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Caporale CD, Chiari F, D’Alessio P, Barbara F, Guarino P. Transoral robotic surgery for supraglottic cancer. A review of oncological and functional outcomes compared to open surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S20-S27. [PMID: 38745513 PMCID: PMC11098539 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 05/16/2024]
Abstract
Objective Supraglottic squamous cell carcinoma (SCC) represents a major surgical challenge in organ-preserving treatment. Type I open partial horizontal laryngectomy (OPHL I) is considered the most popular. To date, minimally-invasive approaches such as laser microsurgery and transoral robotic surgery (TORS) have gained increasing relevance. The aim of this narrative review is to obtain a descriptive comparison of functional and oncological outcomes from studies on patients with supraglottic SCC treated with OPHL I and TORS, respectively. Material and methods A computerised search was performed using the Pubmed database for articles published from 2000 to 2023. A comparative analysis on functional and oncological outcomes of patients treated by TORS and OPHL I was performed. Results The present narrative review shows a superiority of TORS compared to open surgery for supraglottic SCC in terms of functional outcomes, while maintaining comparable oncological outcomes. Conclusions Although recently introduced in the treatment of laryngeal pathology, TORS has been shown to be a reliable technique not only for functional but also for oncological outcomes, ensuring good overall survival, disease-free survival, and disease control rates comparable to OPHL I.
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Affiliation(s)
| | - Francesco Chiari
- Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pasquale D’Alessio
- Otorhinolaryngology and Head and Neck Unit, “Santo Spirito” Hospital, Pescara, Italy
| | - Francesco Barbara
- Otorhinolaryngology and Head and Neck Unit, Policlinico of Bari, Bari, Italy
| | - Pierre Guarino
- Otorhinolaryngology and Head and Neck Unit, “Santo Spirito” Hospital, Pescara, Italy
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Abdelghany M, Amin A, Degni E, Crescio C, Hassan AEMA, Ftohy T, Bussu F. Pectoralis Major in Salvage Total Laryngectomy after Irradiation: Morbidity, Mortality, Functional, and Oncological Results in a Referral Center in Egypt. J Pers Med 2023; 13:1223. [PMID: 37623473 PMCID: PMC10455500 DOI: 10.3390/jpm13081223] [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: 05/18/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Nonsurgical organ preservation protocols have seen a large diffusion worldwide in the last decades. Their oncological and functional effectiveness in a real-world setting has been recently questioned because of the high morbidity of salvage procedures. The aim of this study is to review the outcomes of postirradiation salvage total laryngectomy (STL) and reconstruction with pectoralis major flap. METHODS This retrospective observational study included 37 cases of STL in the period from January 2015 to December 2021. Data for each patient were extracted from the hospital information system and reviewed. RESULTS The 3-year overall and disease-specific survival are, respectively, 28% and 51%. Only seven recurrences after salvage surgery were recorded and all of them died from the disease. The other 14 deaths derived from comorbidities, with diabetes being the most significant predictive parameter for overall survival. Also, lower postoperative albumin levels were associated with a higher risk of death. CONCLUSIONS Overall survival after STL and reconstruction with PMMF is low but most deaths are due to comorbidities and not to cancer progression or recurrence.
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Affiliation(s)
- Mahmoud Abdelghany
- Maxillofacial Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag 82524, Egypt; (M.A.); (T.F.)
| | - Ayman Amin
- Surgery Department, National Cancer Institute (NCI), Cairo University, Cairo 12613, Egypt;
| | - Emilia Degni
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Viale San Pietro 12, 07100 Sassari, Italy; (C.C.); (F.B.)
| | - Claudia Crescio
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Viale San Pietro 12, 07100 Sassari, Italy; (C.C.); (F.B.)
| | | | - Tarek Ftohy
- Maxillofacial Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag 82524, Egypt; (M.A.); (T.F.)
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Viale San Pietro 12, 07100 Sassari, Italy; (C.C.); (F.B.)
- Department of Medicine, Surgery and Pharmacy, Università di Sassari, 07100 Sassari, Italy
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Jia Y, Jiang D, Wu X, He X, Tang J, Sun Z. Analysis of Clinical Treatment of Laryngeal Stenosis After Radiotherapy and Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy of Mid-stage and Advanced Laryngeal Cancer. EAR, NOSE & THROAT JOURNAL 2023:1455613221149644. [PMID: 36772810 DOI: 10.1177/01455613221149644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE To investigate the possible causes and treatment methods of laryngeal stenosis after radiotherapy following supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). METHODS The data of seven patients with laryngeal stenosis after radiotherapy following SCPL-CHEP were analysed retrospectively. All patients were diagnosed with mid-stage or advanced laryngeal carcinoma before surgery, and the pathological type was squamous cell carcinoma. All patients met the requirements for SCPL-CHEP surgery. When laryngeal stenosis was found during the post-surgical follow-up period, patients were immediately given the appropriate treatment according to their conditions. RESULTS All seven patients had laryngeal stenosis. One patient underwent granulation resection using a laryngoscope, four patients underwent granulation removal + low-temperature plasma ablation using a laryngoscope, and two patients underwent laryngeal dehiscence surgery + laryngotracheal T-tube placement. All patients recovered well after surgery, with patent airways. CONCLUSION Laryngeal stenosis in patients with mid- and late-stage laryngeal carcinoma is one of the rare complications of SCPL-CHEP. Second-stage laryngeal dilatation can be selected according to the patient's laryngeal stenosis. Most patients with laryngeal stenosis can be extubated completely.
