Evenboer, J. (Januska) (2012) Use of the Thulium laser in the oral cavity does not interfere with a good pathological assessment. thesis, Medicine.
Full text available on request.Abstract
Introduction: In the Netherlands more than 1000 patients are yearly diagnosed with oral cavity cancer. Predictions are that this number will increase in the upcoming years. For patients who are suffering from a tumour in the oral cavity, the need for a suitable instrument for the resection of these tumours is of great importance. In the University Medical Centre of Utrecht (UMCU) in the Netherlands, two different modalities for the resection of squamous cell carcinomas in the oral cavity (OSCC) are currently used, the Thulium laser (TL) and monopolar electrosurgery (MES). So far no other study described the use of the TL in the oral cavity. A good pathological assessment is essential for planning an optimal oncological treatment. The primary aim of this study was to investigate if a head and neck pathologist was able to assess the resections made by the TL as good as the ones made by using MES. Methods: Forty-two patients with an OSCC, stage I-IV, were included in this pilot study. The medical charts and pathological reports were analysed from patients treated for an OSCC from January 2011 till December 2011. Nineteen patients were treated by an Otolaryngologist using the TL and 23 patients were treated by an Oral and Maxillofacial Surgeon using MES. The TL was used in a continuous way with energy settings of 7-19 Watts (W). For MES the tongue resections were done using 20-30 W and for other areas 10-20 W both in cut-blend mode. The resections were followed by the assessment of the retrieved specimens by three independent pathologists, with special attention for thermal damage and the possibility of margin interpretation. Results: Pathological assessment was possible for all the specimens. The median depth of thermal damage was 2.0 mm, being the same in both groups, ranging from 1.0-3.5 mm in the TL group and from 1.0-4.0 mm in the MES group. There were no other resection modality specific artefacts visible which made it impossible for the pathologists to speculate which modality had been used. Also irradical excisions were three times higher in the MES group. Conclusion: This pilot study shows equally good pathological assessments retrieved by one of the two modalities. Secondarily the TL shows more radical excised tumours. This could be due to good cutting and ablating properties as well as better haemostasis during ablation leading to a better overview. A prospective randomized-controlled trial is warranted in which more patients are included, to reduce limitations directly related to small sample sizes and to non-randomized studies. The overall survival will probably not improve by using another resection modality, this is why in a following study more focus should be led on the Health-related Quality of Life after tumour resection and cost-effectiveness when using the TL.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Westerlaken, Dr. B. Otolaryngologist and Department: Otolaryngology, Head and Neck Surgery |
| Supervisor name: | Supervisors: and Pothen, Drs. A. and Otolaryngologist and and Heijden, Dr. G.J.M.G. van der and Epidemiologist, University Medical Centre of Utrecht |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/118 |
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