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Succo G, Bertolin A, Santos IC, Tascone M, Lionello M, Fantini M, de Freitas AS, Bertotto I, Sprio AE, Sanguineti G, Dias FL, Rizzotto G, Crosetti E. Partial Laryngectomy for pT4a Laryngeal Cancer: Outcomes and Limits in Selected Cases. Cancers (Basel) 2023; 15:2861. [PMID: 37345197 DOI: 10.3390/cancers15102861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
A large multi-institutional case series of laryngeal cancer (LC) T4a was carried out, including 134 cases treated with open partial horizontal laryngectomies (OPHL) +/- post-operative radiation therapy (PORT). The goal was to understand better whether OPHL can be included among the viable options in selected pT4a LC patients who refuse a standard approach, represented by total laryngectomy (TL) + PORT. All 134 patients underwent OPHL type I (supraglottic), II (supracricoid), or III (supratracheal), according to the European Laryngological Society Classification. Comparing clinical and pathological stages showed pT up-staging in 105 cases (78.4%) and pN up-staging in 19 patients (11.4%). Five-year data on overall survival, disease-specific survival, disease-free survival, freedom from laryngectomy, and laryngo-esophageal dysfunction-free survival (rate of patients surviving without a local recurrence or requiring total laryngectomy and without a feeding tube or a tracheostomy) were, respectively, 82.1%, 89.8%, 75.7%, 89.7%, and 78.3%. Overall, complications were observed in 22 cases (16.4%). Sequelae were observed in 28 patients (20.9%). No patients died during the postoperative period. This large series highlights the good onco-functional results of low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction, treated with OPHLs. The level of standardization of the indication for OPHL should allow consideration of OPHL as a valid therapeutic option in cases where the patient refuses total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy.
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Affiliation(s)
- Giovanni Succo
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Oncology Department, University of Turin, 10124 Torino, Italy
| | - Andy Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | | | - Martina Tascone
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - Marco Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | - Marco Fantini
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | | | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute FPO IRCCS, Candiolo, 10060 Turin, Italy
| | - Andrea Elio Sprio
- Department of Research, ASOMI College of Sciences, 2080 Marsa, Malta
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Fernando Luiz Dias
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, RJ, Brazil
| | - Giuseppe Rizzotto
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | - Erika Crosetti
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
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Colizza A, Ralli M, Di Stadio A, Cambria F, Zoccali F, Cialente F, Angeletti D, Greco A, de Vincentiis M. Outcomes of Laryngeal Cancer Surgery after Open Partial Horizontal Laryngectomies with Lateral Cervical Approach. J Clin Med 2022; 11:jcm11164741. [PMID: 36012980 PMCID: PMC9410219 DOI: 10.3390/jcm11164741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell carcinoma (LSCC) treated with OPHL, performed using a minimally invasive technique. Methods: This is a prospective case−control study. We enrolled 17 consecutive patients with LSCC treated with OPHL through a lateral cervical approach (LCA). Patients were evaluated using their Penetration Aspiration Scale score (liquid, semiliquid and solid) and Voice Handicap Index (VHI) at three different endpoints: 15 days (T1), 3 months (T2), and 6 months (T2) after surgery. Results: The functional outcomes of the LCA are stackable with that of the classical anterior cervical approach in terms of respiration, swallowing, and speech. One-way ANOVA was performed to evaluate the variances of PAS and VHI scores at the three different observation points. No statistically significant differences were observed between OPHL- PAS scores for liquid (p = 0.1) at the three different observation points. A statistically significant improvement was observed in the OPHL- PAS score for semisolids and solids (p < 0.00001) between T1 and T3 (p = 0.0001) and for solids between T2 and T3 (p < 0.00001). The improvement of VHI-10 was statistically significative (p < 0.00001) at the three different observation points (T1−T2 and T2−T3). Conclusion: The LCA is a potential approach for laryngeal surgery in selected cases. The preoperative staging and planning are of the utmost importance to ensure oncological radicality. The main advantage of this approach is the preservation of the healthy tissues surrounding the larynx and the functional and oncological outcomes are stackable with the classic anterior cervical approach.