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Affiliation(s)
- Yanxuan Jia
- Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Kunming, China
| | - Donghui Jiang
- Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Kunming, China
| | - Xiaoguang Wu
- Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Kunming, China
| | - Xiaoguang He
- Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Kunming, China
| | - Ju Tang
- Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Kunming, China
| | - Zewu Sun
- Department of Otolaryngology,The People' Hospital of Mengzi, Yunnan Mengzi, China
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Nakayama M, Wada T, Isono Y, Sano D, Nishimura G, Oridate N, Holsinger FC, Orosco R. Narrow-field supracricoid partial laryngectomy: Procedure development and initial clinical experiences. Auris Nasus Larynx 2022; 50:403-409. [PMID: 36216666 DOI: 10.1016/j.anl.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the feasibility of narrow-field supracricoid partial laryngectomy with cricohyoidoepiglottopexy (NF-SCPL-CHEP). METHODS Between 2019 and 2020, five patients with glottic cancers underwent NF-SCPL-CHEP. The mean durations of surgical drains, tracheostomy canula, and nasogastric tube use were evaluated. Length of stay following NF-SCPL-CHEP was compared with that of our open SCPL historical controls. A case summary is provided for the first patients, with detailed information about postoperative management and function. RESULTS All five patients achieved uneventful postoperative recoveries without major complications. The average time for surgical drains, tracheostomy canula, and nasogastric tube use were 2, 15, and 46 days, respectively. The mean overall hospitalization period was 36 days for NF-SCPL-CHEP patients. The mean period of hospitalization based on our early experiences between 1997 and 2005 with classical open SCPL was 72 days. All patients were fully functional and local recurrences or distant metastases were not encountered during a mean observation period of 39 months. CONCLUSIONS NF-SCPL-CHEP with 6 cm cervical access appeared technically feasible and oncologically sound in this initial clinical experience. An extra 2 cm incision, which enabled lateral neck dissection, was not felt to detract from the overall minimally invasive basis of NF-SCPL-CHEP. The clinical results were encouraging with limited complications and predictable postoperative recovery. The length of stay for patients undergoing NF-SCPL was half that of open SCPL historical controls. Less damages to local circulation may associate with the positive influences. Further study with a large patient sample across multiple institutions are needed to carefully evaluate long-term functional and oncological outcomes.
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Affiliation(s)
- Meijin Nakayama
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan.
| | - Takashi Wada
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Yasuhiro Isono
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Daisuke Sano
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Goshi Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Nobuhiko Oridate
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Ryan Orosco
- Division of Head and Neck Surgery, University of California San Diego, La Jolla, California, USA
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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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Mannelli G, Lazio MS, Luparello P, Gallo O. Conservative treatment for advanced T3-T4 laryngeal cancer: meta-analysis of key oncological outcomes. Eur Arch Otorhinolaryngol 2017; 275:27-38. [PMID: 29119321 DOI: 10.1007/s00405-017-4799-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022]
Abstract
GOAL Controversies exist regarding the treatment of advanced laryngeal carcinomas. The purpose of this systematic review was to evaluate the oncologic outcomes of both transoral laser and open partial laryngectomies for advanced (T3-T4) squamous cell laryngeal cancers management. INTRODUCTION A systematic review of literature was led searching for articles mentioning the following terms: advanced (T3-T4) laryngeal cancer AND laser; AND open partial laryngectomy; AND transoral laser microsurgery; AND cordectomy; AND conservative surgery; AND tracheohyoidopexy or tracheohyoidoepiglottopexy; AND supratracheal partial laryngectomy; AND supracricoid partial laryngectomy; AND cricohyoidopexy or cricohyoidoepiglottopexy. Then a quantitative analysis was carried on papers published after 1980. DISCUSSION The search identified 110 publications, and a total of 21 articles satisfied inclusion criteria and were selected for quantitative synthesis. 10 out of 21 studies had a good quality score, 10 were fair and only one rated a poor score. The pooled disease-free survival (DFS) was 79% (95% CI 74-85), and pooled overall survival (OS) was 71% (95% CI 64-78) at 5 years from all 1921 patients included in the study, with significant heterogeneity (I 2 = 89.7% and I 2 = 90.4%), respectively. Significant heterogeneity value (p = 0.118) was seen by comparing transoral laser and open partial laryngectomies in terms of DFS. CONCLUSION The two surgical techniques are both valid conservative surgical options for advanced laryngeal cancer treatment.
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Affiliation(s)
- Giuditta Mannelli
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy.
| | - Maria Silvia Lazio
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
| | - Paolo Luparello
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
| | - Oreste Gallo
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
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7
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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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.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head & Neck Surgery, University Hospital of Leipzig, Germany
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Oliveira IBD, Marialva DRSD. Laringectomias supracricóides: revisão de literatura em protocolos de qualidade de vida. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618315115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO: A Laringectomia Parcial Supracricóide (LPSC) é indicada para tratamento de tumores com estadiamento1 e 2 e certos casos de tumores avançados. É considerada pela literatura como apresentando resultados satisfatórios em ambas situações, preservação da laringe e funcionalidade. Este estudo tem como objetivo rever de forma sistemática a literatura voltada para qualidade de vida em voz de pacientes submetidos a LPSC, identificando-se os protocolos de qualidade de vida em câncer de cabeça e pescoço. Para a revisão de literatura sistemática exploratória foram considerados os seguintes bancos de dados: MEDLINE, SciELO, LILACS; PubMed. Utilizados descritores em português, inglês e espanhol. A seleção dos artigos seguiu critérios de inclusão, para aplicação de teste de Relevância. Esta revisão de literatura revelou que os protocolos específicos para pacientes oncológicos de cabeça e pescoço mais utilizados são o EORTC-C30/H&N35, UW-QOL e HNQOL. A LPSC embora seja considerada uma cirurgia que vise à preservação das funções de deglutição e fonação é apontada como tendo possibilidade de permanência de queixas em tais funções. A literatura afirma que os pacientes se declaram satisfeitos com a própria voz, tendo pouca dificuldade para se comunicar de forma inteligível. Estudos relacionam pacientes com dificuldades respiratórias após LPSC, inclusive com apneia obstrutiva do sono. Conclui-se que há necessidade de mais pesquisas que visem pontuar as dificuldades resultantes da LPSC e que utilizem protocolos específicos em cabeça e pescoço, para melhor mostrar o impacto da LPSC na qualidade de vida.
