Cryolaser Destruction of Larynx Tumors Through Laryngofissure

Feb 2001
Vladimir I.Kochenov,M.D.
The Nizhni Novgorod Medical Research Center 1, Meditsinskaya Street, Nizhni Novgorod 603104, RUSSIA

While the majority of laryngooncologists insist on the deep frost or C02 laser destruction of larynx tumors through direct laryngoscope, surgical access through thyroid cartilage dissection followed by tracheostomy through cryodestmction or laser radiation of larynx tumors is more commonplace in Russia. (V.V.Shental, Kh.Sh.Davudov).

We have combined surgical cryogenics with laser methods in the radical T2-T3 larynx tumor treatment in the absence of complete arytenoids cartilage fixation in 96 patients using «Penguin» fixed cryogenic and «Ledok» (Icelet) portable units along with special cryoapplicators of our own design and «Romashka» (Daisy) C02 laser unit. The surgery included cryogenic cutting of larynx tumor with prior cryodestruction of tumor in the anterior commeasure in direct laryngoscopy and dissection of pathological tissue within the frozen organ focused by laser radiation always directed along the median line. Thus the ablation method allowed the most comfortable access to tumor, which was cut in two separate parts then independently destroyed by cryolaser.

Under cryolaser destruction we mean the following sequence: freezing of neoplasm, stratified laser evaporation of the frozen tumor within the primary tumor-affected node, visualization of its borders and depth followed by cryodestruction of tumor infiltrate and temperature lowering. Temperature lowering of thyroid cartilage inner surface in each freezing-thawing cycle as limited to -20 degrees ó drop at mean application temperatures of-170 degrees C. In case with temperatures lower than - 30 degrees C, the outer surface of the thyroid cartilage was dissected.

In case with epiglottal cancer, tissues in the vestibule of the larynx and epiglottal space proper were further laser evaporated and cryogenically destroyed.

To arrest hypothermia and prevent the development of post-operative edema and dysphasia, temperatures in laryngopharyngeal and esophageal mucous membranes were kept near + 20 degrees C with a special device concurrently with the deep local freezing of the tumor-affected tissue in the posterior segments of the organ.

All patients underwent operation well. Tracheostomy was performed within 2-7 days. Cryonectrotic rejection and epithelialisation lasted 1 to 3 months with the patients feeling no discomfort. Post-operative screening revealed 92% and 76% of the patients with T2 and T3 phases respectively had no recurrences for the last five years following cryolaser destruction of larynx tumor through laryngofissure. Method of cryolaser destruction of larynx tumor allowed:

  1. to locally ablate immediately tumor-affected tissues without damaging the healthy ones thus directing the course of operation from pathological to normal tissues;

  2. to bring total tumor destruction a step closer individualizing the bulk and depth of physical detection through better visualization of tumor node borders;

  3. to maximize advantages of laser and cryogenic methods minimizing their adverse effects;

  4. to provide for a most comfortable and least traumatic access to tumor disintegration beyond the reach of other methods;

  5. to improve efficiency of laser attack on tumors evaporating frozen tissues in the absence of burns, hemorrhages or coagulational crusts;

  6. to provide for a reliable and easier cryodestruction of tumor infiltrate left in the larynx following target node evaporation;

  7. to reduce Cryonectrotic mass volume in larynx, to speed up decannulation, to prevent dysphasia, to considerably reduce accompanying deem in the esophagus, larynx and epiglottis;

  8. to employ advantages of tumor cryodestruction healing plasticity in the absence of tissue defects and specific antitumoral(antineoplastic) immune stimulation.

Cryolaser detection was not accompanied by any negative influence on reactivity of an organism. Cryolaser detection of larynx tumors through laryngofissure appeared to be a sparing organ-saving method (whereas traditional methods would imply extensive resection or laryngectomy in most cases), yet it is reasonably radical and can be used independently in the absence of radiotherapy.

Cryolaser destruction can be used in the treatment of cancer of any location.

U.S.S.R. Regd. Patent Nos. 170919, 1732947, 1710075, 1650106, 1438035, 1316113, 1281257, 1231654,1153409,1117877,1958821,1105192. Russian Patents Nos. 2018273, 2018274.

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