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Affiliation(s)
- Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
- Correspondence: ; Tel.: +39-340-380-7820
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Arianna Di Stadio
- Department GF Ingrassia, University of Catania, 95125 Catania, Italy
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Federica Zoccali
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Diletta Angeletti
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
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Fantini M, Crosetti E, Pizzorni N, Sprio AE, Bertolin A, Rizzotto G, Schindler A, Succo G. Voice and communication after open partial horizontal laryngectomies: A cross-sectional outcome study. Head Neck 2022; 44:2248-2256. [PMID: 35792420 DOI: 10.1002/hed.27132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study evaluates voice and communication after open partial horizontal laryngectomies (OPHLs), according to surgery and patient-related variables. METHODS Fifty-eight patients were included: 18 type I OPHL, 20 type II OPHL and 20 type III OPHL. Acoustic, aerodynamic, endoscopic, perceptual and self-assessment analyses were carried out. Surgery-related variables and patient-related variables were considered for the analysis. RESULTS Type I OPHL revealed the best phonatory outcomes. Type II and type III OPHL showed similar and poor results, with a highly deteriorated voice quality. A significant difference in MTP was found for patients who had both arytenoids/cricoarytenoid units preserved. Age and time from surgery showed significant correlations with voice quality after OPHLs. CONCLUSIONS Voice and communication outcomes after OPHLs are heterogeneous and might be influenced by several factors. Knowing variables with a substantial impact on phonatory outcomes may help clinicians in the preoperative decision-making process and the postoperative rehabilitative program.
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Affiliation(s)
- Marco Fantini
- Otorhinolaryngology Service, Koelliker Hospital, Turin, Italy.,Otorhinolaryngology Service, San Feliciano Hospital, Rome, Italy
| | - Erika Crosetti
- Otolaryngology Head and Neck Surgery Unit, San Luigi Gonzaga Hospital, Turin, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Andy Bertolin
- Otolaryngology Head and Neck Surgery Unit, Ospedale Civile of Vittorio Veneto, Vittorio Veneto, Italy
| | - Giuseppe Rizzotto
- Otolaryngology Head and Neck Surgery Unit, Ospedale Civile of Vittorio Veneto, Vittorio Veneto, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Department of Oncology, University of Turin, Turin, Italy.,Otolaryngology Head and Neck Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy
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Fantini M, Crosetti E, Affaniti R, Sprio AE, Bertotto I, Succo G. Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies. Head Neck 2021; 43:3459-3467. [PMID: 34405480 DOI: 10.1002/hed.26845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In minority of cases, the clinical recovery of the neolarynx after open partial horizontal laryngectomies (OPHLs) can be challenging, possibly affecting the final functional outcome. METHODS One hundred and twenty-three patients who underwent OPHLs were selected. A series of clinical preoperative independent variables were considered. All patients were monitored for the following dependent outcome variables: sequelae; need for percutaneous endoscopic gastrostomy positioning; days before tracheal cannula removal and nasogastric tube removal; and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify significant associations between preoperative clinical variables and outcomes variables. RESULTS Multivariate analysis confirmed age, cT classification, body mass index, and smoking habits as significant prognostic factors for worse functional and clinical recovery outcomes. CONCLUSIONS Knowing what variables are significantly associated with worse clinical and functional outcomes can guide clinicians in defining the best surgical choice not only from an oncological perspective, but also for a better postoperative recovery.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Riccardo Affaniti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy.,Oncology Department, University of Turin, Orbassano (TO), Italy
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Başaran B, Doruk C, Aydemir L. Our Experience with Supratracheal Partial Laryngectomy in Advanced Laryngeal Cancer: A Report of Five Cases. Turk Arch Otorhinolaryngol 2020; 58:193-196. [PMID: 33145505 DOI: 10.5152/tao.2020.5079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022] Open
Abstract
Supratracheal laryngectomy (STL) is the ultimate option in conservation surgery, and can be used as an alternative to total laryngectomy in selected tumors. This case series is the first report from Turkey that analyzes the oncological and functional outcomes of STL along with a literature review. Files of five patients who underwent STL between June 2016 and June 2019 were analyzed. Primary tumor findings, postoperative pathology reports, treatment modalities and oncological and functional outcomes of the surgical intervention were noted. Two patients were operated on for horse-shoe glottic tumors with subglottic extension, one patient for primary subglottic mass and two for transglottic ventricular tumors with anterior subglottic extension. Pathological stage of two patients was T3, and of three patients was T4a due to thyroid cartilage invasion. No neck metastases were observed. Three patients with T4a primary tumor were treated with adjuvant radiotherapy. All patients were found disease free in their last follow-up visit. Nasogastric tube was removed in the 1st postoperative month in all patients. While one patient remained tracheostomized in the follow-up period, the remaining four were decannulated. This technique can be used as an alternative to total laryngectomy especially in selected cases with subglottic extension.