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10
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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]
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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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Nakayama M, Miyamoto S, Seino Y, Okamoto T, Kano K, Hasebe M, Okamoto M. One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control? Jpn J Clin Oncol 2015; 45:732-7. [PMID: 25981622 DOI: 10.1093/jjco/hyv072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/16/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Supracricoid laryngectomy with cricohyoidoepiglottopexy has been known to be able to cope with tumor excisions with minimal margins. Extended resection may result in a limited margin and may impair the prognosis. We conducted a clinicopathologic analysis of local recurrence in supracricoid laryngectomy with cricohyoidoepiglottopexy patients. METHODS Between 1997 and 2013, 100 patients with glottic cancers underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. The clinicopathologic findings were evaluated. We also analyzed: (i) cancer-specific and overall survival rates, (ii) the correlation between locoregional recurrence and overall survival, (iii) T staging and larynx preservation rates and (iv) previous radiation history and larynx preservation rates. RESULTS Local recurrence was recognized in eight of the 100 patients (8%); all were initially staged as T3 or T4. Recurrence was identified in the submucosal regions of the ipsilateral arytenoid and/or infraglottis. Six patients were salvaged by completion total laryngectomy except two. Cancer-specific survival at 5 years was 93%; overall survival at 5 years was 89%. There was no significant difference between overall survival and locoregional recurrence. There was a significant difference between larynx preservation in T1-2 and T3-4 patients. There was no significant difference between larynx preservation and the previous radiation therapy status. CONCLUSIONS Our experience convinced us of the clinical potential of supracricoid laryngectomy with cricohyoidoepiglottopexy as one of the effective options for functional larynx preservation. Supracricoid laryngectomy with cricohyoidoepiglottopexy is the most suitable for unfavorable T2 and T3a cases and is applicable for appropriately selected radiation-failed patients. Thorough pre-operative evaluation, proper surgical techniques and careful follow-up are prerequisites for the success of supracricoid laryngectomy with cricohyoidoepiglottopexy.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Shunsuke Miyamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Yutomo Seino
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Tabito Okamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Koichi Kano
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Masayuki Hasebe
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Makito Okamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
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Salvage supracricoid laryngectomy after failed radiotherapy and partial laryngectomy. The Journal of Laryngology & Otology 2014; 129:101-5. [PMID: 25547569 DOI: 10.1017/s0022215114003235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A case of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after failed radiation therapy and vertical partial laryngectomy had successful oncological and functional outcomes. This is the first reported application of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after the failure of two major treatments. CASE REPORT A 65-year-old man was referred for salvage supracricoid laryngectomy with cricohyoidoepiglottopexy. The right recurrent hemilarynx was successfully resected. After pexis, the right lobe of the thyroid gland was repositioned to overlap and reinforce the pexis gap and fill the devoid portion of the strap muscular closure. Multiple scattered foci (recurrent tumour-node-metastasis stage T2) were identified around the arytenoid cartilage and beneath the musculocutaneous flap. Four years after supracricoid laryngectomy with cricohyoidoepiglottopexy, the patient's recovery was following a favourable course and he had satisfactory laryngeal function. CONCLUSION Appropriate case selection and proficient surgical skills were essential for a successful outcome. Head and neck surgeons should not be afraid to adopt functional preservation open surgical procedures in well-selected and well-motivated patients. A requirement for more challenging surgical procedures and meticulous rehabilitation processes should not exclude appropriate treatments from a surgeon's repertoire.
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Yu Y, Wang XL, Xu ZG, Wu YH. Laryngeal reconstruction with a sternohyoid muscle flap after supracricoid laryngectomy: postoperative respiratory and swallowing evaluation. Otolaryngol Head Neck Surg 2014; 151:824-9. [PMID: 25205642 DOI: 10.1177/0194599814549002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare postoperative respiratory and swallowing functions between patients who underwent classic supracricoid laryngectomy (SCL) and those who underwent SCL with laryngeal reconstruction using the sternohyoid muscle. STUDY DESIGN Prospective study. SETTING National cancer center. SUBJECTS AND METHODS Forty-four patients who consecutively underwent SCL for laryngeal squamous cell carcinoma from December 2009 to March 2011 were included. Postoperative parameters including the mean tracheostomy decannulation time, tracheostomy decannulation rate at 6 months, mean nasogastric tube (NGT) removal time, degree of dysphagia at 3 months, and survival time after surgery were evaluated. RESULTS Twenty-one patients underwent classic SCL (group A), and 23 underwent SCL with laryngeal reconstruction (group B). After a median follow-up period of 37 months (range, 3-44 months), group A had a significantly longer mean decannulation time (120.05 ± 109.38 days vs 33.43 ± 22.60 days, respectively; P < .01) and NGT removal time (37.30 ± 29.97 days vs 17.22 ± 10.95 days, respectively; P < .01) than group B. Swallowing function after 6 months was significantly better in group B than in group A (P = .004). The decannulation rate after 6 months was significantly higher in group B than in group A (95.7% vs 66.7%, respectively; P = .036). The 3-year disease-free survival rate was not significantly different between group A and group B (95.2% vs 95.7%, respectively; P = .961). CONCLUSION Laryngeal reconstruction using a sternohyoid muscle flap seems to improve quality of life in the early postoperative period after SCL.
