Partial laryngectomy after irradiation failure.

INTRODUCTION: Radiation therapy is often the first method of treating patients with early cancer of the glottis. There is a substantial failure rate among these patients. Total laryngectomy has usually been the means of treating patients with failure after radiation. In recent decades, partial laryngectomy has been used for salvage in such patients. This article will discuss the use of partial laryngectomy for radiation failure both from the oncologic result as well as the morbidity. PATIENTS AND METHODS: Between 1984 and 1995, 27 patients with early-stage laryngeal carcinoma underwent salvage partial laryngectomy after irradiation failure. Vertical laryngectomy was performed in 18 patients (13 with T1 N0 and 5 with T2 N0) and horizontal-supraglottic laryngectomy in 9 patients (3 with T1 N0, 1 with T2 N0, and 5 with T2 N1). The mean follow-up was 4.1 years. RESULTS: Local control was obtained in 77.7% of patients with glottic lesions (T1: 84.6%; T2: 60%, P = NS) and in 55.5% of patients with supraglottic lesions (T1: 66.6%; T2: 50%; P = NS). There was no regional recurrence in the vertical laryngectomy group, whereas the regional control rate in the horizontal-supraglottic laryngectomy group was 77.7%. Distant control was achieved in 94.4% of patients with glottic disease and in 77.7% of patients with supraglottic disease. The overall survival rate for glottic lesions was 88.8% (T1: 92.3%; T2: 80%; P = NS) versus 66.6% for supraglottic lesions (T1: 100%; T2: 50%; P = NS). CONCLUSION AND SIGNIFICANCE: Vertical laryngectomy was not associated with an increased complication rate. Morbidity in the horizontal-supraglottic laryngectomy group was higher, but a satisfactory functional outcome was obtained in all cases. Therefore, in early laryngeal cancer (glottic T1-T2, supraglottic T1) partial laryngectomy can be performed with good expectation of cure and satisfactory laryngeal function. In T2 supraglottic lesions, the oncologic results are less satisfactory; further research is required for developing more efficient complimentary or alternative treatments modalities.     

Management and outcome of early glottic carcinoma.

OBJECTIVE AND STUDY DESIGN: We designed a retrospective study to analyze treatment methods and outcomes for patients with lesions ranging from carcinoma in situ to invasive T1 glottic squamous cell carcinoma. Patients with nonsquamous cell carcinoma, verrucous variant of squamous cell carcinoma, anterior commissure involvement, and T2 lesions were excluded. SETTING: University of Pittsburgh School of Medicine, a tertiary referral center. RESULTS: Fifty-four patients met the inclusion criteria. Mean follow-up was 49 months (range 24 to 96 months). Forty-eight of 54 (89%) were treated with endoscopic excision. Forty of these 48 patients (83%) were successfully treated with endoscopic excision(s) as the only treatment modality. Four patients had persistence of disease despite multiple endoscopic excisions. Two of these patients underwent hemilaryngectomy, 1 received radiation treatment, and 1 received radiation therapy followed by a hemilaryngectomy. Four patients had recurrence of disease. Two patients with recurrence required radiation therapy and 2 patients required a total laryngectomy. With the selective application of multiple endoscopic excisions, radiation therapy, and more invasive operation, 100% of patients are without evidence of disease with a laryngeal preservation rate of 96%. CONCLUSIONS: This study supports the use of endoscopic excisional biopsy as the primary treatment modality for lesions ranging from carcinoma in situ to invasive T1 glottic carcinoma. This study also highlights the importance of close clinical follow-up and the potential need for further treatment. By reserving open operation and radiation therapy to selective cases, we successfully treated all patients while limiting the disadvantages of radiation therapy and more invasive operation to the minority of patients.     

Supracricoid laryngectomy with CHEP: functional results and outcome.

OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.     