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Affiliation(s)
- Bora Başaran
- Department of Otolaryngology & Head and Neck Surgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Can Doruk
- Department of Otolaryngology & Head and Neck Surgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Levent Aydemir
- Department of Otolaryngology & Head and Neck Surgery, İstanbul University School of Medicine, İstanbul, Turkey
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Fantini M, Gallia M, Borrelli G, Pizzorni N, Ricci Maccarini A, Borragan Torre A, Schindler A, Succo G, Crosetti E. Substitution Voice Rehabilitation After Open Partial Horizontal Laryngectomy Through the Proprioceptive Elastic Method (PROEL): A Preliminary Study. J Voice 2020; 36:291.e1-291.e7. [PMID: 32553498 DOI: 10.1016/j.jvoice.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim was to investigate the efficacy of the Proprioceptive Elastic Method (PROEL) in the rehabilitation of the substitution voice after open partial horizontal laryngectomy (OPHL). STUDY DESIGN Prospective outcome study. METHODS Fifteen patients surgically treated by OPHL type II or type III for laryngeal cancer were recruited (experimental group). Each patient underwent a specific program of voice rehabilitation based on the PROEL method with the same speech and language pathologist. Acoustic-aerodynamic analysis: maximum phonation time (MPT); spectrographic classification (Titze's modified classification), perceptual analysis (INFVo rating scale) and self-assessments (SECEL questionnaire) were performed before the treatment (T0), after 3 months of rehabilitation (T1), and at the end of the 6-month rehabilitation program (T2). A control sample of other 15 patients who underwent OPHL type II or type III and who underwent a standard perioperative rehabilitation was randomly extracted from an historical database and compared to the experimental group. RESULTS Significative voice improvements between T0-T1 and T2 were found for acoustic, aerodynamic, perceptual, and self-assessments analysis in the experimental group. Significative differences were found between the experimental group at T2 and the control sample for aerodynamic, self-assessment, and perceptual analysis. CONCLUSIONS The results of the present study support PROEL method as an effective approach for substitution voice rehabilitation after OPHL type II and III. Randomized controlled trials on larger groups of patients are needed in future in order to compare PROEL with other rehabilitative approaches.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.
| | - Michela Gallia
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Gabriella Borrelli
- Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | | | | | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy; Oncology Department, University of Turin, Turin, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
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7
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Zica GM, Freitas ASD, Silva ACAE, Dias FL, Santos IC, Freitas EQ, Koch HA. Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy. EINSTEIN-SAO PAULO 2020; 18:eAO5390. [PMID: 32428067 PMCID: PMC7233281 DOI: 10.31744/einstein_journal/2020ao5390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.
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Pizzorni N, Crosetti E, Santambrogio E, de Cillis G, Bertolin A, Rizzotto G, Fantini M, Succo G, Schindler A. The Penetration-Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis. Dysphagia 2019; 35:261-271. [PMID: 31161405 DOI: 10.1007/s00455-019-10025-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/06/2019] [Accepted: 05/25/2019] [Indexed: 11/25/2022]
Abstract
A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter- and intra-rater agreement was assessed using unweighted Cohen's kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter- and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Elena Santambrogio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giada de Cillis
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andy Bertolin
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Giuseppe Rizzotto
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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Garcia AM, Dias FL, Gonçalves AJ, Cernea CR, Freitas EQ, Menezes MB, Kulcsar MAV. Supratracheal laryngectomy: a multi-institutional study. Braz J Otorhinolaryngol 2019; 86:609-616. [PMID: 31175040 PMCID: PMC9422495 DOI: 10.1016/j.bjorl.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/07/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.
