1
|
Cantaffa C, Donvito S, Manto AL, Serafini E, Caffagni R, Luppi MP, Tonelli R, Daniele M, Francesco M. Effect of Aging on Long-Term Functional Outcomes After Open Partial Laryngectomy. Otolaryngol Head Neck Surg 2024. [PMID: 38946680 DOI: 10.1002/ohn.863] [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: 10/01/2023] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Open partial horizontal laryngectomies (OPHLs) represent a comparable alternative to total laryngectomy and nonsurgical protocols in selected cases. While short-term functional outcomes of OPHLs have been widely investigated, few have focused on the effect of aging on residual laryngeal structures. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. METHODS Patients who underwent OPHLs after at least 1 year follow-up and optimal functional rehabilitation were included in the study. Swallowing function was assessed according to PAS (Penetration aspiration scale) and Pooling scores. Spectrogram analysis of voice was conducted according to Yanagihara classification and acoustic parameters were also recorded. Subjective questionnaire data about phonation and swallowing were also recorded. Data obtained were compared among patients according to age at time of surgery, evaluation and duration of follow-up. RESULTS Ninety-seven patients were enrolled with a mean age at surgery and evaluation of 63 and 70 years old, respectively. Median follow-up length was 5 years. OPHL type II was mostly performed. No significant correlation was observed between most of the analyzed variables and patient's age at the time of surgery and at the time of evaluation. Some acoustic parameters were negatively correlated with follow-up length, while Jitter, NHR (Noise-Harmonic Ratio), and Global grade and Roughness were significantly higher in patients >65 years old. CONCLUSION Patients who complete rehabilitation reach equally good results as their younger peers with stability over time. Finally, the effects of aging on residual larynx are of minor entity compared to the nonoperated patients. LEVEL OF EVIDENCE Level IV-retrospective cohort study.
Collapse
Affiliation(s)
- Carla Cantaffa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Sara Donvito
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alfredo L Manto
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliera-Universitaria of Bologna, Bologna, Italy
| | - Rebecca Caffagni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria P Luppi
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences, University Hospital of Modena, Modena, Italy
| | - Marchioni Daniele
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Mattioli Francesco
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| |
Collapse
|
2
|
Saturno M, Shaari AL, Yun J, Wein LE, Shaari D, Kappauf C, Laitman BM, Chai RL. Outcomes of Supracricoid Partial Laryngectomy Performed in the United States: A Systematic Review. Laryngoscope 2024; 134:3003-3011. [PMID: 38251796 DOI: 10.1002/lary.31273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/09/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE The primary objective of this study was to evaluate oncologic outcomes of all published cases of supracricoid partial laryngectomy (SCPL) performed in the United States. The secondary objective was to assess the functional outcomes associated with this procedure. REVIEW METHODS A systematic review of PubMed, SCOPUS, and Embase for all English-language studies pertaining to SCPL performed in the United States was conducted until August 2021. Primary outcomes included disease-specific survival (DSS), overall survival, and local recurrence rate. Secondary outcomes included larynx preservation rate, gastrostromy tube dependency, days to gastrostomy tube removal, decannulation rate, and days to decannulation. RESULTS A total of six studies were included in the analysis. A total of 113 patients (58.5%) underwent SCPL surgery as a primary treatment method whereas 80 patients (41.5%) underwent SCPL as salvage surgery. The 5-year DSS rates were 87.8% and 100% for primary and salvage procedures, respectively. Approximately 10.3% of patients undergoing a salvage SCPL procedure experienced a local recurrence whereas only 1.85% of primary SCPL procedures resulted in local recurrence. The rates of decannulation following primary and salvage SCPL were 92.7% and 88.1%, respectively. With regard to swallowing, primary and salvage SCPL procedures demonstrated comparably low postoperative gastrostomy tube dependency rates of 3.66% and 4.76%, respectively. CONCLUSIONS SCPL performed in the United States is an effective surgical technique that produces excellent outcomes in qualifying patients, thus validating its viability as an organ-preserving surgical alternative. Laryngoscope, 134:3003-3011, 2024.