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Affiliation(s)
- Yue Yu
- Department of Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-lei Wang
- Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen-gang Xu
- Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue-huang Wu
- Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Nakayama M, Okamoto M, Hayakawa K, Miyamoto S, Ishiyama H, Komori S, Okamoto T, Seino Y, Kano K, Soda I, Sekiguchi A, Kawakami S. Clinical outcomes of 849 laryngeal cancers treated in the past 40 years: are we succeeding? Jpn J Clin Oncol 2013; 44:57-64. [PMID: 24174633 DOI: 10.1093/jjco/hyt162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We analyzed the clinical outcomes of 849 laryngeal cancers treated in the past 40 years, which overlapped with the era of the global treatment shift. METHODS To compare the chronological outcomes, patients were divided into four groups according to their registration year as 1972-82, 1983-92, 1993-2002 and 2003-12; treatment trends, larynx preservation rate and overall survival rate were compared. RESULTS There were 104, 173, 253 and 319 patients registered in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. Five-year overall survival rates were 74, 76.5, 75.6 and 82.2% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. The five-year larynx preservation rates were 65.5, 75.7, 75.4 and 80.9% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. CONCLUSIONS The number of patients treated at our institute increased, and the overall survival and larynx preservation rates exhibited favorable improvements over the past four decades. In the analysis of nonsurgical options, S1 combined radiotherapy showed superiority over concurrent chemoradiotherapy and radiotherapy in larynx preservation, and S1 combined radiotherapy, concurrent chemoradiotherapy and Tegafur Uracil combined radiotherapy showed superiority over radiotherapy in overall survival. In nonsurgical approaches, proper case selection is the key to success and may be much more important than pursuing radiotherapy dose escalation. In the analysis of surgical options, laser and supracricoid laryngectomy with cricohyoidoepiglottopexy contributed to larynx preservation in early- and intermediate-stage cancers, respectively. Supracricoid laryngectomy with cricohyoidoepiglottopexy demonstrated overall survival not worse than total laryngectomy, which is the prerequisite treatment basis for larynx preservation options. We must make extra efforts in pursuing an ideal balance between nonsurgical and surgical larynx preservation options.
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Affiliation(s)
- Meijin Nakayama
- *Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan.
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Nakayama M, Okamoto M, Hayakawa K, Ishiyama H, Kotani S, Miyamoto S, Seino Y, Okamoto T, Soda I, Sekiguchi A. Clinical outcome of supracricoid laryngectomy with cricohyoidoepiglottopexy: Radiation failure versus previously untreated patients. Auris Nasus Larynx 2013; 40:207-10. [DOI: 10.1016/j.anl.2012.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 07/18/2012] [Accepted: 07/26/2012] [Indexed: 11/26/2022]
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Nakayama M, Watanabe A, Matsuki T, Tamura E, Seino Y, Okabe S, Okamoto T, Miyamoto S, Okamoto M. Buccal fat augmentation for insufficient neoglottal closure after supracricoid laryngectomy with cricohyoidoepiglottopexy. Auris Nasus Larynx 2012; 40:500-5. [PMID: 23068187 DOI: 10.1016/j.anl.2012.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/20/2012] [Accepted: 09/24/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Supracricoid laryngectomy with Cricohyoidoepiglottopexy (SCL-CHEP) is a functional organ preservation surgery for laryngeal cancers. Post-operative laryngeal function is generally promising. Some patients, however, cannot attain satisfactory functional results because of an excessively wide neoglottis resulting in an insufficient neoglottal closure. Autologous buccal fat augmentation was conducted to correct the insufficiency. PATIENTS AND METHODS Two patients underwent intervention. Under general anesthesia, autologous fat was harvested from the buccal fat pad. Fat tissue was injected into the widest plane of the neoglottis under direct laryngoscopy; a navigation system was incorporated to identify the responsible site. Acoustic, aerodynamic, and perceptual analyses along with videofluoroscopic swallowing study and screening questionnaires were used for functional evaluation. RESULTS A total of 0.8ml (Case 1) and 0.7ml (Case 2) of fat tissues were injected into the submucosal space of the responsible sites. Both patients experienced functional improvement subjectively after augmentation; psychological parameters for voice and swallowing also improved. CONCLUSIONS Buccal fat augmentation to correct insufficient neoglottal closure after SCL-CHEP was technically feasible. A navigation system was helpful for confirmation. Fat absorption occurred and one third of the volume remained at 3 and 6 months. Although, vocal measurements remained unchanged, psychological parameters for voice and swallowing improved.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology, Kitasato University School of Medicine, Japan.
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Pinar E, Imre A, Calli C, Oncel S, Katilmis H. Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes. Otolaryngol Head Neck Surg 2012; 147:1093-8. [PMID: 22886078 DOI: 10.1177/0194599812457334] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the functional and oncologic results of supracricoid partial laryngectomy. STUDY DESIGN Case series with chart review. SETTING Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECT AND METHODS The medical records of 56 patients, who underwent supracricoid partial laryngectomy between March 2002 and December 2010, were reviewed in this study. Forty-three patients underwent supracricoid partial laryngectomy with cricohyoidopexy, and 13 patients underwent cricohyoidoepiglottopexy. The overall and disease-specific survival, local control rates, and the mean time of decannulation and nasogastric tube removal were evaluated. Association of type of surgery with the functional and oncologic outcomes was evaluated and statistically compared. RESULTS The median follow-up period was 58 months. The 1-, 3-, and 5-year overall survival rates were 100%, 96.4%, and 82.1%, respectively. The 1-, 3-, and 5-year local control rates were 100%, 96.1%, and 92.5%, respectively. Type of surgery did not show any significant difference in survival and local control rates (P = .546, P = .455). The mean (SD) decannulation and nasogastric feeding tube removal time was 11.43 (2.03) and 16.79 (3.51) days, respectively. The mean time of decannulation and nasogastric tube removal was significantly longer in patients who underwent cricohyoidopexy when compared with those who underwent cricohyoidoepiglottopexy (P = .002, P = .000). CONCLUSION Although delaying deglutition functions could be termed a disadvantage of supracricoid laryngectomy, especially with cricohyoidopexy, supracricoid laryngectomy has reliable oncologic and functional results for locally advanced laryngeal cancers while maintaining laryngeal functions.
