observationnelle, rétrospective, multicentrique, d’une cohorte de 59 patients. Objectifs principaux : évaluer le nombre, les caractéristiques et les modalités pratiques des trachéotomies réalisées, ainsi que le statut Covid-19 des opérateurs. Objectifs secondaires : préciser la durée de trachéotomie, le taux de décanulation, les complications immédiates et l’état de l’axe laryngo-trachéal. Résultats : Le motif de réalisation était l’aide au sevrage et l’échec d’extubation respectivement dans 86% et 14% de cas. La technique utilisée était chirurgicale, percutanée et hybride respectivement dans 91,5%, 3,4 % et 5,1% des cas. Aucun des opérateurs ne développait de symptômes compatibles avec une infection par le Covid-19. Une complication post opératoire survenait dans 15 % des cas, sans différence statistiquement significative entre les techniques chirurgicales et percutanée / hybride, même si aucune complication ne survenait après trachéotomies percutanées et hybrides. Aucune trachéotomie ni aucune complication n’était suivie par la mort du patient. Le taux de décanulation était de 74,5 % avec une durée moyenne de port de la trachéotomie de 20±12 jours. Pour 55% des patients évalués par nasofibroscopie après décanulation, une anomalie laryngée était notée. En analyse univariée, aucune des caractéristiques cliniques n'influait, de façon statistiquement significative sur la durée de trachéotomie, le taux de décanulation et la survenue d’une altération de l’état laryngé. Conclusion: L’absence de contamination des chirurgiens, l’hétérogénéité de pratiques selon les centres, le taux élevé de complications et de lésions laryngées quelle que soit la technique utilisée et des particularités des patients sont les quatre points principaux qui ressortent de cette étude rétrospective.