Complications of endoscopic CO2 laser surgery for laryngeal cancer and concepts of their management [Komplikacije endoskopske CO2 laserske kirurgije karcinoma grkljana i koncept njihovog zbrinjavanja]

Prgomet, Drago and Bačić, Antun and Prstačić, Ratko and Janjanin, Saša (2013) Complications of endoscopic CO2 laser surgery for laryngeal cancer and concepts of their management [Komplikacije endoskopske CO2 laserske kirurgije karcinoma grkljana i koncept njihovog zbrinjavanja]. Collegium Antropologicum, 37 (4). pp. 1373-1378. ISSN 0350-6134

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Abstract

Endoscopic CO2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly reported advantages of ELS are good oncologic results with low incidence of complications. Although less common if compared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complications of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Complications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.

Abstract in Croatian

Endoskopska CO2 laserska kirurgija široko je prihvaćena metoda liječenja početnog karcinoma grkljana karakterizirana odličnim onkološkim rezultatom uz nisku učestalost komplikacija. Iako se komplikacije javljaju rjeđe nego kod otvorenih zahvata na grkljanu, one mogu biti vrlo ozbiljne, ponekad čak i smrtonosne. Javljaju se u širokom opsegu od intraoperativnog zapaljenja endotrahealnog tubusa ili krvarenja, do ranih ili kasnih postoperativnih komplikacija koje nerijetko zahtijevaju intenzivno liječenje, transfuzije krvi ili revizijsko kirurško liječenje. U radu opisujemo naše 20-godišnje iskustvo i rezultate tog tipa kirurgije, te raspravljamo o potencijalim komplikacijama uz poseban naglasak na koncept njihovog zbrinjavanja i sveobuhvatan pregled literature. Komplikacije su učestalije nakon endoskopskih resekcija supraglotičnih nego glotičnih tumora, a u usporedbi s otvorenim operacijama grkljana incidencija komplikacija laserske kirurgije je značajno manja. Svaki kirurg koji se upušta u endoskopsku CO2 lasersku kirurgiju grkljana treba se držati točnih procedura kako bi se komplikacije spriječile, no istovremeno imati i jasan koncept njihovog zbrinjavanja ukoliko se razviju.

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