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Affiliation(s)
- Ercan Pinar
- Otorhinolaryngology Department, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Thomas L, Drinnan M, Natesh B, Mehanna H, Jones T, Paleri V. Open conservation partial laryngectomy for laryngeal cancer: A systematic review of English language literature. Cancer Treat Rev 2012; 38:203-11. [DOI: 10.1016/j.ctrv.2011.05.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/01/2011] [Accepted: 05/29/2011] [Indexed: 11/25/2022]
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Bussu F, Paludetti G, Almadori G, De Virgilio A, Galli J, Miccichè F, Tombolini M, Rizzo D, Gallo A, Giglia V, Greco A, Valentini V, De Vincentiis M. Comparison of total laryngectomy with surgical (cricohyoidopexy) and nonsurgical organ-preservation modalities in advanced laryngeal squamous cell carcinomas: A multicenter retrospective analysis. Head Neck 2012; 35:554-61. [PMID: 22495830 DOI: 10.1002/hed.22994] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Functional outcome and quality of life (QOL) have become relevant endpoints in the field of laryngeal oncology, leading to the emergence of organ-preserving strategies. METHODS The medical records of 166 patients with advanced (stages III and IV) laryngeal squamous cell carcinoma (SCC) who were treated with a total laryngectomy, radiochemotherapy, or cricohyoidopexy (CHP) were reviewed. RESULTS In the whole series, no statistically significant differences among the 3 treatment arms with respect to the overall survival (OS) and disease-specific survival (DSS) rates were observed. The organ-preservation rate was 45% for radiotherapy and 76.7% for CHP (p = .0002). Among the cT4a cases, a longer survival was observed for the patients treated with total laryngectomy (3 yr-OS = 78% vs 68% for CHP and 54% for radiochemotherapy, p = .031). CONCLUSIONS In advanced laryngeal SCC, CHP shows survival rates comparable to those of radiochemotherapy and a higher larynx-preservation rate, although it may not replace radiochemotherapy because it can be recommended only in selected cases.
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Affiliation(s)
- Francesco Bussu
- Institute of Otorhinolaryngology, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
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Topaloğlu I, Bal M, Salturk Z. Supracricoid laryngectomy with cricohyoidopexy: oncological results. Eur Arch Otorhinolaryngol 2011; 269:1959-65. [PMID: 22130913 DOI: 10.1007/s00405-011-1844-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022]
Abstract
This study assessed the oncological results in patients undergoing supracricoid laryngectomy with cricohyoidopexy. A cohort of 44 patients surgically treated using supracricoid laryngectomy with cricohyoidopexy between June 2001 and December 2009 was retrospectively analyzed. The mean follow-up period was 53.2 (±24.7) months. The Kaplan-Meier method was used to analyze overall survival and disease-specific survival, as well as survival according to T2 and T3 subgroups. Overall survival rates at 3 and 5 years were 90.5 and 84.1%, respectively. The 3- and 5-year disease-specific survival rates were 95.4 and 92.5%, respectively. Overall survival for patients with T2 disease was 87.5% at 3 years and 80.8% at 5 years. For T3, the corresponding rates were 91.8 and 87.0%. Disease-specific survival for patients with T2 disease was 93.3% at 3 years and the same at 5 years; the corresponding rates for T3 were 96.4 and 91.4%. The differences between T2 and T3 patients at 3 and 5 years with respect to overall and disease-specific survival were not statistically significant (P = 0.903 and P = 0.863, respectively). Recurrence was local in one patient (2.2%) and regional in three (6.8%). There were three distant metastases (6.8%) and one second primary carcinoma (2.2%). These findings support the use of supracricoid laryngectomy with cricohyoidopexy as an oncologically safe technique in properly selected patients with laryngeal carcinoma.
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Affiliation(s)
- Ilhan Topaloğlu
- 1st Ear Nose and Throat Clinic, İstanbul Okmeydanı Training and Research Hospital, İstanbul, Turkey.
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Topaloglu I, Köprücü G, Bal M. Analysis of swallowing function after supracricoid laryngectomy with cricohyoidopexy. Otolaryngol Head Neck Surg 2011; 146:412-8. [PMID: 22075077 DOI: 10.1177/0194599811428582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the swallowing function after supracricoid laryngectomy with cricohyoidopexy, focusing on the effects of arytenoid cartilage resection and radiation therapy. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Thirty supracricoid laryngectomy-cricohyoidopexy patients, at least 1 year after treatment, were retrospectively analyzed. Fiber-optic endoscopic evaluation of swallowing was performed for each patient. Three blinded judges evaluated the video recordings based on 3 parameters. The M. D. Anderson Dysphagia Inventory was completed by each patient for assessment of disease-specific quality of life. RESULTS All patients were decannulated at an average of 23.6 days. Nasogastric feeding tubes were removed at an average of 27.3 days, and all patients could eat orally. Fiber-optic endoscopic evaluation of swallowing showed that patients with total resection of 1 arytenoid had more bolus retention than patients with both arytenoids preserved (P = .008). Compared with patients who did not receive radiotherapy, patients who did receive radiotherapy exhibited increased retention (P = .021) and aspiration (P = .007). The M. D. Anderson Dysphagia Inventory results revealed no differences in quality of life according to the level of arytenoid resection or the administration of radiotherapy. CONCLUSION The functional evaluation of swallowing after supracricoid laryngectomy-cricohyoidopexy showed satisfactory results. Patients with total resection of 1 arytenoid had significantly higher bolus retention, and those who received radiotherapy had significantly increased retention and aspiration.
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Affiliation(s)
- Ilhan Topaloglu
- Ear, Nose, and Throat Clinic, İstanbul Okmeydanı Training and Research Hospital, İstanbul, Turkey.