Collapse
Affiliation(s)
- Michael Saturno
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ariana L Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jun Yun
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Lauren E Wein
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Diana Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
| | - Catharine Kappauf
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Benjamin M Laitman
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Raymond L Chai
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| |
Collapse
|
3
|
Zorzi SF, Lazio MS, Pietrobon G, Chu F, Zurlo V, Bibiano D, De Benedetto L, Cattaneo A, De Berardinis R, Mossinelli C, Alterio D, Rocca MC, Gandini S, Gallo O, Chiocca S, Tagliabue M, Ansarin M. Upfront surgical organ-preservation strategy in advanced-stage laryngeal cancer. Am J Otolaryngol 2022; 43:103272. [PMID: 34757315 DOI: 10.1016/j.amjoto.2021.103272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Advanced-stage laryngeal cancer is a challenging disease that needs multimodal treatment. Medical and surgical organ-preservation strategies have been developing in the last decades to spare these functions while granting cancer cure. The current work presents the experience of a tertiary-care center in conservative surgery for advanced-stage laryngeal cancer. MATERIALS AND METHODS We collected clinical data of patients submitted to open partial horizontal laryngectomies (OPHLs) and any possible adjuvant treatment from 2005 to 2018. Outcomes were also compared to the most recent studies reporting on both medical and surgical organ-preservation strategies. RESULTS One hundred ten patients were included in the analysis. Adjuvant therapy was employed in 51% of cases. The local control rate was 96.4%, while overall survival (OS) was 67%, and laryngo-esophageal dysfunction free survival (LEDFS) was 66%. Stage IV and vascular invasion were associated with a statistically-significant worse survival. CONCLUSIONS OPHLs are valid as upfront treatment in fit patients affected by advanced-stage laryngeal cancer. Disease control and function preservation are granted in a significant percentage of cases, even when followed by adjuvant therapy.
Collapse
Affiliation(s)
- Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Silvia Lazio
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Zurlo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Debora Bibiano
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi De Benedetto
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Augusto Cattaneo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Mossinelli
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Maria Cossu Rocca
- Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Oreste Gallo
- First Clinic of Otolaryngology Head-Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Pizzorni N, Schindler A, Castellari M, Fantini M, Crosetti E, Succo G. Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study. Cancers (Basel) 2019; 11:cancers11040549. [PMID: 30999620 PMCID: PMC6520791 DOI: 10.3390/cancers11040549] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure (p = 0.021). Inefficient swallowers presented a longer pharyngeal transit time (p = 0.008), a reduced pharyngoesophageal segment opening lateral (p = 0.008), and a worse tongue base retraction (p = 0.018 with solids and p = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL.
Collapse
Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20154 Milano, Italy.
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20154 Milano, Italy.
| | - Micol Castellari
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20154 Milano, Italy.
| | - Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Strada Provinciale 142 km 95, 10060 Candiolo (TO), Italy.
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Strada Provinciale 142 km 95, 10060 Candiolo (TO), Italy.
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Strada Provinciale 142 km 95, 10060 Candiolo (TO), Italy.
- Department of Oncology, University of Turin, 10043 Orbassano (TO), Italy.
| |
Collapse
|
7
|
Di Santo D, Bondi S, Giordano L, Galli A, Tulli M, Ramella B, Bussi M. Long-term Swallowing Function, Pulmonary Complications, and Quality of Life after Supracricoid Laryngectomy. Otolaryngol Head Neck Surg 2019; 161:307-314. [DOI: 10.1177/0194599819835189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives Long-term effects of supracricoid laryngectomies are nowadays under discussion. The purpose of this study was to detect the prevalence of chronic aspiration and incidence of pulmonary complications, to investigate possible influencing factors, and to analyze dysphagia-related quality of life in a cohort of patients who recovered swallowing function after undergoing supracricoid laryngectomies. Study Design Retrospective observational study. Setting San Raffaele Hospital, Vita-Salute University, Milan, Italy. Methods A cohort of 39 patients who recovered swallowing function free of disease after a minimum 3-year follow-up period was retrospectively investigated between October and December 2017—clinically with the Pearson’s Scale and M. D. Anderson Dysphagia Inventory and instrumentally with fiberoptic endoscopic evaluation of swallowing. Results Chronic aspiration was demonstrated in a significant portion of patients (clinically in 33.3% and instrumentally in 35.9%). Aspiration was influenced by advanced age at surgery ( P = .020). Type of surgical procedure, resection of 1 arytenoid cartilage, postoperative rehabilitation with a speech-language therapist, radiotherapy, age at consultation, and length of follow-up did not influence the prevalence of aspiration. Pulmonary complications affected 5 patients; incidence of pulmonary complications was related to aspiration and was favored by poor laryngeal sensation/cough reflex. Aspiration significantly affected quality of life. Conclusions Chronic aspiration is frequent and affects patients’ quality of life. However, incidence of pulmonary complications is low; therefore, oral feeding should not be contraindicated for aspirating patients. Preservation of laryngeal sensation and cough reflex is mandatory to prevent pulmonary complications.
