伴有声带运动障碍的下咽癌手术

目的 探讨手术治疗伴有声带运动障碍下咽癌患者喉功能保留的可能性.方法 回顾性分析手术治疗伴有声带运动障碍的下咽癌26例患者的临床资料,其中梨状窝内侧壁癌23例,前壁癌2例,环后癌1例;T220例,T3 4例,T42例.全部患者均行梨状窝切除+喉部分切除术,切缘术中冰冻病理检查.残留下咽黏膜缝合修复5例,会厌复合组织瓣转移修复21例,术后均给予放射治疗.结果 全部患者3、5年生存率分别为61.4%、50.8%,喉功能全部恢复者(发音、呼吸及存咽保护功能)20例(76.9%),喉功能部分恢复者(发音及吞咽保护功能)6例(23.1%).结论 对伴有声带运动障碍的下咽癌患者,经过选择可行保留喉功能手术,以提高患者的生活质量.

Abstract：

Objective To explore the feasibility of laryngeal function preservation in surgical treatment of hypopharyngeal carcinoma with restrained vocal cord motility. Methods Twenty-six cases of hypopharyngeal carcinoma with restrained vocal cord motility treated with conservative hypopharyngectomy were retrospectively analyzed. Partial resection of pyriform sinus and partial laryngectomy were performed.The hypopharyngeal wounds were repaired by remaining hypopharyngeal mucosa in 5 cases and by epiglottis complex flaps in 21 cases. All patients received postoperative radiotherapies. Results The overall 3- and 5-year survival rates were 61.4% and 50. 8% respectively. Laryngeal functions ( voice, respiration and deglutition) were completely restored in 20 cases (76. 9% ) and partial laryngeal functions (voice and deglutition) were restored in 6 cases (23. 1% ). Conclusions To improve the postoperative life quality of the patients, the preservative surgery is feasible for some selected cases of hypopharyngeal carcinoma with restrained vocal cord motility.     

Subtotal pharyngolaryngectomy conservation surgery for carcinoma of sinus pyriformis extending toward the larynx.

In newly developed surgery for pyriform sinus tumor extending toward the larynx, the supraglottic portion of the larynx and the vertical half of the larynx on the tumor side are included in the area of resection. The arytenoid and cricoid cartilages on the tumor side and the vertical half of the hypopharyngeal wall are resected. Three out of seven patients remain cured at the end of 5 years and this ratio is the same as that for total pharyngolaryngectomy for pyriform sinus tumor. The resulting voice is somewhat hoarse, however, verbal communication is not remarkably affected. It is concluded that in surgical repair for pyriform sinus tumor extending toward the larynx, subtotal pharyngolaryngectomy is the procedure of choice to preserve the laryngeal function and anticipate reasonable prospects for a cure.     

Transoral videolaryngoscopic surgery for laryngeal and hypopharyngeal cancer — Technical updates and long-term results

