Article

Supracricoid partial laryngectomies after failure of radiation therapy.

Department of Otolaryngology-Head and Neck Surgery, Hopital Gui de Chauliac, University of Medecine, Montpellier 34295, France.
The Laryngoscope (impact factor: 1.75). 03/2005; 115(2):353-7. DOI:10.1097/01.mlg.0000154751.86431.41 pp.353-7
Source: PubMed

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.

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    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, 2010
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    Article: Analysis of postoperative complications of open partial laryngectomy.
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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.
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    Article: Modified supracricoid laryngectomy: oncological and functional outcomes in the elderly.
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Keywords

5 cases
 
functional results
 
global survival rate
 
intercurrent disease
 
irradiated T1b
 
key surgical objective
 
laryngeal function
 
mean cannulation time
 
partial vertical surgery
 
postoperative period
 
primary irradiation therapy
 
recurrent T1/T2 tumors
 
salvage treatment
 
supracricoid partial laryngectomies
 
surgical margins
 
T1/T2 glottic carcinoma recurrence
 
T1/T2 vocal cord carcinomas
 
T2 glottic carcinoma
 
tube time
 
vertical partial laryngectomy