95. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Prof. Dr.

Moderation

NUR Wissenschaftliches Programm/ ONLY Scientific Program

Rekonstruktion und Reinnervation

Vortrag auf Einladung

Laryngeale Rekonstruktion nach onkologischer Therapie

Larynx-Quiz 

Diskussion

Enhancing autologous fat transfer in Laryngeal reconstruction: Evaluating the effect of adipose-derived stem cells and their impact on long-term outcomes

Optimierung des Eigenfetttransfers in der Kehlkopfrekonstruktion: Analyse des Einflusses von Adipozytären-Stammzellen und deren Einfluss auf Langzeitergebnisse

Introduction: The autologous fat transfer involves the extraction and transplantation of adipose tissue to enhance contour and form at the targeted site. In laryngeal reconstruction, autologous fat presents advantages over allogeneic materials due to its biocompatibility, availability, and adaptability. The presence of adipose-derived stem cells (ASC) in autologous fat contributes to improved outcomes by promoting the survival of the transplant. However, causes negatively influencing long-term results, such as variable fat resorption, remain unclear. Material and methods: Our study aims to assess ASC quantity and vitality in autologous fat grafts using flow cytometry, quantitative PCR, proliferation and cytotoxicity assays, differentiation potential tests, metabolic analyses, and evaluations of migration potential. Each method has its pros and cons, with accuracy influenced by factors like sample processing, storage, and analysis techniques. Results: Further research is necessary to optimize these methods for measuring ASC levels in autologous fat grafts. Following the establishment of a protocol for ASC identification and quantification, correlations with clinical outcomes, including videostroboscopic recordings and various vocal parameters, will be explored. These data, routinely collected during postoperative follow-ups, aim to deepen the understanding of ASC behavior in autologous fat grafts for laryngeal reconstruction. Conclusion / Discussion: The study seeks to improve surgical outcomes, enhance patient safety, and advance understanding of stem cell biology in laryngeal reconstruction.Einleitung: Der Eigenfetttransfer beinhaltet die Entnahme und Transplantation von autologem Fett zur Verbesserung von Kontur und Form am Zielort. In der Kehlkopfrekonstruktion bietet autologes Fett gegenüber allogenen Materialien Vorteile aufgrund seiner Biokompatibilität, Verfügbarkeit und Anpassungsfähigkeit. Die Anwesenheit von Fettstammzellen (ASC) trägt zu besseren Ergebnissen bei, indem sie das Überleben des Transplantats fördern. Ursachen, die Langzeitergebnisse negativ beeinflussen, wie die variable Fettresorption, bleiben jedoch unklar. Methoden: Unsere Studie hat zum Ziel, den ASC-Gehalt und ihre Vitalität in autologen Fetttransplantaten zu bewerten. Hierfür verwenden wir Durchflusszytometrie, quantitative PCR, Proliferations- und Zytotoxizitätsassays, Differenzierungspotenzialtests, Stoffwechselanalysen und Bewertungen des Migrationspotenzials. Ergebnisse: Jede Methode hat ihre Vor- und Nachteile, wobei die Genauigkeit von Faktoren wie Probenverarbeitung, Lagerung und Analysetechniken beeinflusst wird. Weitere Forschung ist notwendig, um diese Methoden zur Messung des ASC-Gehalts in autologen Fetttransplantaten zu optimieren. Nach der Etablierung eines Protokolls zur ASC-Identifikation und -Quantifizierung sollen Korrelationen mit klinischen Ergebnissen, wie videostroboskopischen Aufnahmen und verschiedenen Stimmparametern, erfolgen. Diese Daten, die während der postoperativen Nachsorge routinemäßig erfasst werden, sollen das Verständnis des Verhaltens von ASC in autologen Fetttransplantaten für die Kehlkopfrekonstruktion vertiefen. Schlussfolgerung: Die Studie zielt darauf ab, chirurgische Ergebnisse zu verbessern, die Patientensicherheit zu erhöhen und das Verständnis der Stammzellbiologie für die Kehlkopfrekonstruktion voranzutreiben.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Optimierung des Eigenfetttransfers in der Kehlkopfrekonstruktion: Analyse des Einflusses von Adipozytären-Stammzellen und deren Einfluss auf Langzeitergebnisse

Aerodigestivtrakt / Laryngologie / Phoniatrie

Larynx

Freier Vortrag

PD Dr.

Retrospective comparison of swallowing function: Organ-Preserving approach in laryngeal carcinoma vs. total Laryngectomy

Retrospektiver Vergleich der Schluckfunktion: Organerhaltender Ansatz bei Larynxkarzinom vs. komplette Laryngektomie