ObjectiveTransoral videolaryngoscopic surgery (TOVS) was developed as a non-robotic procedure for en bloc laryngo-hypopharyngeal cancer resection. Straight devices had been used for this procedure, however, some cases had difficulty to reach the lesions especially in hypopharyngeal area. To overcome this problem, technical updates to facilitate transoral manipulation were developed and long term oncological and functional results were analyzed.MethodsSurgical indications were Tis, T1, T2 and selected T3 cases. In advanced T3 or T4 lesions, neoadjuvant chemotherapy was performed before surgery. Radiation failure cases (rT1 and rT2) were also indicated for TOVS. Resectable nodal involvement can be managed by combination of neck dissection. Ninety hypopharyngeal and 25 supraglottic cancer cases were retrospectively reviewed for survival analyses. In fresh hypopharyngeal cancer, 51 Stage 0–II disease and 32 Stage III-IV disease were included. In supraglottic cancer, 11 Stage I–II disease and 9 Stage III-IV disease were included. Twelve radiation failure cases were analyzed separately. As new devices, malleable forceps and malleable suction coagulator were introduced to reach the whole laryngo-hypopharynx. New curved blades for the FKWO retractor were developed and these were applied for difficult hypopharyngeal exposure cases by conventional blades. Swallowing functional outcome and risk factors for postoperative dysphagia were evaluated by univariate analysis.ResultsThe 5-year overall survival, disease-specific survival and larynx preservation rate of fresh hypopharyngeal cancer cases were 83.2%, 94.3% and 94.6%, respectively. Those of supraglottic cancer cases were 80%, 95% and 94.7%, respectively. Those of salvage cases were 87.5%, 87.5% and 82.5%, respectively. Those of T3 and T4 hypopharyngeal cancer treated by neoadjuvant chemotherapy with TOVS were 75.0%, 82.5% and 100% respectively.Surgical complication included bleeding (2.6%) and emergency tracheostomy (3.4%). Oral intake was maintained in 94.8% cases. By univariate analysis, patient’s age (especially 80 years of age or older), larger resected area, arytenoid resection and tracheostomy were regarded as risk factors for postoperative dysphagia.Among 31 recent cases, 5 cases had difficulty in exposing hypopharyngeal lesions by conventional blades. These exposure problems were solved by curved blades.ConclusionUsing malleable devices and new curved blades for the FKWO retractor, exposure problems in the hypopharynx could be solved and TOVS could be applied in more cases. Although oncological outcomes and functional outcomes were good, patients with risk factors for dysphagia should be carefully indicated.     

Voice and swallowing after total laryngectomy

Background: Voice and swallowing problems are often seen in patients with advanced larynx cancer, after total laryngectomy (TL) and chemo/radiotherapy.

The aim of this study was to determine the occurrence of voice and swallowing problems in patients who have been laryngectomised and investigate if these symptoms were related to age, time after TL, radiotherapy and TNM-classification. In addition, we studied how often the patients changed their voice prostheses and the need of therapeutic interventions after TL.

Methods: Forty-five patients were included in the study and completed the Swedish version of the Sydney Swallow Questionnaire and the Voice Handicap Index-T.

Results: Swallowing problems were reported by 89% of the patients and moderate-to-severe voice handicap was reported by 66%. Most of the subjects who had dysphagia also presented voice problems (r_s?=?0.67 p?≤?.01). Additional therapeutic interventions to manage problems with voice and/or swallowing after TL were required in 62% of the patients.

Conclusions: Swallowing and voice problems after TL are common. Thus, the preoperative information and assessment of these functions, as well as the treatment and the post-operative rehabilitation should be evaluated and optimised to provide better functional results after treatment of advanced larynx cancer.     

Indication and surgical technique for extended hemilaryngectomy

Previous experience has shown that conservation of the healthy hemilarynx is possible for the treatment of extended lateralized laryngeal and hypopharyngeal cancers. One major indication for supracricoid hemilaryngectomy is glottic cancer involving either the arytenoid or Morgagni’s ventricle. Hemilaryngopharyngectomy is also indicated when tumor of the pyriform sinus involves its anterior part, lateral wall, medial wall and ary- and pharyngoepiglottic folds. Supracricoid hemilaryngopharyngectomy was performed in seven cases. The resection consisted of removal of the surpacricoid hemilarynx and ipsilateral pyriform sinus. The reconstruction was performed by elevating the posterior pharyngeal wall and suturing the mucosa to the midline. This surgical technique provided good functional results. Patients had no airway impairments, but the recovery of satisfactory deglutition may require 14–32 days. Phonatory rehabilitation was successful, and each patient had a satisfactory vocal quality. Postoperative irradiation did not affect the functional results. Received: 26 September 1998 / Accepted: 23 March 1999     

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as predictors of wound healing failure in head and neck reconstruction

Conclusions: In microsurgical head and neck reconstruction, a higher rate of post-operative wound complication could be predicted by a lower pre-operative neutrophil ratio (Objectives: To evaluate the predictor of post-operative wound complications in microsurgical head and neck reconstruction.

