The current role of vertical partial laryngectomy and open supraglottic laryngectomy

Current concepts of organ preservation in head and neck cancer

The treatment of laryngeal and hypopharyngeal cancer nowadays is not limited by surgical resection. There are many interdisciplinary approaches which we can offer these patients in our clinics. These include radiotherapy, chemotherapy, biologicals and surgery. The combination of radiotherapy, chemotherapy, biologicals and surgery techniques more and more allows us to perform organ and function preservation in a former often mutilating and function destroying treatment. Since the early 1990s, evidence from large randomized trials has shown that organ preservation studies using sequential and concomitant radio-chemotherapy do not compromise survival when compared with surgery followed by radiotherapy. However, using these therapies side effects have to be taken into consideration and not organ preservation but function preservation is the treatment goal. The current most common treatment options are shown here in this review. For future treatment protocols there is an urgent need to refine the definition of a functional organ, to define quality of life endpoints and to refine the recommendations for evaluating treatment response.

Vertical partial hemilaryngectomy with reconstruction by false cord imbrication

BACKGROUND

To evaluate global survival, disease-free period, complications, evolution and function in vertical partial hemilaryngectomy (VPHL) plus reconstruction with false cord.

METHODS

Descriptive and retrospective study. In aertiary care medical center in Mexico City. Eight patients with early diagnosis of early glottic cancer (T1 and T2), treated with VPHL plus reconstruction with false cord imbrication.

RESULTS

Fifty percent of the patients were clinical stage I, 37.5% stage II and 12.5% stage III. Nasogastric tube was not placed and oral feeding was reinitiated within 3 days on average. Tracheostomy was removed after an average of 2.1 days. Average hospital stay was 3.3 days. Average of the PSS-HNC (Performance Status for Head and Neck Cancer) and Karnofsky Performance Status evaluation was 91 to 97 and 100 at 1 year of evaluation. Voice evaluation demonstrated normal voice in 87.5% of patients. Intensity was below normal with improvement on annual evaluation. Global survival was 100% and disease-free period was 71% at 3 years.

CONCLUSIONS

VPHL with reconstruction by false cord imbrication is an excellent therapeutic option for early glottic cancers. Multiple functional advantages are demonstrated without sacrificing oncological control as well as providing an audible and intelligible voice. In cases of recurrence, various management options are available.

Transoral resection of laryngeal and hypopharyngeal cancers

The advent of transoral microlaryngoscopic laser surgery is making a significant impact on treatment decisions in the management of early squamous cancers of the larynx and the hypopharynx. It has, to a great extent replaced the conventional open partial laryngectomy procedures. Moreover many cancers of the larynx or the hypopharynx that were earlier being treated with radiation therapy are now resected transorally with the CO(2) laser. This article focuses on the progress of transoral laser microsurgery in the management of early larygopharyngeal cancers.

Organ preservation surgery for laryngeal cancer

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.

Rehabilitation of dysphagia following head and neck cancer

Patients who have cancers of the oral cavity, pharynx, or larynx may be treated with surgery, radiotherapy, chemotherapy, or a combination of these modalities. Each treatment type may have a negative impact on posttreatment swallowing function; these effects are presented in this article. A number of rehabilitative procedures are available to the clinician to reduce or eliminate swallowing disorders in patients treated for cancer of the head and neck. The various procedures-including postures, maneuvers, modifications to bolus volume and viscosity, range-of-motion exercises, and strengthening exercises-and their efficacy in patients treated for head and neck cancer are discussed.