Introduction The decision between partial laryngectomy (pLE) and total laryngectomy (tLE) in locally advanced laryngeal carcinomas (LA-LC) depends on various factors, including the extent of the tumor. The advantage of pLE is postulated to be better speech capability compared to complete laryngectomy. However, there is a potential risk of aspiration. Over the past ten years, there has been a reevaluation of the resection of LA-LC, shifting from pLE to tLE. The aim is to compare functionality between the two methods in two groups with comparable tumor extents. Material and methods Open pLEs and tLEs performed over a 13-year period were included. All reconstruction techniques were reconsidered. Assessment of functional outcomes was conducted four months after therapy completion. Transoral (open) tumor resections were excluded. Results A total of 109 pLEs and 69 tLEs were performed. An R0 status was achieved in 104 pLEs and 66 tLEs (95% vs. 96%, p=0.611). A total of 51 T3 (31 pLEs, 20 tLEs) and 53 T4 tumors (12 pLEs, 41 tLEs) underwent surgery. Unproblematic oral nutrition was significantly better achieved after tLE compared to pLE (T3: 90% vs. 48%, p=0.002; T4: 92.6% vs. 16%, p=&lt;0.001). The tracheostoma could not be closed in 71% of T3- and 92% of T4-pLEs. No significant differences were observed regarding the ability for phonation (T3: 66% vs. 70%, p=0.961; T4: 58% vs. 54%, p=0.669) or the 5-year survival rate (T3: 43% vs. 47%, p=0.702; T4: 40% vs. 24%, p=0.479). Discussion With comparable 5-year survival rates and outcomes in voice rehabilitation, pLE- patients exhibit less advantageous outcomes in terms of swallowing and often retain the tracheostoma. These results support the paradigm shift in the surgery of advanced LA-LC, which involves a decrease in open pLE.Die Autorinnen(Autoren geben an, dass kein Interessenkonflikt besteht.

Retrospektiver Vergleich der Schluckfunktion: Organerhaltender Ansatz bei Larynxkarzinom vs. komplette Laryngektomie

Hals

Sonstiges

Dr. med.

Dr. med. univ.

Transoral laser microsurgery for the treatment of laryngeal cancer using a 3D-exoscope

Transorale Laserchirurgie zur Behandlung von bösartigen Kehlkopferkrankungen unter Verwendung eines 3D-Exoskops

Introduction: In the last decades, new technological devices and instruments have been developed to overcome the technical limits of transoral laser microsurgery (TOLS). The recent introduction of 3D-exoscopy (3Dex) seems to be a promising tool in the field of diagnostic and operative laryngology as an alternative to the traditional microlaryngoscopy applying an operating microscope (OM). Materials &amp; Methods: We gathered first experiences combining a 3Dex (VITOM® 3D, Karl Storz) with a CO2 laser for the treatment of glottic neoplasms two years ago and recently aquired semi-robotic holding and steering element (ARTip Cruise®, Karl Storz) for the exoscope and an attached CO2-Laser micromanipulator. A series of 3 patients with T1a glottic carcinoma was operated using a 3Dex and key parameters were compared to cases where an OM was applied. Results: Comparison of operation time and oncological results between the 3Dex and OM groups did not reveal significant differences. Conlcusion: The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in TOLS.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Transorale Laserchirurgie zur Behandlung von bösartigen Kehlkopferkrankungen unter Verwendung eines 3D-Exoskops

Dr. rer. nat.

PD Dr. med. habil.

Prof. Dr. med.

Outcome differences of patients with early stage glottic or supraglottic cancer emphasize the importance of a precise examination and description of tumor localization

Eine präzise anatomische Lokalisierung von frühen Karzinomen der Glottis und Supraglottis dient der besseren Prognostizierung bei differentem Gesamtüberleben

Introduction Early laryngeal cancer and especially glottic carcinomas can be safely cured by resection and achieve the best survival rates amongst head and neck cancer. As accurate distinction between of glottic (GC) or supraglottic carcinoma (SGC) is hampered by anatomical proximity of glottis and supraglottic region, we asked if overall survival (OS) varies. Methods Patients diagnosed 2007-2020 with stage I or II GC or SGC (ICD-10C32.0, C32.1, C32.8 or C32.9) were included as part of a monocentric, retrospective study at the Leipzig University Hospital. Before survival analyses, we closely examined reports about biopsy excision and definitive surgery to differentiate more precisely between GC and SGC. Results 225 patients with early GC and SGC were included. After tumor-resection, 5 patients were reclassified into higher UICC stage; 18 had carcinoma in situ. While OS in the 131 UICC stage I patients did not differ between localizations, n=46 UICC stage II GC patients had superior mean OS (109.8, 95% confidence interval (CI) 86.3-133.4 months; median OS 107.7, 95% CI 88.7-126.7 months) compared to n=25 SGC (mean 75.2, 95% CI 53.0-97.4 months; median 77.3, 95% CI 32.6-122.0 months; p=.085). Altogether, OS was superior for GC (mean 123.8, 95% CI 112.3-135.3 months, median 147.1, 95% CI 107.7-186.5 months) vs. SGC (mean 79.9, 95% CI 60.2-99.6 months, median 77.3, 95% CI 44.8-109.8 months; p&lt;.001). Discussion OS in patients with GC or SGC differs significantly. Consequently, great effort increase accuracy in differentiating between both types of laryngeal cancer will improve prognostication. SGC patients will benefit from closer surveillance and potentially from modified therapy regimens.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Eine präzise anatomische Lokalisierung von frühen Karzinomen der Glottis und Supraglottis dient der besseren Prognostizierung bei differentem Gesamtüberleben

Raum A&B

Session 2

Rekonstruktion des Larynx

Wissenschaftliche Sitzung

Session 2
Rekonstruktion des Larynx

Termin

Moderation

Thema

Programm

Session 2Rekonstruktion des Larynx

Termin

Moderation

Thema

Programm

Session 2
Rekonstruktion des Larynx