Partial laryngectomy for recurrent glottic carcinoma after radiotherapy

BACKGROUND: Early laryngeal cancer is treated with surgery or radiotherapy. A partial laryngectomy instead of a total laryngectomy can be used for treating patients with radiation failures. METHODS: Patients were grouped by the two types of partial laryngectomies we performed: group I, endoscopic laser surgery (n = 42); and group II, frontolateral partial laryngectomy (n = 21). RESULTS: With CO2 laser treatment, 14 of 24 patients (no involvement of the anterior commissure) and eight of 18 patients (involvement of the anterior commissure) were cured. With the frontolateral partial laryngectomy, we achieved local control in 15 of 21 patients. CONCLUSIONS: If the surgeon is familiar with the different techniques of, and indications for, partial laryngectomy, this can be a good and satisfying treatment in selected patients with radiation failure for glottic cancer     

CO2-laser treatment of recurrent glottic carcinoma.

BACKGROUND: Evaluation of the results of CO2 laser treatment of recurrent glottic carcinoma after radiotherapy. METHODS: Records of all patients treated in the University Hospital Rotterdam and the Dr. Daniel den Hoed Cancer Center between 1980 and 1996 by CO2 laser for recurrent glottic carcinoma were studied. RESULTS: Forty patients were treated by laser surgery. Average follow-up was 77 months. Twenty-three patients (58%) had another recurrence develop after laser surgery. Three were cured by a second laser procedure. Therefore, 20 patients (50%) were successfully treated with laser surgery. In 23 patients the recurrence did not extend into the anterior commissure; in 57% a total laryngectomy could be avoided. In 17 patients the recurrence did extend into the anterior commissure; in 41% a total laryngectomy was avoided. CONCLUSION: Most patients with recurrent carcinoma of the larynx after radiotherapy can be cured by laser surgery if the tumor does not extend into the anterior commissure.     

Platysma skin flap: Laryngeal repair material to produce phonatory flap vibrational wave

The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty‐nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty‐six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.     

Stomal recurrence after total laryngectomy for squamous cell carcinoma of the larynx.

OBJECTIVE: Stomal recurrence after total laryngectomy is one of the most serious issues in the management of laryngeal carcinoma. The management of stomal recurrence, including chemotherapy, radiotherapy, and surgery, has been reported as unsatisfactory. STUDY DESIGN AND SETTING: From 1985 to 1995, 69 patients underwent total laryngectomy for the treatment of laryngeal cancer at the University of Tokyo Hospital. To identify the risk factors for stomal recurrence, we analyzed these patients according to various clinicopathological factors. RESULTS: Stomal recurrence developed in 6 of 69 patients who underwent total laryngectomy for laryngeal carcinoma. Statistical analysis reveals that primary site, preoperative tracheotomy, and paratracheal lymph node metastasis are significant risk factors for stomal recurrence. CONCLUSION: Intensive follow-up should be performed for patients with glottic carcinoma who had preoperative tracheotomy, paratracheal lymph node metastasis, or both to detect stomal recurrence at an early stage.     

Obstructive sleep apnea in patients undergoing supracricoid horizontal or frontolateral vertical partial laryngectomy

OBJECTIVE: To assess obstructive sleep apnea (OSA) in patients undergoing supracricoid horizontal partial laryngectomy (SCPL) or frontolateral vertical partial laryngectomy (VPL) for the treatment of laryngeal carcinoma and correlate it with age, body mass index, physical examination, and upper airway evaluation. STUDY DESIGN AND SETTING: A prospective study was carried out involving 22 patients between 50 and 80 years of age divided into 2 equal groups. The patients underwent SCPL and VPL, and were evaluated by anamnesis, otolaryngologic examinations, nasopharyngolaryngoscopy, and polysomnography. RESULTS: A significant direct correlation was observed between the apnea/hypopnea index (AHI) and age of the patients. An inversely proportional relation was found between glottic opening and AHI. The presence of OSA was 81% in SCPL and 91% in VPL. CONCLUSION: We observed a high incidence of OSA in patients undergoing SCPL and VPL.     

Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma

Background: Partial laryngectomy after failure of radiotherapy for early glottic cancer is an accepted surgical salvage procedure. However,there have been only a few studies on recurrent disease or long‐term survival. Methods: Twenty‐one patients who were treated with salvage partial vertical laryngectomy (PVL) following failure of primary radiotherapy were prospectively studied. Median follow up was 69 months(range 24?204 months). Patients were seen at two‐ monthly intervals for the first 24 months and then 3?4 monthly for 5 years after their partial surgery or until death. Results: Local control was 71.4% (15/21).Among the six patients who recurred within the larynx, two patients developed a second primary; one on the ipsilateral false cord at 24 months and the other on the contra‐lateral vocal cordat 10 years. The no evidence of disease rate following salvage PVL was 95%, 85% and 73% at 12,24 and 36 months, respectively, with a mean disease free interval of 34.9 months (range 7?120). Survival was 90%, 85% and 80% at 12, 24 and 36 months, respectively, with a median survival of 152 months forthe group. Three patients died of their disease and four from other causes. Four local recurrences occurred within 32 months.Two developed neck metastases and died of their disease. Four patients were treated successfully with completion laryngectomy. Only one of these died, but this was due to a second primary squamous cell carcinoma in the lung. Three of the four patients with local recurrences had an extended procedure. Conclusion: Partial vertical laryngectomy is an excellent alternative to total laryngectomy for salvage following failure of ­radiation.Although local recurrence occurred more frequently in those patient shaving an extended partial procedure, this was not statistically different.     

Primary radiation therapy for early glottic cancer.

OBJECTIVES/HYPOTHESIS: Early glottic squamous cell carcinoma can be effectively treated with either radiation or surgical intervention. We evaluated our experience treating early glottic cancer with primary radiation therapy and our vertical hemilaryngectomy (VHL) salvage experience. STUDY DESIGN/METHODS: Retrospectively, patient records between January 1986 and December 1994 were reviewed and 45 patients with early glottic squamous cell carcinoma who received full-course radiation therapy at the Cleveland Clinic Foundation were identified. RESULTS: Local control after radiation therapy was 80% overall, 87.5% for T1 lesions, and 75% for T2 lesions. Four patients underwent VHL for salvage after local recurrence; 1 was successfully salvaged with VHL. Five patients underwent total laryngectomy salvage after radiation therapy; all were successful. Only 1 of the 6 patients who were originally candidates for VHL before radiation therapy was successfully salvaged with the larynx preserved. CONCLUSIONS: Our local control rates using primary radiation therapy are consistent with prior published series, but voice sparing salvage is poor.     

Management of local recurrence in well-differentiated thyroid carcinoma.

Local recurrence of well-differentiated thyroid carcinoma has a reported mortality approaching 50%. The University of Kentucky experience was reviewed to determine whether aggressive surveillance and treatment with reoperation and/or I-131 ablation increased survival following recurrence. Records of 66 consecutive patients with well-differentiated thyroid carcinoma treated at the University of Kentucky Medical Center (1980-1989) were reviewed. Forty-nine cases of papillary carcinoma and 17 cases of follicular carcinoma were studied; median follow-up was 68 months. At presentation, patients with follicular carcinoma were older (48 versus 35 years; P less than 0.05) and more frequently had metastatic disease (17% versus 2%, P less than 0.05). Fifty-eight (88%) patients were alive and disease-free at last follow-up. Fifteen patients (24%) had developed recurrent disease; median time to recurrence was 24 months. Multivariate regression examined the variables of age, sex, histology, tumor size, cervical adenopathy, capsular and vascular invasion, multicentricity, and surgical procedure. While distant metastases affected actuarial survival, no factor independently predicted local recurrence. In six patients with local recurrence, nonpalpable disease was detected by I-131 scan. All were treated with ablation and remain disease-free (mean follow-up 42 months). Eight patients with local recurrence presented with palpable lesions; seven underwent surgery. While two patients developed repeated local recurrences, the other five remain disease-free (mean follow-up 52 months). Early detection and aggressive treatment of local recurrence improve survival in patients with well-differentiated thyroid carcinoma. To facilitate use of I-131, we advise total thyroidectomy for patients with well-differentiated thyroid carcinoma.     