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Affiliation(s)
- Ariana M Garcia
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil.
| | - Fernando L Dias
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Antônio J Gonçalves
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Claudio R Cernea
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Emilson Q Freitas
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Marcelo B Menezes
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marco Aurélio V Kulcsar
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Succo G, Crosetti E. Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs. Front Oncol 2019; 9:408. [PMID: 31192120 PMCID: PMC6540733 DOI: 10.3389/fonc.2019.00408] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022] Open
Abstract
The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.
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Affiliation(s)
- Giovanni Succo
- Oncology Department, University of Turin, Turin, Italy.,Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
| | - Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
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11
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Relationship between swallowing-related quality of life and fiberoptic endoscopic evaluation of swallowing in patients who underwent open partial horizontal laryngectomy. Eur Arch Otorhinolaryngol 2018; 275:973-985. [DOI: 10.1007/s00405-018-4888-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
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Supratracheal partial laryngectomy: indications, oncologic and functional results. Curr Opin Otolaryngol Head Neck Surg 2018; 25:127-132. [PMID: 28169863 DOI: 10.1097/moo.0000000000000344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe current evidence about supratracheal laryngectomies, focusing on indications, contraindications, oncologic results, functional outcomes and side-effects of this 'extreme' function-sparing surgical approach to laryngeal cancer. RECENT FINDINGS In the latest years, some studies have analyzed oncologic and functional results of open partial supratracheal laryngectomy, a surgical approach whose modern technique was recently described. In selected patients, supratracheal partial laryngectomies show promising long-term oncologic and functional outcomes, similar to those of supracricoid partial laryngectomies. SUMMARY The application of supratracheal laryngectomy in the context of a surgical modular approach can be considered a valid and effective therapeutic choice for selected patients with glottic or transglottic laryngeal cancer with subglottic extension, not only in terms of oncologic results, but also in regard of functional outcomes.
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Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemoradiotherapy of Head and Neck Malignancy. Dysphagia 2018. [DOI: 10.1007/174_2018_179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Crosetti E, Fantini M, Arrigoni G, Salonia L, Lombardo A, Atzori A, Panetta V, Schindler A, Bertolin A, Rizzotto G, Succo G. Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant? Eur Arch Otorhinolaryngol 2016; 274:337-346. [PMID: 27435595 DOI: 10.1007/s00405-016-4217-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/14/2016] [Indexed: 11/21/2022]
Abstract
The aim was to investigate telephonic voice intelligibility in patients treated for laryngeal cancer using different approaches. In total, 90 patients treated for laryngeal cancer using different approaches and 12 healthy volunteers were recruited. Each patient and each healthy control read a list of words and sentences during a telephone call. Six auditors listened to each telephonic recording and transcribed the words and sentences they understood. Mean intelligibility rates for each treatment were assessed and compared. Regarding words, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by total laryngectomies. The best intelligibility was found for transoral laser microsurgery, followed by radiotherapy alone. For sentences, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by chemoradiotherapy. The best intelligibility was found for radiotherapy alone and transoral laser microsurgery. More aggressive surgery as well as chemoradiotherapy correlated with significantly poorer outcomes. Transoral laser microsurgery or radiotherapy alone ensured the best telephonic voice intelligibility. Intermediate-advanced T stages at diagnosis also showed significantly poorer intelligibility outcomes, suggesting that T stage represents an independent negative prognostic factor for voice intelligibility after treatment.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.