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Three-dimensional computed tomography analysis of neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy. The Journal of Laryngology & Otology 2011; 126:385-90. [PMID: 22032473 DOI: 10.1017/s002221511100257x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Supracricoid laryngectomy with cricohyoidoepiglottopexy is an organ-preserving procedure used to treat laryngeal cancer. However, the post-operative neoglottis tends to be variable in form and difficult to predict. METHODS We retrospectively analysed three-dimensional images reconstructed from multidetector-row computed tomography data for 21 patients, assessing arytenoid motion and minimum neoglottic gap cross-sectional area. RESULTS While mean transverse and coronal motion was similar for bilateral and unilateral arytenoids, movement along the sagittal axis was greater for unilateral than bilateral arytenoids. The neoglottic gap during respiration was wider in patients with bilateral arytenoids, but both groups had a similar neoglottic gap during phonation. CONCLUSION Anterior shifting of the unilateral arytenoid plays an important role in compensating for the inability to achieve neoglottic closure. These two results demonstrate that the unilateral arytenoid alone is capable of achieving sufficient neoglottic narrowing to compensate for the resected arytenoid. Three-dimensional analysis was useful to evaluate the physiological status of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy.
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'Flaccid neoglottis' following supracricoid partial laryngectomy: laryngoscopic revision assisted by navigation system. The Journal of Laryngology & Otology 2011; 125:1315-9. [PMID: 21888753 DOI: 10.1017/s0022215111002386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had 'flaccid neoglottis', i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication. METHOD The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated. RESULTS Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this. CONCLUSION Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.
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Nakayama M, Seino Y, Okamoto M, Mikami T, Okamoto T, Miyamoto S. Clinical Significance of Positive Delphian Node in Supracricoid Laryngectomy with Cricohyoidoepiglottopexy. Jpn J Clin Oncol 2011; 41:987-91. [DOI: 10.1093/jjco/hyr091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Nakayama M, Okamoto M, Iwabuchi K, Mikami T, Seino Y. Clinical significance of intraoperative surgical margin study in supracricoid laryngectomy. Auris Nasus Larynx 2011; 38:261-5. [PMID: 20729021 DOI: 10.1016/j.anl.2010.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/22/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
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Paleri V, Thomas L, Basavaiah N, Drinnan M, Mehanna H, Jones T. Oncologic outcomes of open conservation laryngectomy for radiorecurrent laryngeal carcinoma. Cancer 2011; 117:2668-76. [PMID: 21287526 DOI: 10.1002/cncr.25831] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/22/2010] [Indexed: 11/12/2022]
Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology-Head and Neck Surgery, The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom.
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Computer-based analysis with three-dimensional imaging constructed from fine-slice computed tomography scan of supracricoid laryngectomy with cricohyoidoepiglottopexy: report of two cases. The Journal of Laryngology & Otology 2011; 125:523-7. [PMID: 21269555 DOI: 10.1017/s0022215110002690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Supracricoid laryngectomy with cricohyoidoepiglottopexy is an organ-preserving surgical technique used to treat laryngeal cancer. This procedure resects the vocal folds; however, it is unclear how the sound source and airway morphology are involved in phonation through the post-operative neoglottis. METHOD Multidetector helical computed tomography scanning was performed on two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. The cricoid and arytenoid cartilages and the airway were visualised using three-dimensional images. RESULTS The mobility of the arytenoid cartilages was well preserved in the one patient with bilateral arytenoids, and in the other patient with only one arytenoid remaining. Two types of airway configuration were observed during phonation: one patient had a single stream airway, while the other had a combination of several streams. CONCLUSION In the patient with only one arytenoid remaining, the preserved arytenoid tended to be rotated excessively inward. Therefore, phonation may have also occurred in various airways followed by mucosal vibration, which may be a sound source.
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Rifai M, Hassouna MS, Abdel Fattah AEF, Badran H. Experience with supracricoid laryngectomy variants. Head Neck 2010; 33:1177-83. [PMID: 21755561 DOI: 10.1002/hed.21593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 02/05/2010] [Accepted: 07/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the outcomes after supracricoid laryngectomy (SCL) as an alternative to total laryngectomy (TL) for treatment of laryngeal cancer. METHODS This retrospective study involved 333 patients who underwent 4 types of SCL for squamous cell carcinoma of the larynx in an Egyptian hospital between May 1984 and May 2007. Both functional outcomes and oncological outcomes were evaluated. RESULTS Surgical margins were free from tumor invasion. The overall 5-year survival rate was 74%. Three hundred nine patients (92.8%) were decannulated, whereas 8 patients had permanent stenosis, 6 patients underwent TL, and 10 patients died. Only 7 patients (2.1%) had persistent aspiration; 6 of these patients underwent TL, whereas 1 patient died of pneumonia. The voice intelligibility score ranged from 70% to 100%, with a mean score of 89%. The score was highest when both arytenoids were preserved (mean, 95%). Ten patients died of complications directly related to the surgery. CONCLUSION Supracricoid laryngectomy is effective for managing laryngeal cancer. Modification of the technique to permit resection of both arytenoids is possible in select patients.
