Supracricoid partial laryngectomies after failure of radiation therapy.
ABSTRACT Conservation of laryngeal function is a key surgical objective in cases of limited recurrence after previously irradiated T1b or T2 glottic carcinoma. Only a few articles have mentioned the use of supracricoid partial laryngectomies (SCPL) to treat recurrent T1/T2 tumors that cannot be managed with vertical partial laryngectomy.
To evaluate oncologic and functional results of SCPL in selected cases of T1/T2 glottic carcinoma recurrence after primary irradiation therapy.
Between 1986 and 2000, 23 selected patients (T1b, 12 cases; T2, 11 cases) underwent SCPL as salvage treatment: cricohyoidepiglottopexy (CHEP) in 18 cases and cricohyodopexy (CHP) in 5 cases.
The mean cannulation time was 28 (14-90) days. The mean nasogastric feeding tube time for CHP and CHEP was 55 (28-96) days and 21 (9-45) days, respectively. Four (17.4%) patients had major swallowing recovery problems. Three patients died in the postoperative period, one of intercurrent disease and two because of aspiration pneumonia. Six (26.08%) patients relapsed and underwent total laryngectomy. Three were subsequently controlled. The T stage was correlated with the onset of a new recurrence (P = .0258). The surgical margins were not correlated with recurrence (P = .0741). At 3 and 5 years, the global survival rate was 82.9% and 69.04%. The success rate for oncologic control and oncologic control with organ preservation was 74% and 66.6%, respectively.
In selected cases of limited recurrence after radiation therapy for T1/T2 vocal cord carcinomas, SCPL can be an alternative to total laryngectomy when partial vertical surgery appears unsuitable.
Article: Current concepts and new horizons in conservation laryngeal surgery: An important part of multidisciplinary care[show abstract] [hide abstract]
ABSTRACT: Background New surgical techniques in conservation laryngeal surgery (CLS) have emerged over the past 20 years and now offer a viable “organ-preservation” approach for patients with laryngeal cancer. We review traditional and new CLS procedures and summarize the functional and oncologic outcomes of CLS in both primary and salvage settings.Methods We searched the literature by accessing Medline for articles from 1991 to 2007 on primary or salvage surgery (open and transoral) for laryngeal neoplasms.Conclusion Our review of the literature suggests that proper selection of patients for CLS can yield long-term local control rates equal to or better than those obtained using radiation-based approaches. We believe that CLS should be directly compared with radiation or chemoradiation to further refine the indications for each kind of treatment in cases of primary and recurrent/refractory laryngeal cancer. © 2009 Wiley Periodicals, Inc. Head Neck, 2010Head & Neck 08/2009; 32(5):656 - 665. · 2.40 Impact Factor
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ABSTRACT: The objective of this study was to report the incidence of postoperative complications for partial laryngectomy and to identify patient- and tumor-related factors predictive of postoperative complications. A total of 150 patients who had a partial laryngectomy were identified from an existing database of 662 patients treated for squamous cell carcinoma of the larynx from 1984 to 1998. Postoperative complications were recorded and categorized into local, swallowing, airway, and systemic complications. Patient- and tumor-related predictors of complications were identified by univariate and multivariate analyses. There was no postoperative mortality. Twenty percent of patients developed a postoperative complication following partial laryngectomy. Local complications were the most frequent complication and occurred in 17 (11%) patients. Laryngocutaneous fistula occurred in 6 (4%) patients. Multivariate analysis showed that prior radiation was an independent predictor of local complications and laryngocutaneous fistula with a 13-fold increase in relative risk for both. Partial laryngectomy following radiotherapy was more frequently associated with postoperative complications. Problems related to local wound healing, especially the development of laryngocutaneous fistula, constituted the most common postoperative complication in these patients.Head & Neck 01/2009; 31(3):338-45. · 2.40 Impact Factor
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ABSTRACT: BACKGROUND: Supracricoid laryngectomy is an organ preservation surgical technique for early-stage glottic tumors. Modified supracricoid laryngectomy using sternohyoid muscles for neoglottis reconstruction is a new surgical technique. This report evaluates oncological and functional outcomes of this new technique and its feasibility in elderly patients. METHODS: Clinical records from 21 consecutive patients affected by glottic cancer and treated by modified SCL between 2004 and 2009 were retrospectively reviewed. Postoperative parameters and quality of voice after modified SCL were retrospectively reviewed. Actuarial overall survival, disease-specific survival rates, and recurrence-free survival rates were assessed. The functional and oncological outcomes of patients over 65 years were compared with those of patients younger than 65 years of age. RESULTS: There were no postoperative complications and all of the patients had complete swallowing rehabilitation. Twenty of the 21 patients had decannulation. Two patients received total laryngectomy for locoregional relapse. Overall survival and disease-specific survival rates were 100%. Recurrence-free survival rates were 90.1% and 90% in patients younger and older than 65 years of age, respectively. The larynx preservation index was lower in patients who were older than 65 years of age. The postoperative courses with regard to functional outcome and voice quality in elderly patients were similar to those of patients younger than 65 years of age. CONCLUSION: Modified SCL is a new open organ preservation surgical technique that is oncologically safe. The positive functional and oncological outcomes of this surgical procedure allow it to be performed in elderly patients.Clinical Interventions in Aging 01/2012; 7:475-480. · 2.08 Impact Factor