Voice, swallowing, and quality of life after total laryngectomy: results of the west of Scotland laryngectomy audit

Background

The purpose of this study was to determine the effects of radiotherapy and surgical voice restoration on functional outcome after total laryngectomy.

Methods

Questionnaire packs were posted to all 258 laryngectomy patients in the West of Scotland Managed Clinical Network. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW‐QOL).

Results

Significantly better VoiSS and MDADI scores were reported by patients undergoing laryngectomy alone in comparison with patients receiving adjuvant radiotherapy and patients undergoing salvage laryngectomy (p < .02). Patients using tracheoesophageal voice reported significantly better VoiSS scores than patients using other communication methods (p < .005).

Conclusion

Radiotherapy has a highly significant and detrimental effect on voice and swallowing outcome after total laryngectomy. Surgical voice restoration confers significant benefit in terms of self‐reported voice outcome. These findings have implications for patients with advanced laryngeal cancer considering laryngectomy and organ preservation. © 2011 Wiley Periodicals, Inc. Head Neck, 2012     

Functional analysis of swallowing outcomes after supracricoid partial laryngectomy

BACKGROUND: In this study, we analyzed swallowing recovery after supracricoid partial laryngectomy (SCPL). METHODS: We retrospectively reviewed 27 patients treated with SCPL (September 1997 to March 2005). We evaluated recovery course, nutritional outcomes, and swallowing using objective analysis. Modified barium swallow (MBS) study results identified swallowing physiology and therapeutic effectiveness. RESULTS: Average length of hospitalization was 7.7+/-9.2 days; time to decannulation was 5.3+/-8.2 weeks. The most common complications included pneumonia and subcutaneous emphysema (26%). Twenty-two patients had MBS studies, in which initially, all patients aspirated due to neoglottic incompetency, and impaired base of tongue and laryngeal movements. Although aspiration rates did not change significantly over time, use of appropriately selected swallowing strategies effectively protected the airway (p= .0365). Ultimately, 81% of patients returned to complete oral intake with median tube removal at 9.4 weeks. CONCLUSION: SCPL produces severe dysphagia initially. Our findings suggest that objective swallowing assessment is important for return to oral nutrition after SCPL.     

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.     

Salvage with supracricoid partial laryngectomy after radiation failure

BACKGROUND: Supracricoid partial laryngectomy (SCPL) is an alternative to total laryngectomy (TL) for selected glottic and supraglottic carcinomas but its role in the setting of radiation failure is unclear. The aim of the present study was to present a series of patients with laryngeal cancer undergoing salvage surgery for local recurrence and examine the morbidity associated with this intervention. METHODS: A retrospective review of 111 patients presenting with laryngeal cancer between 1997 and 2002 was performed. A total of 21 patients with recurrent disease following radiation therapy were identified, of which salvage surgery was performed in 18 patients. Minimum follow up of survivors was 22 months. RESULTS: The 5-year cumulative local control and disease-specific survival was 76% and 85%, respectively. Surgical salvage consisted of TL in 12 patients and SCPL in six. The mortality and major morbidity rates for TL were 0% and 33%, and for SCPL they were 33% and 50%, respectively. Median length of hospital stay was similar in both groups (21 and 19 days). No patient undergoing SCPL developed recurrent disease at a median follow up of 19 months. CONCLUSIONS: Supracricoid partial laryngectomy is an oncologically sound alternative to TL as salvage for radiation failure. The operative morbidity and potential for mortality is high in this setting.     

Supratracheal partial laryngectomy with tracheohyoidoepiglottopexy (open partial horizontal laryngectomy type IIIa + cricoarytenoid unit): Surgical technique illustrated in the anatomy laboratory

The first supratracheal partial laryngectomy (STPL) with tracheohyoidoepiglottopexy was performed in 1972. This procedure entailed preservation of the suprahyoid epiglottis as well as a pexy of the hyoid bone and residual epiglottis to the first tracheal ring; however, this technique was abandoned by the same author in the early 1980s because of poor functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 39: 392–398, 2017     

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Surgical technique illustrated in the anatomy laboratory

Background.Methods.Results.Conclusion. © 2014 Wiley Periodicals, Inc. Head Neck 37: 906–908, 2015     

Management of swallowing in supraglottic and extended supraglottic laryngectomy patients.

