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Sanguineti G, D'Urso P, Bottero M, Farneti A, Goanta L, Giannarelli D, Landoni V. Stereotactic Radiotherapy in 3 fractions for T1 Glottic Cancer: SBRT in 3 fractions for early glottic cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03452-7. [PMID: 39362311 DOI: 10.1016/j.ijrobp.2024.09.051] [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: 03/12/2024] [Revised: 09/11/2024] [Accepted: 09/20/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE/OBJECTIVE(S) To report the results of a phase I-II study on SBRT for early glottic cancer. MATERIALS/METHODS This a prospective study at a single Institution enrolling patients with T1 glottic cancer. The true vocal cords (TVC) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. SBRT was delivered by a LINAC-based approach using multiple arcs. Toxicity was scored by CTCAE and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the voice handicap index (VHI) at regular intervals. The planned sample size was 75 patients. RESULTS Accrual was discontinued after 33 patients due to concerns for late toxicity. T stage was as follows: T1a: 23 pts (69.7%); T1b: 10 pts (30.3%). All patients received the planned treatment and the median follow-up time is 51.5 months (IQR: 47.9-61.0 months). At last follow up, all patients are alive and without evidence of disease but two patients who died for intercurrent causes. The local control rate is 100% at 4 yrs. Six patients (18.2%) developed soft tissue necrosis (N=4) or cartilage necrosis (N=2) after a median time of 14.9 months from SBRT. Five out of 6 necrotic events were observed in patients who kept smoking and/or had a recent COVID infection. All 4 soft tissue events healed with conservative therapy. After an initial deterioration the average VHI score significantly improved at 6 months over baseline. CONCLUSION SBRT to 36 Gy in 3 fractions is highly effective in controlling T1 TVC carcinoma, but necrosis, though mostly transient, is a concern. Based on the present results, a reduction in total dose as well as a more accurate patient selection are warranted.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, Department of Physics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Pasqualina D'Urso
- Department of Radiation Oncology, Department of Physics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Marta Bottero
- Department of Radiation Oncology, Department of Physics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, Department of Physics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Lucia Goanta
- Department of Radiation Oncology, Department of Physics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Diana Giannarelli
- Department of Statistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
| | - Valeria Landoni
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Hans S, Baudouin R, Circiu MP, Couineau F, Rigal T, Remacle MJ, De Vito A, Cammaroto G, Crevier-Buchman L, Lechien JR. One hundred fifty years of total laryngectomies. Front Oncol 2024; 14:1351549. [PMID: 38915362 PMCID: PMC11194346 DOI: 10.3389/fonc.2024.1351549] [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: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 06/26/2024] Open
Abstract
The inaugural total laryngectomy in history was conducted by Billroth in 1873. Nevertheless, significant enhancements to the technique were achieved through the contributions of Gluck, Sorensen, and various other surgeons. Throughout the twentieth century, advancements in anesthesia, infectious disease, hospital hygiene, antibiotic therapy, resuscitation, and the expertise of numerous laryngologists elevated total laryngectomy to a pivotal surgical intervention in head and neck surgery. The latter half of the twentieth century witnessed a paradigm shift with the emergence of organ preservation protocols. Total laryngectomy became the preferred choice for patients experiencing radiotherapy failure. However, the widespread use of laryngeal conservative treatments appears to be correlated with a decline in overall survival rates in the United States and Europe. The evolution of new minimally invasive surgical approaches in the twenty-first century may usher in a revolutionary era in the management of laryngeal carcinoma, offering the potential for improved survival and functional outcomes.