Transoral carbon dioxide laser microsurgery for recurrent glottic carcinoma after radiotherapy

BACKGROUND: Transoral laser microsurgery is successfully performed in the treatment of primary laryngeal carcinomas. Few publications deal with the application in patients with recurrent glottic carcinomas after radiation failure. Our study aims to review our experience with transoral laser microsurgery in these patients. METHODS: Thirty-four patients with early and advanced recurrent glottic carcinoma after full-course radiotherapy (rT1, n = 11; rT2, n = 10; rT3, n = 10; rT4, n = 3) had CO(2) laser treatment with curative intent between 1987 and 1998. RESULTS: Twenty-four patients (71%) were cured with one or more laser procedures. In nine patients, recurrences could not be controlled by laser microsurgery: six patients underwent total laryngectomy and three palliative treatment. One patient received total laryngectomy because of chondronecrosis after laser treatment. With a median follow-up interval of 38.6 months, the 3-year and 5-year disease-specific survival was 86%. The overall 3-year survival rate was 74%; the corresponding 5-year survival rate was 53%. No major complications occurred. In three cases, temporary tracheostomy was needed. CONCLUSIONS: In early-stage and advanced-stage recurrent glottic carcinomas after radiotherapy, CO(2) laser treatment can successfully be used as a curative organ-preserving procedure. Compared with salvage laryngectomy, results are superior with respect to preservation of laryngeal function. Great expertise is required, especially in resections of advanced-stage recurrent carcinomas.     

Vertical partial laryngectomy for recurrent glottic carcinoma after irradiation

Vertical partial laryngectomy after a full course of irradiation was performed in 26 patients as salvage surgery for recurrent or residual glottic carcinoma. An excellent cure rate and conservation of function was obtained, while complications were few. A prerequisite for this type of surgery is a limited extent and infiltration of the recurrent local tumor growth. As the great majority of local recurrence appears within the first 2 years after radiotherapy, frequent follow-up during this period is stressed for early detection of a recurrence.     

Management of advanced glottic carcinomas

One hundred twenty-eight patients with T3 or T4 glottic cancers were treated by initial surgery; 59 had a total laryngectomy and 69 had total laryngectomy with regional node dissection. Fifty-eight percent of the total laryngectomy group and forty-nine percent of the total laryngectomy with neck dissection group remained free of disease for 5 or more years. Forty-seven percent (60 of 128 patients) treated surgically developed regional recurrences requiring further treatment. Nine patients had evidence of widespread metastases, leaving 51 suitable for salvage radiotherapy. Twenty-three percent (12 of 51 patients) were salvaged with radiotherapy given for postoperative recurrences. Twenty-five patients received an initial 6,600 rads to larynx and neck with curative intent, 28 percent of whom remained free of disease for 5 or more years. Seventeen percent of patients were salvaged with one laryngectomy for persistent or recurring tumors. Initial total laryngectomy gave better survival figures for advanced glottic carcinoma.     

