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The CO2 waveguide laser with flexible fiber in transoral resection of oral and oropharyngeal cancers: a retrospective cohort study on postoperative and quality of life outcomes

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Abstract

The aim of this study was to evaluate the CO2 waveguide laser (WG CO2 laser) with flexible fiber (Lumenis Ltd., Yokneam, Israel) in the treatment of oral and oropharyngeal cancers, specifically focusing on postoperative outcomes, pain, and quality of life (QoL). Eighty-one patients, 43 women and 38 men, with oral or oropharyngeal cancer who consecutively underwent transoral resection by WG CO2 laser from August 2015 to April 2020 were retrospectively enrolled. Resections were performed in super pulsed mode with a power setting ranging between 3 and 10 W. Data about frozen sections, reconstruction, complication rate, length of hospital stay, tracheostomy rate and time to decannulation, nasogastric feeding tube rate and time to oral feeding, pain, and QoL were reviewed. Continuous variables were presented as mean and standard deviation. Concordance between intraoperative frozen section examination and definitive histology was calculated using Cohen’s K test of agreement. The mean length of hospital stay was 13 days. The feeding tube rate was 81%; the tracheostomy rate was 35%; the feeding tube was left in place for 8 days on average, and the time to decannulation was 9 days. The only complication was a postoperative bleeding in 4 patients. The median postoperative pain score measured by the Numeric Pain Rating Scale on postoperative days 1, 3, and 5 was 0 and there was a constant decrease in painkiller use over the days. The overall mean composite QoL score was 77 ± 14, with excellent results in saliva, taste, pain, and speech domains. Frozen section evaluation had a specificity of 99% and a negative predictive value of 98%. WG CO2 laser is a good and safe tool for transoral tailored resection of oral and oropharyngeal cancers. It ensures a good overall QoL and guarantees fast recovery and a very low postoperative pain.

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Data availability

The data that support the findings of this study are available from the corresponding author, NG, upon reasonable request.

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Funding

The work was supported by Lumenis Ltd., Yokneam, Israel, the manufacturer of the CO2 waveguide laser with flexible fiber. The authors were trained in the use of the tool.

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Authors and Affiliations

  1. ENT Clinic, Head and Neck Department, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    Nicoletta Gardenal, Stefania Rigo, Paolo Boscolo-Rizzo, Annalisa Gatto & Giancarlo Tirelli

  2. Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud “Madre Teresa Di Calcutta” Hospital Monselice (Padova)-ULSS, 6 Euganea, Padua, Italy

    Francesca Boscolo Nata

  3. Department of Otolaryngology, Hospital Universitario Gregorio Marañón, Madrid, Spain

    Mario Marcos Fernández-Fernández

Authors
  1. Nicoletta Gardenal
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  2. Stefania Rigo
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  3. Francesca Boscolo Nata
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  4. Mario Marcos Fernández-Fernández
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  5. Paolo Boscolo-Rizzo
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  6. Annalisa Gatto
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  7. Giancarlo Tirelli
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Contributions

Prof. GT and Prof. MMFF actively contributed to the conception and design of the study; FBN and AG contributed to the acquisition and analysis of data; NG and SR contributed to acquisition of data and drafted the manuscript; Prof PBR critically revised the manuscript.

Corresponding author

Correspondence to Nicoletta Gardenal.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee on Clinical Investigation of the University of Trieste approved the study protocol (Report No. 58).

Informed consent

Informed consent was obtained from all individual participants included in the study. Consent for publication was received from every participant patient.

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The authors declare no competing interests.

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Gardenal, N., Rigo, S., Boscolo Nata, F. et al. The CO2 waveguide laser with flexible fiber in transoral resection of oral and oropharyngeal cancers: a retrospective cohort study on postoperative and quality of life outcomes. Lasers Med Sci 37, 1755–1762 (2022). https://doi.org/10.1007/s10103-021-03430-x

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  • DOI: https://doi.org/10.1007/s10103-021-03430-x

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