Methods: Patients who were undergoing tumor ablation and microsurgical reconstruction from April 2011 to March 2014 were analyzed retrospectively. The pre-operative hematological data, age, sex, co-morbidities, body mass index (BMI), adjuvant therapies, smoking, operation time, blood loss, total protein, T-stage, and Anesthesiologists Performance Status (ASA-PS) score were collected. Cases of post-operative wound healing failure were reviewed.

Results: One hundred and three consecutive patients were enrolled. Among these, the results of 77 patients who were younger than 70 years of age were analyzed. The distributions of the neutrophil ratio (p?=?.0005), lymphocyte ratio (p?=?.0166), monocyte ratio (p?=?.0341), NLR (p?=?.005), and PLR (p?=?.008) differed significantly between the patients with and without post-operative wound healing failure. Neutrophil ratio, NLR, and PLR cut-off values of 64.9, 3.5, and 160 were significantly associated with the rate of wound healing failure rate (p?=?.0002, .00021, .0042, respectively).     

Scar contracture prevention with local steroid injections in transoral videolaryngoscopic surgery

ObjectiveThe aim of this study was to evaluate the efficacy and safety of local steroid injections to prevent scar contracture after transoral videolaryngoscopic surgery (TOVS) in hypopharyngeal cancer patients.MethodsPatients were enrolled in this study if they had received a local steroid injection during TOVS and had attended an outpatient clinic after at least three months. All patients were being treated for hypopharyngeal cancer and received a single session of triamcinolone acetonide, injected using a 21-gage needle. Retrospective chart reviews were performed, and the degree of scar contracture, pharyngeal stenosis, vocal fold movements, and adverse events were evaluated. Scar contracture was assessed using a scoring system, which compared the endoscopic findings of treatment and matched pair control groups.ResultsA total of 20 patients received local steroid injections during TOVS and were enrolled in the treatment. Scar contracture was seen in 14 patients (70%); however, the degree of scar contracture was significantly decreased when compared to control cases. Vocal fold immobility was observed in five patients, but no pharyngeal stenosis was noted. Adverse effects, such as postoperative laryngeal chondritis or cervical spondylitis, were seen in three patients who had previously been treated with resection to the muscularis propria or definitive irradiation.ConclusionLocal steroid injection during TOVS significantly reduced the degree of postoperative scar contracture. However, caution should be used when treating with local steroid injection during TOVS, as this may complicate wound healing in patients who have already received treatment.     

梨状窝内侧壁癌切除与喉功能保留

目的 探讨梨状窝内侧壁癌切除喉功能保留犬的技术方法和临床疗效。方法 回顾分析手术治疗的梨状窝内侧壁癌71例。其中49例行喉功能保留术;22例未保存喉功能。喉功能保留手术方法：①切除范围：声带活动正常者行患侧水平上半喉＋梨状窝内侧壁切除;声带活动受限者行同侧水平半喉＋声门旁间隙＋梨状窝内侧壁切除;声带固定者行患侧垂直半喉＋梨状窝内侧壁和部分梨状窝外侧壁切除,梨状窝尖受累者切除范围扩大到环状软骨环和颈段食管;②修复:喉修复对利用会厌、甲状软骨膜、带状肌肌筋膜、颈前皮瓣修复喉缺损;梨状窝修复对缺损范围小者用下咽粘膜瓣或残缘粘膜后直接讨合,对缺损范围大者用胸大肌肌皮瓣转移及胸三角皮瓣修复;③颈淋巴结处理：71例中65例（91．5％）行颈清扫术,其中同侧颈清扫术39例,双侧颈清扫术26例;④术后全部病例予以辅助放射性治疗,剂量60－75Gy。结果 寿命表法统计3年、5年生存率：喉功能保留组分别为63．4％和49．6％;喉功能不保留组分别为52．4％和42．4％。喉功能保留组喉功能全部恢复者占71．4％（35／49）,部分恢复者占28．6％（14／49）。结论 梨状窝内侧壁癌易侵入喉部,但多数病例在彻底切除肿瘤病灶的前提下保留喉功能是可行的。     