Collapse
Affiliation(s)
- Davide Di Santo
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Stefano Bondi
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Leone Giordano
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Andrea Galli
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Michele Tulli
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Barbara Ramella
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| |
Collapse
|
8
|
Role of supracricoid partial laryngectomy with cricohyoidoepiglottopexy in glottic carcinoma with anterior commissure involvement. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:249-253. [DOI: 10.1016/j.anorl.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
9
|
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]
|
10
|
Crosetti E, Caracciolo A, Molteni G, Sprio AE, Berta GN, Presutti L, Succo G. Unravelling the risk factors that underlie laryngeal surgery in elderly. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:185-93. [PMID: 27214829 PMCID: PMC4977005 DOI: 10.14639/0392-100x-817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/10/2016] [Indexed: 01/13/2023]
Abstract
Older patients are not considered good candidates to undergo more challenging therapeutic treatments, e.g. highly invasive surgery and complex chemotherapy. However, their exclusion from standard therapeutic options is not justifiable. Herein, we reviewed 212 patients aged ≥ 70, affected with laryngeal squamous cell carcinoma, and treated with transoral laser microsurgery or open neck (partial / total) laryngectomy with radical intent. The main aim was to compare patient outcomes to identify predictive factors that can be used by surgeons to choose the most appropriate treatment option. In our cohort, patients affected with more advanced tumour and hence treated by invasive open neck surgeries (above all TL) are more prone to develop complications and undergo fatal outcome than those with early disease treated by laser microsurgery, independently of age at surgery. In conclusion, elderly patients affected by laryngeal cancer can be treated similarly to younger patients, keeping in mind that more invasive surgeries are associated with a higher risk of developing complications. The advantages of mini-invasive surgery make it a possible first choice treatment in very old and frail patients suffering from laryngeal cancer, especially considering the recent success in treatment of some advanced stage tumours. Furthermore, comorbidities, by themselves, should not be used as exclusion criteria for subjecting an elderly patient to a different treatment that is from standard therapy.
Collapse
Affiliation(s)
- E Crosetti
- Head and Neck Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - A Caracciolo
- Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Italy
| | - G Molteni
- Otorhinolaryngology Service, Policlinico di Modena Hospital, University of Modena, Department of Head and Neck Surgery, Modena, Italy
| | - A E Sprio
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - G N Berta
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - L Presutti
- Otorhinolaryngology Service, Policlinico di Modena Hospital, University of Modena, Department of Head and Neck Surgery, Modena, Italy
| | - G Succo
- Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Italy
| |
Collapse
|
11
|
Giordano L, Di Santo D, Crosetti E, Bertolin A, Rizzotto G, Succo G, Bussi M. Open partial horizontal laryngectomies: is it time to adopt a modular form of consent for the intervention? ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:403-407. [PMID: 27958601 PMCID: PMC5225796 DOI: 10.14639/0392-100x-769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 06/11/2016] [Indexed: 11/23/2022]
Abstract
Nowadays, open partial horizontal laryngectomies (OPHLs) are well-established procedures for treatment of laryngeal cancer. Their uniqueness is the possibility to modulate the intervention intraoperatively, according to eventual tumour extension. An OPHL procedure is not easy to understand: there are several types of procedures and the possibility to modulate the intervention can produce confusion and lack of adherence to the treatment from the patient. Even if the surgery is tailored to a patient's specific lesion, a unified consent form that discloses any possible extensions, including a total laryngectomy, is still needed. We reviewed the English literature on informed consent, and propose comprehensive Information and Consent Forms for OPHLs. The Information Form is intended to answer any possible questions about the procedure, while remaining easy to read and understand for the patient. It includes sections on laryngeal anatomy and physiology, surgical aims and indications, alternatives to surgery, complications, and physiology of the operated larynx. The Consent Form is written in a "modular" way: the surgeon defines the precise extension of the lesion, chooses the best OPHL procedure and highlights all possible expected extensions specific for the patient. Our intention, providing these forms both in Italian and in English, is to optimise communication between the patient and surgeon, improving surgical procedure arrangements and preventing any possible misunderstandings and medico-legal litigation.