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Affiliation(s)
- Stéphane Hans
- Research Committee of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta P. Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Florent Couineau
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Tiffany Rigal
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marc J. Remacle
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Andrea De Vito
- Department of Otolaryngology-Head and Neck Surgery, Forlì & Faenza Hospitals Ravenna & Lugo Hospitals, Health Local Agency of Romagna, Forli, Italy
| | - Giovanni Cammaroto
- Research Committee of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Forlì & Faenza Hospitals Ravenna & Lugo Hospitals, Health Local Agency of Romagna, Forli, Italy
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R. Lechien
- Research Committee of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, University of Mons (UMONS) Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
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3
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Tai Y, Zang Y, Liu T, Ma J, Qin L, Ji Y, Dai H, Wang G, Ma L, Liu F. Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study. Int Wound J 2024; 21:e14706. [PMID: 38660912 PMCID: PMC11044006 DOI: 10.1111/iwj.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 04/26/2024] Open
Abstract
To analyse the risk factors and healing factors of pharyngocutaneous fistula (PCF) in patients with laryngeal cancer after total laryngectomy, and to explore the relevant epidemiology. A retrospective analysis was conducted on laryngeal cancer patients who underwent total laryngectomy in our hospital from January 2010 to December 2022. The 349 patients included in the study were divided into a PCF group of 79 and a non-PCF group of 270. Perform one-way analysis of variance and multivariate logistic analysis on various data of patients included in the statistics, and analyse the risk factors and healing factors of PCF. Smoking, history of radiation therapy for laryngeal cancer, history of chemotherapy for laryngeal cancer, tumour location (larynx, pharynx, oesophagus), preoperative albumin, postoperative proteinaemia, <99 haemoglobin, postoperative haemoglobin, postoperative C-reactive protein (CRP) level are the risk factors for PCF. Also, radiation therapy and postoperative proteinaemia were the main reasons for preventing PCF healing. Smoking history, laryngeal cancer, radiation therapy, albumin, haemoglobin and CRP are risk factors for postoperative PCF after total laryngectomy, while radiation therapy and postoperative hypoalbuminaemia are key factors affecting PCF healing.
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Affiliation(s)
- Yong Tai
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Yanzi Zang
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Tongxun Liu
- Department of OtorhinolaryngologyZhongmu County People's HospitalZhengzhouChina
| | - Jiqing Ma
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Litao Qin
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Henan Provincial People's Hospital, Medical Genetics Institute of Henan Province, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Yuzi Ji
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Hanqing Dai
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Guangke Wang
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Lingcao Ma
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
| | - Fei Liu
- Department of Otorhinolaryngology, People's Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouChina
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Meliante PG, Battilocchi L, Costantino A, Lee K, Moon SJ, Ralli M, Minni A, Capaccio P, Pignataro L, de Vincentiis M, Kim SH. Transoral robotic vertical partial laryngectomy (hemilaryngectomy) extended to the hypopharynx. Head Neck 2024; 46:708-712. [PMID: 38221740 DOI: 10.1002/hed.27634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/30/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
Locally advanced laryngeal cancers treatment often involves total laryngectomy, which some patients are unwilling to undergo, even if this choice reduces their survival probability. Therefore, the objective of laryngeal oncologic surgery is not only to remove the tumor, but also to preserve the organ and its functions. To overcome these concerns, several partial laryngectomy techniques have been developed. This article describes the surgical technique and a case study of a 64-year-old male patient with locally advanced laryngeal squamous cell carcinoma who underwent vertical partial laryngectomy extending to the subglottis and hypopharynx using transoral robotic surgery (TORS) with a da Vinci Single Port surgical robot. The video and article provide a detailed description of the surgical technique, which resulted in successful tumor removal with excellent oncological and functional outcomes.
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Affiliation(s)
- Piero Giuseppe Meliante
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ludovica Battilocchi
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Costantino
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Kyuin Lee
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Jin Moon
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
| | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
| | - Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Zhu R, Zhu H. Survival Benefit from Cancer-Directed Surgery for Metastatic Head and Neck Cancer. Laryngoscope 2024; 134:1288-1298. [PMID: 37658720 DOI: 10.1002/lary.31019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES This study aimed to gather evidence for the survival benefit of cancer-directed surgery (CDS) in metastatic head and neck cancer (M1 HNC) and identify which patients will benefit most from CDS. METHODS Patients with M1 HNC were identified within the SEER database. According to whether received CDS, patients were divided into the CDS and non-CDS groups. The bias between the two groups was minimized using Propensity Score Matching (PSM), and the prognostic role of CDS was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The primary endpoint was overall survival (OS), and the secondary endpoint was cancer-specific survival (CSS). RESULTS A total of 3215 patients with M1 HNC were extracted, including 566 patients who received CDS that were 1:1 propensity score-matched with patients who did not receive CDS. In the matched dataset, the median OS and CSS in CDS groups were significantly higher than in non-CDS groups (OS: 19.0 vs. 9.0 months, p < 0.001; CSS: 21.0 vs. 9.0 months, p < 0.001). Meanwhile, multivariable Cox regression analysis also revealed that CDS was a favorable prognostic factor for both OS and CSS. Furthermore, subgroups of patients with M1 HNC (younger age, being married, grade I-II, oropharynx site, earlier T/N stage, radiotherapy) were inclined to benefit from CDS, while those patients who received chemotherapy failed to benefit from CDS. CONCLUSIONS This study indicated that CDS was associated with improved survival in M1 HNC, especially for those subpopulations that benefit more from CDS treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1288-1298, 2024.
