Laryngectomy-free survival after salvage partial laryngectomy: a systematic review and meta-analysis

Vertical Partial Laryngectomy With Temporoparietal Free-Flap Reconstruction for Recurrent Laryngeal Cancer: Long-Term Study

Objective

Treatment options for recurrent early glottic carcinoma's include conservative and radical surgical options. These options offer similar survival benefits with different impacts of patient's quality of life. We previously present our experience with vertical partial laryngectomy (VPL) and showed high locoregional control rates with high-quality voice results and normal swallowing.

Study Design

A long-term retrospective review.

Setting

Tertiary Care Center.

Methods

We analyzed all patients underwent VPL between the years 1995 to 2018. Long-term oncologic and functional outcomes were collected.

Results

A total of 40 patients were included. The majority of whom were male (n = 38, 95%) with a mean age of 64.9 years (SD ± 9.5). With a median follow up time of 12 years (range 0-24), 9 patients (22.5%) had disease recurrence; the majority of whom (8 patients), had local recurrence and all were salvaged with total laryngectomy. Eight patients (20%) developed second primaries in the head and neck region with a median time to diagnosis of 77 months (range 8-227 months). Ten-years overall survival, disease specific survival, and local disease-free survival were 80%, 90%, and 80%, respectively. Five patients had postoperative laryngeal dysfunction with a total 10-years laryngectomy free survival of 70%.

Conclusion

VPL has a sustainable oncologic outcome with a high long-term laryngectomy free survival rate. This entity is an acceptable conservative salvage option for selected postradiated recurrent laryngeal squamous cell carcinoma patients.

Closure without epiglottoplasty or tracheotomy after reconstructive frontal anterior laryngectomy

Reconstructive frontal anterior laryngectomy (RFAL) is a partial laryngeal surgery technique for resecting early-stage (T1-T2) glottic squamous cell carcinoma. Indications comprise a lesion of the anterior commissure of the larynx that cannot be adequately exposed by endoscopy, and cases in which radiotherapy is refused or contraindicated. The initial RFAL technique included epiglottoplasty. Here we propose a technique without epiglottoplasty, with the advantage of avoiding need for tracheotomy in most cases. After the first stage of surgical excision, reconstruction consists in placing a vertical brace transepiglottically and below the cricoid. The epiglottis is thus left at its original height and secured in place to prevent flapping in the pharyngolaryngeal lumen. Transverse bracing is then performed through the thyroid wings: one of the key points of this surgery is to control tension to avoid risk of stenosis. The subhyoid muscles are sutured together to achieve satisfactory sealing. This technique offers satisfying functional results and oncological control. The most frequent complications are (1) secondary tracheotomy, which can be avoided by selecting patients who require a primary tracheotomy and optimizing the seal, and (2) stenosis, which can be limited by not bringing the cartilaginous structures too close together during bracing.

Review of Outcomes after Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Head and Neck

Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery.

Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022

BACKGROUND

The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status.

AIM

The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period.

METHODS AND RESULTS

Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised.

CONCLUSION

NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.

Salvage Partial Laryngectomy after Failed Radiotherapy: Oncological and Functional Outcomes

Objective: To investigate oncological and functional outcomes in patients treated with salvage partial laryngectomy (SPL) after failed radio/chemotherapy. Study design: Retrospective multicenter chart review. Methods: Medical records of patients treated with SPL from January 1998 to January 2018 in two University Medical centers were retrieved. The SPL included horizontal supraglottic laryngectomy, hemi-laryngectomy and crico-hyoido-epiglottopexy. The following outcomes were investigated: histopathological features; overall survival (OS); recurrence-free survival (RFS) local and regional controls; post-operative speech recovery; and the oral diet restart and decannulation. Results: The data of 20 patients with cT1–cT3 laryngeal cancer were collected. The mean follow-up of patients was 69.7 months. The mean hospital stay was 43.0 days (16–111). The following complications occurred in the immediate post-operative follow-up: neck fistula (N = 6), aspiration pneumonia (N = 5), and chondronecrosis (N = 2). Early or late total laryngectomy was carried out over the follow-up period for the following reasons: positive margins and local recurrence/progression (N = 7), chondronecrosis (N = 2) and non-functional larynx (N = 1). The restart of the oral diet was carried out in 12/15 (80%) SPL patients (five patients being excluded for totalization). All patients recovered speech, and decannulation was performed in 14 patients (93%). The 5-year OS and RFS were 50% and 56%, respectively. The 5-year local and regional control rates were 56% and 56%, respectively. Conclusions: Partial laryngectomy is an alternative therapeutic approach to total laryngectomy in patients with a history of failed radiation.