Collapse
Affiliation(s)
- L Giordano
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - D Di Santo
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - E Crosetti
- Head and Neck Oncology Service, IRCCS FPO Candiolo Cancer Institute Turin, Italy
| | - A Bertolin
- Otolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
| | - G Rizzotto
- Otolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
| | - G Succo
- Otolaryngology Service, Oncology Department, "San Luigi Gonzaga" Hospital, University of Turin, Italy
| | - M Bussi
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| |
Collapse
|
12
|
Wiegand S. Evidence and evidence gaps of laryngeal cancer surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc03. [PMID: 28025603 PMCID: PMC5169076 DOI: 10.3205/cto000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.
Collapse
Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head & Neck Surgery, University Hospital of Leipzig, Germany
| |
Collapse
|
13
|
Kılıç C, Tunçel Ü, Kaya M, Cömert E, Özlügedik S. Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy? Clin Exp Otorhinolaryngol 2016; 10:344-348. [PMID: 27440130 PMCID: PMC5678037 DOI: 10.21053/ceo.2015.01837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions. Methods Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months. Results There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups. Conclusion We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.
Collapse
Affiliation(s)
- Caner Kılıç
- Department of Otorhinolaryngology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ümit Tunçel
- Department of Otorhinolaryngology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Metin Kaya
- Batman Government Hospital, Batman, Turkey
| | - Ela Cömert
- Department of Otorhinolaryngology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Samet Özlügedik
- Department of Otorhinolaryngology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
14
|
The senile functional evolution of the larynx after supracricoid reconstructive surgery. Eur Arch Otorhinolaryngol 2016; 273:4359-4368. [DOI: 10.1007/s00405-016-4177-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Schindler A, Pizzorni N, Mozzanica F, Fantini M, Ginocchio D, Bertolin A, Crosetti E, Succo G. Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know? Eur Arch Otorhinolaryngol 2015; 273:3459-3475. [DOI: 10.1007/s00405-015-3822-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
|
17
|
Succo G, Crosetti E, Bertolin A, Lucioni M, Caracciolo A, Panetta V, Sprio AE, Berta GN, Rizzotto G. Benefits and drawbacks of open partial horizontal laryngectomies, Part A: Early- to intermediate-stage glottic carcinoma. Head Neck 2015; 38 Suppl 1:E333-40. [PMID: 25581514 DOI: 10.1002/hed.23997] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Laryngeal squamous cell carcinoma (SCC) accounts for 1.9% of cancers worldwide. Most of these are diagnosed in the early stages (T1-T2, and N0). For these, a larynx preserving/conserving option is preferable. Beyond transoral laser microsurgery (TLM), open partial horizontal laryngectomy is a function-sparing surgical technique used to treat laryngeal SCC. METHODS We retrospectively analyzed the clinical outcomes of 216 patients who underwent open partial horizontal laryngectomy for glottic cT2 laryngeal cancer. RESULTS Five-year overall survival (OS), disease-specific survival (DFS), locoregional control, local control, laryngeal function preservation, and laryngectomy-free survival rates were 93.1%, 98.0%, 97.1%, 97.5%, 97.8%, and 98.5%, respectively. Disease controls were significantly affected by previous treatment and type of surgery used. CONCLUSION Although TLM for cT2 laryngeal cancer with unimpaired vocal cord mobility still represents a sound option, open partial horizontal laryngectomy offers higher local control and laryngeal preservation rates for selected patients with impaired mobility of vocal cords combined with involvement of the paraglottic space. © 2015 Wiley Periodicals, Inc. Head Neck 38: E333-E340, 2016.