BACKGROUND: Aspiration of food and liquid following supraglottic and supracricoid laryngectomy has been documented and found to be the most frequent major postoperative complication that extends hospitalization. The advantages as well as disadvantages of discharging a patient with percutaneous endoscopic gastrostomy (PEG) placement and home therapy versus an aggressive in-hospital dysphagia management program remain controversial. The present investigation examines an aggressive in-patient postoperative dysphagia management program following decannulation. METHODS: Twenty-one patients participated in a four-part dysphagia management program following decannulation: patient education, indirect therapy, swallowing evaluation, and nutrition education. RESULTS: Eleven patients achieved functional swallowing goals prior to discharge with no reports of pneumonia or rehospitalization over a 3-month follow-up period. Six patients were discharged with a tracheostomy and duo tube; five of these patients were started on an oral diet the same day of decannulation. Four patients decannulated prior to discharge did not achieve functional swallowing. CONCLUSION: Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in-home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non-compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery.     

Improving the functional outcome of Tucker's reconstructive laryngectomy

BACKGROUND: The goal of reconstructive laryngectomy addressing glottic carcinoma, as described by Tucker, is twofold: achieve local control and preserve as much as possible the physiological laryngeal function. METHODS: The study consisted of long-term assessment of oncological, deglutitory, and vocal outcome in 34 patients following Tucker's reconstructive laryngectomy. Postoperative follow-up included fiberscopic examination, videoradiography, and voice assessment after speech rehabilitation. RESULTS: The 5-year overall survival rate was 92% +/- 5%. Fiberscopic examination and videoradiography contributed to observing and understanding the rehabilitation process and impairment to its progress. Two main compensatory movements were identified: the anticipatory backward movement of the tongue base (50%) and the anticipatory upward laryngeal motion (15%). Both movements occurred simultaneously at the beginning of the pharyngeal stage of the swallow (35%). The median duration prior to tracheostomy tube removal was 14 days. Swallowing of solids resumed on day 9 (median), and liquid intake (water and soup) resumed on day 12 (median). The median duration of hospitalization was 16 days. Following speech rehabilitation, the latest follow-up visit measured as follows: the mean conversational voice intensity at 64 dB (range, 57-79 dB); the mean maximum intensity at 87 dB (range, 78-96 dB); the minimum intensity at 54 dB (range, 45-65 dB); the mean maximum phonation time at 16 seconds (range, 10-29 seconds); and the mean phonation quotient at 284 mL/second (range, 205-341 mL/second). According to our classification, voice spectral analysis revealed 19 class-III patients, 12 class-II patients, and three class-I patients. CONCLUSION: Tucker's reconstructive laryngectomy is reliable in terms of both the oncological and functional outcome. Fiberscopic examination and videoradiography are two complementary methods for assessing postoperative deglutition.     

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     

无喉患者食管语康复训练现状及影响因素调查

目的 了解无喉患者食管语康复训练现状及影响因素,为开展针对性干预提供参考。 方法 应用喉癌患者语音康复训练现状调查问卷对93例喉癌行全喉切除术后的无喉患者进行调查。 结果 患者语言康复总分为43.48±10.34;不同家庭月收入、手术医院级别、手术时间、发声训练时长及吸烟与否患者语音康复得分差异有统计学意义（P＜0.05,P＜0.01）;发声训练时长是其主要影响因素（P＜0.01）。 结论 无喉患者食管语康复训练水平亟待提高,对患者进行食管语康复训练应持续1年以上,以提高训练效果,从而提高患者生活质量。     

Supracricoid partial laryngectomies after radiation failure: a multi-institutional series

BACKGROUND: Radiation therapy (RT) is one of the gold standard treatments for early laryngeal cancer, and total laryngectomy is still the most applied surgical procedure after failure. Selected recurrences can be managed by supracricoid partial laryngectomies (SCPLs). METHODS: A multi-institutional retrospective analysis was carried out in 78 consecutive patients treated by SCPLs for the recurrence of glottic-supraglottic cancer after RT. Cricohyoidoepiglottopexy was performed in 62, and cricohyoidopexy (CHP) in 16 cases. RESULTS: Disease-free survival at 3 and 5 years were 95.5%. Early and late postoperative complications occurred in 27% and 17.9% of cases. Decannulation and satisfactory swallowing were achieved in 97.4% of cases. CONCLUSIONS: SCPLs represent effective surgical organ-preservation strategies in the treatment of selected recurrences after RT failure, resulting in a good local control as well as functional recovery with acceptable morbidity, despite a complication rate which is not negligible.