[Laryngectomy-still state of the art?]

A Novel and Simple Technique to Reduce the Rate of Pharyngocutaneous Fistula Formation Following a Total Laryngectomy - our Initial Results

Objective: Pharyngocutaneous fistula (PCF) is a common and often devastating complication of total laryngectomy. Patients undergoing a total laryngectomy need enhancement of the neopharynx to reduce the risk of PCF formation. Our study aimed to evaluate the formation of a PCF following a total laryngectomy in patients that underwent a modified closure technique of their neopharynx. This technique included the recruitment of a flap of the muscular division of the pretracheal fascia that invests the strap muscles as a protective blanket. We called this surgical technique the 'curtain call'. Methods: We conducted a retrospective study for patients who underwent a total laryngectomy in our department between May 2022 and May 2023. Results: Twelve patients were identified. Our results demonstrated that the recruitment of this modified closure technique to cover the neopharynx resulted in a very low rate of postoperative PCF formation (8.3%). Conclusion: The 'curtain call' technique is an excellent method to support the neopharynx with extremely low rates of postoperative chronic dysphagia and with no evidence of impairing the development of esophageal speech. It could sometimes substitute much more time-consuming techniques like major pectoralis flap and supraclavicular flap.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04343-7.

Total laryngectomy for laryngeal cancer 150 years after its first description: A boon more than a calamity: A STROBE analysis

OBJECTIVE

To illustrate the boon rather than a calamity that total laryngectomy can be for a patient with laryngeal cancer in the 21st century.

MATERIAL AND METHOD

An observational retrospective analysis using the STROBE guideline compared two cohorts of patients with previously untreated cancer, managed by total laryngectomy: the first consisting of 123 patients collected by Morell Mackenzie during the fifteen years (1873-1887) following the initial description, and the second consisting of 53 patients consecutively treated in a French university otorhinolaryngology department during the fifteen years (2006-2020) preceding the 150th anniversary of the first performance. The main endpoint was the comparison of survival and locoregional control estimates (Kaplan-Meier life table method). Secondary endpoints comprised mortality estimates and causes, adjuvant treatments, and phonation modalities.

RESULTS

The 26.2%, 13.1%, and 13.1% 1-, 3-, and 5-year actuarial survival estimates in the Makenzie cohort increased to 88.6%, 68.4%, and 60.9% in the recent French cohort (P<0.0001). The 50.1%, 40.4%, and 34.7% 1-, 3-, and 5-year actuarial locoregional control estimates in the Mackenzie cohort increased to 83.7% (P<0.0001). The 77.7% overall mortality in the Mackenzie cohort decreased to 37.7% (P<.0001). In the Mackenzie cohort, 97.8% of deaths were related to postoperative complications and locoregional recurrence, compared to 50% in the recent French cohort. Distant metastasis, metachronous second primary tumor and intercurrent diseases, not mentioned in the Mackenzie cohort, generated 45% of deaths in the French cohort. Adjunctive treatment was not used in the Mackenzie cohort, whereas neck dissection and postoperative radiation therapy were associated in respectively 98.1% and 69.8% of cases in the French cohort. Phonation was not documented in the Mackenzie cohort; 50% of survivors in the French cohort used a phonatory implant.

CONCLUSIONS

The 20th century witnessed an incredible turn-around. Total laryngectomy, with limited indications, has transformed the etiology of deaths and no longer leaves patients "in a state of abject misery" as Morell Mackenzie put it in 1888.

[Robotics in otorhinolaryngology, head and neck surgery]

In many surgical specialities, e.g., visceral surgery or urology, the use of robotic assistance is widely regarded as standard for many interventions. By contrast, in European otorhinolaryngology, robotic-assisted surgery (RAS) is rarely conducted. This is because currently available robotic systems are not adequately adapted to the restricted space and partially difficult access to surgical fields in the head and neck area. Furthermore, RAS is associated with high costs at present. In some Anglo-American regions, robot-assisted surgery is already used regularly for different indications, particularly in transoral surgery of oropharyngeal tumors. Several feasibility studies demonstrate multiple fields of application for RAS in head and neck surgery. For standard use, the robotic systems and surgical instruments need to be reduced in size and adapted to application in the head and neck area.

[Surgery of the Larynx - Part 2b: Transcervical Surgical Therapy of Malignant Lesions]

Transoral endoscopic laryngeal surgery (TEC) is typically used as a cervical tissue-sparing and function-preserving surgical procedure. Transoral robotic surgery (TORS) in particular has been pushing the boundaries towards transoral resection in recent years. Nevertheless, there are still limitations to this approach. Transcervical surgery is then the therapy of choice. It is used in case of insufficient visibility of the entire larynx and especially the tumor-bearing region, cartilage infiltration, a lack of mobility of both arytenoid cartilages or a lack of patient compliance. Even with the transcervical approach, from an oncological point of view, the procedure must be as radical as necessary on the one hand and as function-preserving as possible on the other. In case of a transcervical appraoch, however, additional requirements, side effects and consequences must be considered during planning, implementation and follow-up treatment. In addition to our previous publications, this article is intended to provide an overview of transcervical surgery for malignancies of the larynx.