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Affiliation(s)
- Mohamed Rifai
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Nakayama M, Okamoto M, Seino Y, Miyamoto S, Hayashi S, Masaki T, Yokobori S, Takeda M. Inverted epiglottis: A postoperative complication of supracricoid laryngectomy with cricohyoidoepiglottopexy. Auris Nasus Larynx 2010; 37:609-14. [DOI: 10.1016/j.anl.2009.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/19/2009] [Accepted: 12/12/2009] [Indexed: 10/19/2022]
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Delayed wound infection after supracricoid partial laryngectomy following failure of high dose radiation. Eur Arch Otorhinolaryngol 2010; 268:273-9. [DOI: 10.1007/s00405-010-1352-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 07/23/2010] [Indexed: 11/26/2022]
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High-speed digital imaging laryngoscopy of the neoglottis following supracricoid laryngectomy with cricohyoidoepiglottopexy. The Journal of Laryngology & Otology 2010; 124:1234-8. [PMID: 20492740 DOI: 10.1017/s002221511000109x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to analyse vocal performance and to investigate the nature of the neoglottal sound source in patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy, using a high-speed digital imaging system. METHODS High-speed digital imaging analysis of neoglottal kinetics was performed in two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy; laryngotopography, inverse filtering analysis and multiline kymography were also undertaken. RESULTS In case one, laryngotopography demonstrated two vibrating areas: one matched with the primary (i.e. fundamental) frequency (75 Hz) and the other with the secondary frequency (150 Hz) at the neoglottis. In case two, laryngotopography showed two vibrating areas matched with the fundamental frequency (172 Hz) at the neoglottis. The interaction between the two areas was considered to be the sound source in both patients. The waveform of the estimated volume flow at the neoglottis, obtained by inverse filtering analysis, corresponded well to the neoglottal vibration patterns derived by multiline kymography. These findings indicated that the specific sites identified at the neoglottis by the present method were likely to be the sound source in each patient. CONCLUSIONS High-speed digital imaging analysis is effective in locating the sites responsible for voice production in patients who have undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. This is the first study to clearly identify the neoglottal sound source in such patients, using a high-speed digital imaging system.
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Nakayama M, Hayakawa K, Okamoto M, Niibe Y, Ishiyama H, Kotani S. Phase I/II trial of concurrent use of S-1 and radiation therapy for T2 glottic cancer. Jpn J Clin Oncol 2010; 40:921-6. [PMID: 20495190 DOI: 10.1093/jjco/hyq077] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE A Phase I/II study of S-1 combined radiation therapy was conducted in patients with Stage II (T2N0) glottic cancer. The purpose of the Phase I study was to identify the maximum tolerated dose, the recommended dose and the dose limiting toxicity. The objectives in the phase II study were to estimate the local control and the overall survival, and the incidence of adverse events. METHODS In Phase I, S-1 was administered orally in a split-course fashion as two doses of 40 mg/m(2), for a total daily dose of 80 mg/m(2). The course involved a 2-week rest after a 2-week administration (Level 1) and a 1-week rest after a 3-week administration (Level 2). Radiation therapy was administered in 2-Gy daily (total 60-Gy) standard fractionation. RESULTS Seven patients were enrolled in the Phase I, and 19 in the Phase II study. Mucositis was the most common toxicity encountered. All 26 patients completed radiation therapy without delay. The overall response rate was 100% (26/26) with all patients showing a complete response. One patient developed a local recurrence 28 months after the treatment. The 3-year local control and overall survival rates were 94.7 and 85.4%, respectively (limited to 22 patients from Level 2). CONCLUSIONS The use of S-1 at 80 mg/m(2) per day in a split-course with 1-week rest during the course of radiation therapy was safe and effective for Stage II glottic cancer. The treatment strategy employing orally available S-1 proved to be beneficial over the conventional injection of antitumor agents for maintaining the patients' quality of life.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara, Kanagawa 228-8555, Japan.
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Supracricoid laryngectomy: oncologic validity and functional safety. Eur Arch Otorhinolaryngol 2010; 267:1919-25. [PMID: 20490818 DOI: 10.1007/s00405-010-1279-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
The objectives of this study are to elucidate the oncologic validity of the supracricoid laryngectomy (SCL) for locally advanced endolaryngeal cancers and as a salvage procedure, and to determine its safety in maintaining laryngeal physiology. The medical records of 114 patients that underwent SCL were reviewed. We examined whether the extended procedures, salvage procedure, adjuvant treatment, and type of reconstruction were associated with patient survival and the mean time of decannulation and nasogastric tube removal. Postoperative complications were investigated. There was no significant difference in survival according to the extent of the resection of the primary tumors and the presence or absence of previous treatment. However, the survival of patients that received radiation or concurrent chemoradiation after SCL was significantly lower than that of patients without any adjuvant treatment. Decannulation and nasogastric tube removal was possible for all except for two patients, and the mean time required was 18.4 and 26.1 days, respectively. The interval to starting oral feeding was significantly increased in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery compared to their counterparts. Pulmonary complications, particularly aspiration pneumonia, were the most common postoperative complications. The results of this study suggest that SCL was feasible for locally advanced laryngeal cancers and as a salvage procedure. Active and effective postoperative swallowing rehabilitation, particularly in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery, is needed to prevent aspiration pneumonia.