| | - Marco Fantini
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giulia Arrigoni
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Laura Salonia
- Otorhinolaryngology Service, Department of Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Agata Lombardo
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alessio Atzori
- National Institute of Metrological Research, Turin, Italy
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy and Training, Biostatistics office, Rome, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andy Bertolin
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Giuseppe Rizzotto
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Giovanni Succo
- Otorhinolaryngology Service, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Schindler A, Pizzorni N, Fantini M, Crosetti E, Bertolin A, Rizzotto G, Succo G. Long-term functional results after open partial horizontal laryngectomy type IIa and type IIIa: A comparison study. Head Neck 2015; 38 Suppl 1:E1427-35. [PMID: 26560504 DOI: 10.1002/hed.24254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare long-term swallowing, voice results, and quality of life (QOL) after open partial horizontal laryngectomy (OPHL) type IIa and type IIIa. METHODS Twenty-three patients after OPHL type IIa and 18 patients after OPHL type IIIa were involved. Swallowing skills and neoglottis' motility and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic voice-related and swallowing-related QOL were assessed. Data were statistically compared using Mann-Whitney U test or Fisher exact tests, as appropriate. RESULTS Significant differences were found only for the residue with solids and for the intelligibility (I) parameter of the overall quality impression and intelligibility, additive and unnecessary noise, speech fluency, and presence of voiced segments scale with patients of the OPHL type IIIa group showing worse performances than the OPHL type IIa group. CONCLUSION Patients who underwent OPHL type IIa and type IIIa show comparable long-term functional outcomes. OPHL type IIIa represents a valid surgical alternative to OPHL type IIa. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1427-E1435, 2016.
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Affiliation(s)
- Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Marco Fantini
- Department of Otorhinolaryngology, Ospedale San Luigi Gonzaga, University of Turin, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, Ospedale Martini, Turin, Italy
| | - Andy Bertolin
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Giuseppe Rizzotto
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Giovanni Succo
- Department of Otorhinolaryngology, Ospedale San Luigi Gonzaga, University of Turin, Italy
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Evaluation of swallowing function after supracricoid laryngectomy as a primary or salvage procedure. Dysphagia 2015; 30:686-94. [PMID: 26267541 DOI: 10.1007/s00455-015-9645-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
The primary functional issues following conservative therapy for advanced laryngeal cancer concern swallowing. Here, we evaluated the recovery of swallowing after supracricoid partial laryngectomy (SCL) in patients with primary or recurrent laryngeal cancer. We evaluated the swallowing recovery in 27 SCL patients through oropharyngoesophageal scintigraphy, and we evaluated their quality of life using EORTC questionnaires. Four patients underwent total laryngectomy during follow-up. Patients who retained their larynges were able to feed without nutritional support and without tracheostoma. The only significantly different parameter between the primary and salvage cases was the time elapsed to the removal of nasogastric/PEG tubes, which was longer in salvage cases. SCL has been demonstrated as a valuable option for primary and recurrent laryngeal cancer patients. The present data demonstrate good functional results, particularly in terms of swallowing after previous treatments and in primary settings. The combination of oropharyngoesophageal scintigraphy and questionnaires appears to be an adequate, standardizable approach to assessing swallowing function after SCL.
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Succo G, Crosetti E, Bertolin A, Lucioni M, Arrigoni G, Panetta V, Sprio AE, Berta GN, Rizzotto G. Benefits and drawbacks of open partial horizontal laryngectomies, Part B: Intermediate and selected advanced stage laryngeal carcinoma. Head Neck 2015; 38 Suppl 1:E649-57. [DOI: 10.1002/hed.24064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/26/2015] [Accepted: 04/10/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Giovanni Succo
- Otorhinolaryngology Service; Department of Oncology; San Luigi Gonzaga Hospital, University of Turin; Turin Italy
| | - Erika Crosetti
- Otorhinolaryngology Service; Martini Hospital; Turin Italy
| | - Andy Bertolin
- Otorhinolaryngology Service; Vittorio Veneto Hospital, Vittorio Veneto; Treviso Italy
| | - Marco Lucioni
- Otorhinolaryngology Service; Vittorio Veneto Hospital, Vittorio Veneto; Treviso Italy
| | - Giulia Arrigoni
- Otorhinolaryngology Service; Department of Oncology; San Luigi Gonzaga Hospital, University of Turin; Turin Italy
| | - Valentina Panetta
- L'altrastatistica srl; Consultancy and Training, Biostatistics Office; Rome Italy
| | - Andrea E. Sprio
- Department of Clinical and Biological Sciences; University of Turin; Turin Italy
| | - Giovanni N. Berta
- Department of Clinical and Biological Sciences; University of Turin; Turin Italy
| | - Giuseppe Rizzotto
- Otorhinolaryngology Service; Vittorio Veneto Hospital, Vittorio Veneto; Treviso Italy
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