Phd in ADVANCED SURGICAL TECHNOLOGIES

Thesis title: Valutazione degli outcomes oncologici e funzionali dei pazienti con carcinoma della laringe trattati chirurgicamente

Objective: This study aims to compare the oncological and functional outcomes of patients with squamous cell carcinoma of the larynx (SCCL) based on the surgical treatment they underwent. Patients treated with transoral laser microsurgery (TOLMS) were compared with those treated with open partial horizontal laryngectomy (OPHL). Although radical oncological treatment remains the primary objective, in recent years, attention has shifted toward more conservative therapeutic approaches to preserve laryngeal functions such as phonation and swallowing as much as possible. This study sought to identify the best surgical approach in terms of functional outcomes, based on tumor characteristics and the patient's clinical characteristics. Materials and methods: The study population consisted of 130 patients diagnosed with SCC of the larynx (pT1 – pT3), treated at the ENT Department of Policlinico Umberto I from 2016 to 2025. Of these, 70 underwent TOLMS and 60 underwent OPHL. The oncological outcome was assessed through clinical and radiological follow-up. Functional outcomes were assessed by administering the following questionnaires to patients: Quality of Life Questionnaire (EORTC QLQ-H&N35), Voice Handicap Index-10 (VHI). Perceptual evaluation of the voice was performed using the GRBAS scale, and objective instrumental assessment of swallowing was performed using the PAS (aspiration and penetration scale) modified for partial laryngectomies using fiberoptic endoscopy (FEES). Values were considered statistically significant when p<0.05 using Student's t-test and ANOVA. The statistical analysis was performed using GraphPad Prism® software. Results: Through definitive histological examination, it was possible to divide patients according to staging: 50 patients were classified as pT1 (38%), of whom 42 were treated with TOLMS and 8 with OPHL; 59 patients (45%) were classified as pT2, of whom 28 were treated with TOLMS and 31 with OPHL; and 21 patients (17%) were staged as pT3, all treated with OPHL. Five-year overall survival (OS) was 94.0%, 80.9%, and 86.6% for T1, T2, and T3, respectively. As regards functional outcomes in terms of swallowing and phonation, these are influenced by the initial extent of the disease but, at the same stage, are affected by the extent of surgical resection. Conclusion: The study shows that for both OPHL and TOLMS, the oncological outcome in terms of OS is in line with international literature. Functional outcomes confirm the direct relationship with the extent of surgical resection and the technique used. This study confirms that careful selection of the surgical approach based on patient and tumor characteristics is essential for optimizing oncological and functional outcomes.