Surgery is associated with lower morbidity and longer survival in elderly breast cancer patients over 80

As breast cancer is the most frequent cancer in the elderly with a peak incidence of 1 in 10 by the age of 80, it is important to establish optimum therapy in this group. We conducted a case note-based retrospective study of all elderly primary breast cancer patients aged 80 and above between 1992 and 2002. The type of treatment, complications, disease progression, recurrence, and overall survival were recorded. In all 110 patients aged 80 and above were treated for primary breast cancer, with 32 patients having advanced disease. Of these, 62 patients received primary endocrine treatment. 48 patients underwent surgery with 30 patients undergoing mastectomy. At follow-up, 34 patients suffered disease progression in the primary endocrine treatment group and three patients had local recurrence in the surgical group. The Kaplan-Meier analysis revealed significantly better survival in the surgical treatment group when compared with the primary endocrine treatment group, both in the early disease (n = 41; median survival: 71 months; compared to n = 37; median survival: 42 months; p = 0.0002) and the advanced disease (n = 7; median survival: 48 months; compared to n = 25; median survival: 36 months; p = 0.03). Prompt surgery and adjuvant treatment can decrease relapse and improve survival even in patients older than 80 years.     

Laparoscopic versus open partial nephrectomy for the treatment of pathological T1N0M0 renal cell carcinoma: a 5-year survival rate

PURPOSE: We retrospectively compared the oncological adequacy of laparoscopic partial nephrectomy to that of open partial nephrectomy in the treatment of patients with pathological stage T1N0M0 renal cell carcinoma. MATERIALS AND METHODS: A total of 143 patients with stage T1N0M0 renal tumors confirmed by pathological examination of the surgical specimen underwent partial nephrectomy between January 1996 and June 2004 with a followup of at least 1.5 years. Of these patients 85 were treated laparoscopically and the remaining 58 underwent open surgery. Medical and operative records were retrospectively reviewed with emphasis on tumor recurrence and survival. Statistical analysis was performed using Kaplan-Meier analysis. RESULTS: The mean followup for the laparoscopy group was 40.4 +/- 18.0 months. A total of 83 patients survived. Of these patients 2 patients experienced disease recurrence within 18 to 46.2 months, 1 patient died of cancer metastasis to brain within 29.7 months and 1 died of an unrelated cause. Seeding of the port sites did not develop in any of the patients. The 5-year disease-free and actuarial survival rates for this group were 91.4%, and 93.8%, respectively. The 58 patients who underwent open surgery had a mean followup of 49.68 +/- 28.84 months. A total of 53 patients survived without any disease recurrence, 1 survived with recurrence within 8 months, 1 survived with metastasis within 49 months and 3 died of unrelated causes. The 5-year disease-free and patient survival rates for this group were 97.6% and 95.8%, respectively. Kaplan-Meier disease-free survival and patient survival analysis revealed no significant differences between the laparoscopic and open partial nephrectomy groups. CONCLUSIONS: Laparoscopic partial nephrectomy is an alternative technique with mid-range oncological results comparable to open partial nephrectomy in patients with localized pathological stage T1N0M0 renal cell carcinoma.     

Partial nephrectomy for renal cell carcinoma using a microwave tissue coagulator--postoperative recurrence and renal function

Nowadays, partial nephrectomy is often selected for treatment of small renal cell carcinoma (RCC) because T1a RCC shows a favorable prognosis with a 5-year overall-survival rate exceeding 90%. To determine the methodological usefulness and treatment outcome of partial nephrectomy using microwave tissue coagulator (MTC), we evaluated our series of 121 patients (124 kidneys) with T1 RCC who underwent this procedure. Ninety-nine patients were elective and 22 patients were imperative cases. This procedure was indicated for asymptomatic solitary RCC; < or =4 cm in diameter in elective cases or < or =5 cm in imperative cases, expanding outward with a clear capsule, and showing neither renal pelvis nor renal sinus invasion. The median operation time was 150 minutes and the median blood loss was 217 ml. Eight patients needed transfusion, and conservative therapy cured 4 patients of postoperative urine leakage successfully. Three patients underwent early secondary nephrectomy due to multiple RCCs, invasive spindle cell carcinoma, or prolongation of urine leakage. No significant deterioration of renal function by creatinine clearance (Ccr) was observed, and postoperative Ccr could be precisely predicted from preoperative serum creatinine value and the renal parenchymal volume estimated with 3-dimensinal image reconstruction. Five-year overall-survival rate was 91% at the mean follow-up of up to 37.9 months and 107 patients were alive without disease. One patient showed local recurrence 2 years later and underwent radical nephrectomy. We believe that non-ischemic partial nephrectmy using MTC is a simple and reliable nephron-sparing surgery for small RCC in respect of postoperative recurrence and preservation of renal function.     

