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How we improve the transoral resection for oral and oropharyngeal cancer: the CO2 waveguide laser

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Abstract

Purpose

The main aim of this study was to evaluate the CO2 waveguide laser (CO2 WGL) with flexible fiber (Lumenis, Santa Clara, CA) in the treatment of oral and oropharyngeal cancers specifically focusing on the lateral thermal damage (LTD) induced by this instrument and therefore on the reliability of the analysis of frozen sections collected during margin mapping.

Methods

A total of 48 patients with oral and oropharyngeal cancers from T1 to T4a were prospectively enrolled in the study. We collected data about LTD, pathologic tumor and node stage (pTNM), surgical intervention, kind of reconstruction (no flap, local vs free flap), need for tracheotomy and time of removal, postoperative complications (such as bleeding, mucosal dehiscence, and fistula), need for feeding tube and time of removal.

Results

Mean LTD was 164.7 ± 92.4 μm. Comparing frozen section histology before and after formalin embedding we found 5 true positives, 170 true negatives, 4 false positives and 4 false negatives, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 55.6%, 98%, 55.6%, 98%, and 96.1%, respectively.

Conclusion

CO2 WGL is a very manageable tool, which allows a precise cut. However, its high costs, the inability to re-use the fibers and its low coagulation capability must be considered.

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Acknowledgements

The authors thank Itala Mary Ann Brancaleone, MA, RSA Dip TEFLA, teacher of Medical English at the University of Trieste, for her support in editing the manuscript.

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Authors and Affiliations

  1. ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    G. Tirelli, F. Boscolo Nata, A. Gatto, E. Quatela, S. Rigo & M. Piovesana

  2. UCO Pathological Anatomy and Histopathology Unit, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    R. Bussani

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  1. G. Tirelli
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Tirelli, G., Boscolo Nata, F., Bussani, R. et al. How we improve the transoral resection for oral and oropharyngeal cancer: the CO2 waveguide laser. Eur Arch Otorhinolaryngol 276, 2301–2310 (2019). https://doi.org/10.1007/s00405-019-05473-x

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