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Affiliation(s)
- Runqiu Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Stomatology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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6
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Allegra E, Bianco MR, Modica DM, Azzolina A, Privitera E, Latella D, Occhiuzzi F, Galfano M, Saita V. Multicentric Study on Oncological Outcomes and Prognostic Factors of Open Partial Horizontal Laryngectomies. EAR, NOSE & THROAT JOURNAL 2024:1455613231225906. [PMID: 38321705 DOI: 10.1177/01455613231225906] [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: 02/08/2024] Open
Abstract
Objective: In recent years, the number of open preservation surgeries for the treatment of laryngeal Cancer has increased. This surgery aims to maintain laryngeal function and ensure oncological radicality, thereby avoiding a total laryngectomy (TL) that could significantly impact the patient's quality of life. The purpose of this study was to assess the oncologic results of OPHL I and II and to identify prognostic factors that could impact patient survival and local failure rates. Methods: This study was conducted on 182 patients with laryngeal squamous cell carcinoma treated with OPHLs between 2005 and 2015. The survival rates of a group of patients treated with TL between 2004 and 2014 were taken into consideration to compare survival outcomes. Results: The disease-specific survival in pT2 and pT3 tumors in relation to the type of surgery showed no statistically significant difference between OPHLs and TL (P = .54 and P = .63, respectively). The 5-year T-recurrence-free survival showed that pT4 tumors, perineural/vascular positive invasion, and OPHL IIb + ARY-treated tumors were associated with a higher risk of tumor recurrence (P < .0001, P = .0005 and P = .016 respectively). Conclusions: OPHLs represent an excellent alternative to TL considering the characteristics of the tumor and the general conditions of the patient.
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Affiliation(s)
- Eugenia Allegra
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Maria Rita Bianco
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Alfio Azzolina
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
| | - Elio Privitera
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
| | - Daniele Latella
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Mario Galfano
- Otolaryngology Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Vincenzo Saita
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
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Lechien JR, Chiesa-Estomba CM, Maniaci A, Vaira LA, Gengler IM. Dysphagia after supraglottic laryngeal cancer surgery. Am J Otolaryngol 2023; 44:103925. [PMID: 37207574 DOI: 10.1016/j.amjoto.2023.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/18/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Jerome R Lechien
- Head Neck Surgery Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies, Paris, France; Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Carlos M Chiesa-Estomba
- Head Neck Surgery Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies, Paris, France; Department of Otolaryngology-Head & Neck Surgery, Donostia University Hospital, Biodonostia Research Institute, San Sebastian, Deusto University, Spain
| | - Antonino Maniaci
- Head Neck Surgery Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies, Paris, France; Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Catania 95123, Italy
| | - Luigi A Vaira
- Head Neck Surgery Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies, Paris, France; Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy; Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Italy
| | - Isabelle M Gengler
- Head Neck Surgery Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies, Paris, France; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Kahmke R, Sajisevi M. Larynx Cancer: Reconstructive Options. Otolaryngol Clin North Am 2023; 56:333-343. [PMID: 37030946 DOI: 10.1016/j.otc.2022.11.002] [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: 04/10/2023]
Abstract
Reconstruction for laryngeal cancer will depend on the defect left by surgical resection and patient-related factors such as medical comorbidities and history of previous radiation treatment. The goals of reconstruction are to preserve and/or restore the primary functions of the larynx (breathing, swallowing, voicing). Options include primary closure, locoregional flaps, and microvascular free tissue each with their advantages and disadvantages, which should be considered when planning reconstruction.
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Affiliation(s)
- Russel Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA
| | - Mirabelle Sajisevi
- Department of Surgery, Division of Otolaryngology, University of Vermont Medical Center, 89 Beaumont Avenue, Given B110L, Burlington, VT 05401, USA.
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