The incidence of hypopharyngeal stenosis after surgery for laryngeal cancer

Hypopharyngeal stenosis is a frequent complication of laryngectomy and radiotherapy in patients treated for carcinoma. In a retrospective study of patients treated in the University of Washington Affiliated Hospitals, hypopharyngeal stenosis was more frequent after laryngectomy with partial pharyngectomy than after laryngectomy alone and occurred more commonly in lesions of the pyriform fossa than in glottic tumors. Neck disease and inclusion of radical neck dissection were both significant factors in the development of hypopharyngeal stenosis. Recurrent tumor was significantly more prevalent in these patients.     

Laryngectomy alone for T3 glottic cancer

Background. The long-term survival of 81 patients with T3 squamous cell carcinoma of the glottic larynx treated with laryngectomy alone is presented and pathologic predictors for cancer recurrence above the clavicles and cancer death are identified. Methods. Clinical records, operative notes, and pathologic slides were reviewed. The major end points were failure above the clavicles, cause-specific survival, and overall survival. All patients were followed until death or a minimum of 10.8 years. Results. The main pattern of treatment failure was within an undissected ipsilateral or contralateral neck. Subglottic extension and nodal metastases predicted failure above the clavicles and delayed metastasis within an undissected neck. The 5-year rate of control of disease above the clavicles, cause-specific survival, and overall survival were 74.1%, 73.7%, and 54.3%, respectively. Conclusions. Patients treated with laryngectomy for T3 glottic cancer who have pathologic evidence of subglottic extension or nodal metastasis are at higher risk for recurrence above the clavicles, particularly within an undissected neck. © 1994 John Wiley & Sons, Inc.     

Supracricoid partial laryngectomy as salvage surgery after radiation failure

BACKGROUND: Radiotherapy is often chosen as the definitive treatment for early stage laryngeal carcinoma. Total laryngectomy is the main procedure for failures. Endoscopic treatment of recurrences by CO(2) laser has found limited application. Partial laryngectomy through an external approach has been proposed as salvage surgery, and the vertical partial laryngectomy (VPL) is the most mentioned surgical technique in the literature, although there are, to date, very few reports regarding the use of the supracricoid partial laryngectomy (SCPL) as salvage surgery after radiation failure. OBJECTIVES: The aim of the study is to check the feasibility of SCPL with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) in patients with laryngeal recurrence after radiation failure and to evaluate the oncologic results, morbidity, and functional outcome. METHODS: Fifteen consecutive patients were treated with salvage intent by SCPL from January 1992 to December 1998. CHEP and CHP were performed in 11 and 4 patients, respectively. Five patients underwent homolateral surgical neck dissection, and one underwent bilateral neck dissection. All patients had a temporary tracheostomy, and two patients required percutaneous endoscopic gastrostomy (PEG) to ensure feeding. Functional rehabilitation started 2 weeks after the operation. RESULTS: The results have been evaluated in terms of oncologic outcome and functional preservation. Twelve patients are alive with a minimum follow-up of 36 months and 3 patients died after 36 days, 6 and 14 months after surgery, the first and second patient from heart failure and the third from lung metastasis. Respiratory function was recovered in all cases. Oral intake began 12 days after surgery, and in 14 cases satisfactory swallowing was recovered 30 days after surgery. An acceptable quality of the voice was achieved by most patients, and a high rate of local immediate complications was solved in all cases. CONCLUSIONS: SCPL represents an effective technique as salvage treatment of laryngeal cancer after exclusive radiotherapy; there is a good functional recovery with acceptable morbidity and good oncologic long-term control.