Collapse
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
| | - Alessandra Caracciolo
- 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 Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Giuseppe Rizzotto
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| |
Collapse
|
18
|
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
| |
Collapse
|
19
|
Lips M, Speyer R, Zumach A, Kross KW, Kremer B. Supracricoid laryngectomy and dysphagia: A systematic literature review. Laryngoscope 2015; 125:2143-56. [DOI: 10.1002/lary.25341] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Marieke Lips
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Renée Speyer
- Department of Otorhinolaryngology and Head and Neck Surgery; Leiden University Medical Center; Leiden The Netherlands
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; James Cook University; Townsville Queensland Australia
| | - Anne Zumach
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Kenneth W. Kross
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| |
Collapse
|
20
|
Rizzotto G, Crosetti E, Lucioni M, Bertolin A, Monticone V, Sprio AE, Berta GN, Succo G. Oncologic outcomes of supratracheal laryngectomy: Critical analysis. Head Neck 2014; 37:1417-24. [DOI: 10.1002/hed.23773] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/26/2014] [Accepted: 05/13/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Giuseppe Rizzotto
- Otorhinolaryngology Department; Vittorio Veneto Hospital; Vittorio Veneto Treviso Italy
| | - Erika Crosetti
- Otorhinolaryngology Department; Martini Hospital; Turin Italy
| | - Marco Lucioni
- Otorhinolaryngology Department; Vittorio Veneto Hospital; Vittorio Veneto Treviso Italy
| | - Andy Bertolin
- Otorhinolaryngology Department; Vittorio Veneto Hospital; Vittorio Veneto Treviso Italy
| | | | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences; University of Turin; Turin Italy
| | | | - Giovanni Succo
- Otorhinolaryngology Department; San Luigi Gonzaga Hospital; Turin Italy
- Department of Oncology; University of Turin; Turin Italy
| |
Collapse
|
21
|
Schindler A, Fantini M, Pizzorni N, Crosetti E, Mozzanica F, Bertolin A, Ottaviani F, Rizzotto G, Succo G. Swallowing, voice, and quality of life after supratracheal laryngectomy: preliminary long-term results. Head Neck 2014; 37:557-66. [PMID: 24677483 DOI: 10.1002/hed.23636] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 11/14/2013] [Accepted: 02/17/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to report preliminary long-term outcomes after supratracheal laryngectomy (STL). METHODS Twenty-two male patients who underwent STL were involved in this study. Swallowing skills, 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 quality of life (QOL) were assessed. RESULTS Aspiration was found in 10, 2, and 5 patients, respectively, for liquids, semisolids, and solids. Neoglottis motility was generally preserved, whereas vibration was impaired. Aerodynamic measures showed a poor performance. Perceptual assessment revealed highly dysphonic voices. In only 8 patients, a harmonic structure was visible in the spectrograms. Aspiration pneumonia occurred in 2 patients. Preoperative weight was maintained in 16 patients. Generic, voice-related, and swallowing-related QOL revealed satisfied patients. CONCLUSION After STL, swallowing was sufficiently restored and QOL was satisfactory, whereas the voice was severely impaired even if oral communication was well preserved.
Collapse
Affiliation(s)
- Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco,", University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Analysis of swallowing after partial frontolateral laryngectomy with epiglottic reconstruction for glottic cancer. Eur Arch Otorhinolaryngol 2013; 271:2013-20. [PMID: 24100885 DOI: 10.1007/s00405-013-2750-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/28/2013] [Indexed: 10/26/2022]
Abstract
The aim of the study was to evaluate swallowing using a reproducible objective methodology and to seek preoperative factors that could influence swallowing outcomes in patients operated on for partial laryngectomy. Twenty-four patients who underwent partial frontolateral laryngectomy with epiglottic reconstruction for T1bN0 or T2N0 glottic carcinoma between 2008 and 2012 were retrospectively evaluated. Using fiberoptic endoscopic and videofluoroscopic evaluation, early (15 days postoperatively) and late (2 months postoperatively) scores were obtained for all patients to quantify their swallowing skills. Eighty-three percent of patients achieved at least partial oral feeding at time of hospital discharge and 87.5% achieved exclusive oral feeding within 2 months postoperatively. Early score was good or excellent in 50%, average in 4.2% and poor in 41.8%. Regarding late scores, 63% were classified as having a good or excellent late score, 7 patients (29%) were classified as "middle result" because their time to recover was longer (i.e. between 1 and 2 months postoperatively), and two patients had a poor late score. Finally, at last follow-up, only one patient was partially fed by gastrostomy (180 days after surgery). T stage (p = 0.04) was the only factor influencing early swallowing outcomes and length of hospital stay was longer for poor scores than for good late results (p = 0.02). Our findings show good outcomes in terms of postoperative swallowing. Objective assessment of deglutition is essential for a better understanding of the mechanisms of postoperative swallowing disorders and for patient selection.
Collapse
|
23
|
Clayburgh DR, Graville DJ, Palmer AD, Schindler JS. Factors associated with supracricoid laryngectomy functional outcomes. Head Neck 2012; 35:1397-403. [PMID: 23037861 DOI: 10.1002/hed.23144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Supracricoid partial laryngectomy (SCPL) is an option for laryngeal cancer resection that preserves laryngeal function; however, little information exists regarding factors that are associated with functional outcomes. METHODS A medical chart review was performed on patients that underwent SCPL at our institution between 2006 and 2011. Data were collected on surgical, voice, and swallowing outcomes. RESULTS Eighteen patients were identified. Thirteen underwent cricohyoidoepiglottopexy (CHEP) and 5 had a cricohyoidopexy (CHP). Mean follow-up was 737 days. On average, decannulation occurred at 27.4 days and feeding tube removal at 87.9 days postoperatively. Sixty-seven percent of patients tolerated an unrestricted diet at follow-up. Increased age and a CHP procedure were associated with negative outcomes. Age may be a proxy for more extensive disease and prior treatments. CONCLUSION Patients who undergo an SCPL require extensive rehabilitation after surgery. Those who have undergone multiple cancer interventions and have more extensive surgery may be at risk for poorer outcomes.