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Nakayama M, Seino Y, Hayashi S, Miyamoto S, Takeda M, Masaki T, Yokobori S, Okamoto M. [Clinical review of supracricoid laryngectomy with CHEP and CHP: 50 patients treated in 11 years]. NIHON JIBIINKOKA GAKKAI KAIHO 2009; 112:540-9. [PMID: 19670796 DOI: 10.3950/jibiinkoka.112.540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An analysis of clinical data on 50 patients undergoing supracricoid laryngectomy (SCL) between 1997 and 2008 i.e., cricohyoidoepiglottopexy (CHEP) in 47 and cricohyoidopexy (CHP) in 3 cases showed that the number of SCL cases operated on within a year surpassed that of Total Laryngectomy after 2003. Selection criteria included performance status 0-1 and blood gas PO2>80 torr, especially in those patients over 70-years-old. Postoperative wound infection occurred in 16 patients (32%), with four requiring additional surgical intervention (two ruptured pexis and two chondritis induced by C3-C4 osteophytes). A history of radiotherapy and systemic complications, i.e., diabetes and renal failure, added to the risk of wound infection. Introducing a clinical pathway shortened hospitalization. Vocal function was achieved in 96% and swallowing function in 89% of patients. Five-year crude survival in CHEP was 69% and in TL 51%. Laryngeal preservation was 70%, increasing to 89% after the introduction of SCL. SCL-CHEP is thus indicated for unfavorable T2 (ASCO 2006), well-selected T3, T4, and rT1-4 (radiation failures). Effort should emphasize a good balance in prognosis and function in organ preservation for laryngeal cancer.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara
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Yäce İ, Çaglı S, Bayram A, Karasu F, Satı I, Gäney E. The Effect of Arytenoid Resection on Functional Results of Cricohyoidopexy. Otolaryngol Head Neck Surg 2009; 141:272-5. [DOI: 10.1016/j.otohns.2009.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 04/07/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE: The aim of this study was to evaluate the influence of arytenoid resection on voice and swallowing function in patients who undergo supracricoid laryngectomy with cricohyoidopexy. STUDY DESIGN: A case series with chart review. According to the arytenoid number, patients were divided into two groups: 11 patients with two arytenoids and 9 patients with one arytenoid. The decannulation, nasogastric tube removal, and hospitalization times were noted. Maximum phonation time, average fundamental frequency, percent jitter, percent shimmer, and noise-to-harmonic ratio were measured. Grade, roughness, breathiness, asthenicity and strain scale (for the perceptual evaluation of vocal quality), Voice Handicap Index (for self-assessment of the voice), and dysphagia score were used. RESULTS: The mean decannulation, nasogastric tube removal, and hospitalization time was 18.4, 40.2, and 32.7 days in patients with one arytenoid, whereas 8.8, 20.8, and 25.3 days in patients with two arytenoids, respectively. The differences were statistically significant. For all of the parameters that are associated with voice function and dysphagia, there was no statistically significant difference between one arytenoid and two arytenoids. CONCLUSION: Arytenoid resection may affect the swallowing function in the early postoperative period, but for voice and deglutition functions there was no difference between cricohyoidopexy with one arytenoid and two over the course of time.
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Affiliation(s)
- İmdat Yäce
- From the Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Kayseri, Turkey
| | - Sedat Çaglı
- From the Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Kayseri, Turkey
| | - Ali Bayram
- From the Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Kayseri, Turkey
| | - Fatih Karasu
- From the Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Kayseri, Turkey
| | - Işıl Satı
- From the Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Kayseri, Turkey
| | - Ercihan Gäney
- From the Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Kayseri, Turkey
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Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333-52. [PMID: 19597837 DOI: 10.1007/s00405-009-1028-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Carl E Silver
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Schindler A, Favero E, Capaccio P, Albera R, Cavalot AL, Ottaviani F. Supracricoid laryngectomy: age influence on long-term functional results. Laryngoscope 2009; 119:1218-25. [PMID: 19296505 DOI: 10.1002/lary.20172] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS : Supracricoid laryngectomies (SCL) are conservative surgical techniques for the treatment of selected laryngeal carcinomas, currently adopted also in old patients. Long-term functional results have not been reported in elderly patients. The aim of this study is to compare voice and swallowing in elderly and younger patients following SCL. STUDY DESIGN : Cross-sectional study. METHODS : Twenty male patients who underwent SCL were recruited in the study; 10 were younger than 65 years at the time of surgery and 10 were older. Video-endoscopic ratings were taken of neoglottic vibration patterns and bolus transit. Voices were perceptually rated using the GIRBAS scale. The maximum phonation time (MPT) and the syllables diadochokinesis were measured. Spectrograms were recorded. All of the patients completed a self-assessment questionnaire for both voice and swallowing. The data obtained from the two groups were compared through the Mann-Whitney test. RESULTS : Video-endoscopic ratings of neoglottal vibration and bolus transit showed no difference between the two groups. The perceptual assessment showed a harsh voice in both groups. No significant difference was found for mean syllable diadochokinesis and the mean MPT was 6.3 seconds and 8.8 seconds, respectively in the younger and older group. The mean value of the Yanagihara scale of voice spectrogram was 3.8 and 3.7. Voice and swallowing quality-of-life questionnaires revealed satisfied patients in both age groups. CONCLUSIONS : Age by itself does not have a significant impact on long-term functional results following SCL. Meticulous selection of the candidate to SCL allows the application of this surgical technique with adequate long-term functional results. Laryngoscope, 2009.
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Affiliation(s)
- Antonio Schindler
- Department of Clinical Sciences L. Sacco, University of Milan, Milan, Italy.
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Selective (intra-arterial), rapid infusion chemo-radiotherapy to preserve the larynx in advanced laryngeal carcinoma: preliminary results. The Journal of Laryngology & Otology 2009:30-4. [DOI: 10.1017/s0022215109005052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:We had previously treated patients with advanced stage laryngeal cancer by laryngectomy with or without post-operative radiotherapy. In order to improve such patients' quality of life, we sought to preserve the larynx by selective (intra-arterial), rapid infusion chemotherapy combined with radiotherapy.Methods:Chemotherapy was administered intra-arterially in the angiography suite via transfemoral catheterisation of the superior thyroid artery. Patients received up to four once-weekly infusions of cisplatin (75 mg/patient) with simultaneous intravenous administration of sodium thiosulphate, a neutralising agent. Patients also received external radiation simultaneously at a dose of 1.8 or 2.0 Gy per fraction, once daily for five days a week for 7 weeks.Results:Intra-arterial infusion chemo-radiotherapy was performed in eight patients with advanced laryngeal carcinoma (four glottic, three supraglottic and one subglottic type carcinoma). A complete response was achieved at the primary site and at lymph node metastases in all eight patients. Overall toxic side effects were modest. No catheter-related thrombo-embolic complications were observed during any of the chemotherapy sessions.Conclusions:Selective (intra-arterial), rapid infusion chemo-radiotherapy may enable laryngeal preservation in patients with advanced laryngeal carcinoma.
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