Collapse
Affiliation(s)
- Daniel R Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | | | | | | |
Collapse
|
24
|
Pernambuco LDA, Oliveira JHPD, Régis RMFL, Lima LMD, Araújo AMBD, Balata PMM, Cunha DAD, Silva HJD. Quality of life and deglutition after total laryngectomy. Int Arch Otorhinolaryngol 2012; 16:460-5. [PMID: 25991974 PMCID: PMC4432550 DOI: 10.7162/s1809-97772012000400006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022] Open
Abstract
Introduction: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. Method: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. Results: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains “communication” and “fear” represented severe impact and “eating duration” represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain “eating duration”), cough and cough to remove the liquid or food of the mouth when they are stopped (domain “symptom frequency”), difficulties in understanding (domain “communication”) and fear of choking and having pneumonia (domain “fear”). Conclusion: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in “communication,” “fear,” and “eating duration” domains.
Collapse
Affiliation(s)
- Leandro de Araújo Pernambuco
- Master in Health Sciences - Federal University of Pernambuco. Professor - Speech, Language and Hearing Sciences Department - Federal University of Rio Grande do Norte
| | | | | | - Leilane Maria de Lima
- Graduated in Speech, Language and Hearing Science - Federal University of Pernambuco.Speech and Language Pathologist
| | - Ana Maria Bezerra de Araújo
- Specialist in Dysphagia - Federal Council of Speech, Language and Hearing Sciences. Speech and Language Pathologist - Cancer Hospital of Pernambuco
| | - Patrícia Maria Mendes Balata
- Master of Science in Adolescent Health - Pernambuco University. Speech and Language Pathologist. Institute of Human Resources of Pernambuco State
| | | | - Hilton Justino da Silva
- Ph.D in Nutrition - Federal University of Pernambuco. Professor - Speech, Language and Hearing Science Department - Federal University of Pernambuco
| |
Collapse
|
25
|
Alicandri-Ciufelli M, Piccinini A, Grammatica A, Chiesi A, Bergamini G, Luppi MP, Nizzoli F, Ghidini A, Tassi S, Presutti L. Voice and swallowing after partial laryngectomy: Factors influencing outcome. Head Neck 2012; 35:214-9. [DOI: 10.1002/hed.22946] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2011] [Indexed: 11/09/2022] Open
|
26
|
Schindler A, Mozzanica F, Barbiera F. Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemo-radiotherapy for Head and Neck Malignancies. Dysphagia 2012. [DOI: 10.1007/174_2012_606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
27
|
Pharyngeal swallowing sound profile assessed after partial and total laryngectomy. Dysphagia 2010; 26:366-73. [PMID: 21188605 DOI: 10.1007/s00455-010-9322-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
Abstract
Recently, we described three components of a normal pharyngeal swallowing sound. The aim of the present study was to identify variations of these components using synchronized acoustic-radiological data in partially laryngectomized (PL) and totally laryngectomized (TL) patients before and after surgery. In this prospective study, from January 2003 to December 2006 we enrolled 14 patients in a PL group and 9 patients in a TL group. A fluoroscopy camera and a microphone were connected to a computer to obtain acoustic-radiological data (25 images/s). The subjects were asked to perform six deglutitions of 10 ml of barium suspension. The average durations of the sound variables were measured before and after surgery. The duration of the preoperative pharyngeal sound was 602 ms in the PL group and 562 ms in the TL group. It was significantly decreased after the TL (296 ms) and was increased after the PL (740 ms). A typical profile of the swallowing sound for each group was obtained. This study allowed us to describe the main variations of the pharyngeal swallowing sound induced by PL and TL. This noninvasive tool could be useful to assess postoperative swallowing function.
Collapse
|
28
|
Respiratory complications after supracricoid partial laryngectomy. Eur Arch Otorhinolaryngol 2010; 267:1415-21. [DOI: 10.1007/s00405-010-1238-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
|