Results of conservation surgery for cancers of the supraglottis and pyriform sinus

A retrospective review of patients treated by surgery and/or radiation for carcinoma of the supraglottic larynx and the pyriform sinus was accomplished for the period 1964-1974. This patient population reflects the 10-year period following earlier experience with conservation surgery at this institution, and, thus, updates the current status of treatment for these cancers. Endpoints examined included survival, control, pattern of failure, the influence of nodal metastasis, and voice preservation. Of 160 patients treated for supraglottic laryngeal carcinoma, 119 received conservation surgery (subtotal supraglottic laryngectomy, SSL, or partial laryngopharyngectomy, PLP); 21 patients received total laryngectomy; and 20 others received palliative radiation. The 3-year actuarial survivals for these groups were 67%, 43% and 30%, respectively. Voice was preserved in 85% of the patients treated by conservation surgery, in 70% of those treated by radiation alone, and, of course, in none of the patients receiving total laryngectomy. There were 175 patients treated for carcinoma of the pyriform sinus; 85 received PLP; 57, total laryngopharyngectomy (TLP); and 33, palliative radiation. Actuarial 3-year survival was 59% for the PLP-treated group, 36% for the TLP-treated group and 11% for the palliation group. Voice was preserved in 52% of the patients treated by conservation surgery, in 6% of those treated by radiation alone, and in none of those patients treated by total laryngectomy. Comparison of this data with that in other published reports indicates that, for selected patients, conservation surgery is as effective in controlling disease as is radical surgery. Furthermore, it is possible to preserve speaking ability in a significant number of patients having carcinoma of the supraglottic larynx or pyriform sinus.     

Supracricoid hemilaryngopharyngectomy in selected pyriform sinus carcinoma staged as T2

From 1964 to 1985 supracricoid hemilaryngo-pharyngectomy (SCHLP) was performed at the authors' institution for 34 selected pyriform sinus carcinomas staged as T2. Tumors involved the anterior part of the pyriform sinus, the lateral wall, the medial wall, and the whole aryepiglottic fold in all cases. Tumors with invasion of the apex of the pyriform sinus, of the retrocricoid region, of the posterior pharyngeal wall, or with fixation of the true vocal cord were excluded from the study. Such a technique was aimed at preserving physiologic phonation, respiration, and swallowing while achieving the same local control rate as pharyngolaryngectomy. Patients were monitored for at least 6 years or until death. No patients were lost to follow-up. The 5-year cause-specific survival rate was 55.8%. The main cause of death was second primary tumor. The 5-year actuarial local recurrence rate was 3.4%. The authors' experience with the SCHLP technique challenges the traditional teaching of pharyngolaryngectomy and establishes this technique as a safe method of voice preservation in selected cases of pyriform sinus carcinomas.     

Efficacy and toxicity profiles of two chemoradiotherapies for stage II laryngeal cancer – a comparison between late course accelerated hyperfractionation (LCAHF) and conventional fractionation (CF)

Objective: To evaluate the treatment results of late course accelerated hyperfractionation (LCAHF) compared with conventional fractionation (CF) for stage II laryngeal cancer.

Methods: Fifty-nine consecutive patients treated for stage II laryngeal cancer were retrospectively reviewed. Thirty-two patients underwent LCAHF, twice-daily fractions during the latter half with a total dose of 69?Gy. Twenty-seven patients received CF of 70?Gy.

Results: The local control rates (LCRs), overall survival (OS), and disease-specific survival (DSS) at 5 years were 80.6%, 74.0%, and 90.4%, respectively, after LCAHF and 64.7%, 68.2%, and 90.5%, respectively, after CF. There were no significant differences in LCR, OS, and DSS (p?=?.11, 0.68, and 0.69, respectively). In a small number of patients with supraglottic cancer, LCAHF was associated with a significantly higher LCR at 5 years compared with CF (100% vs. 41.7%; p?=?.02).

Conclusions: This is the first report that compared the results of LCAHF and CF for stage II laryngeal cancer. We could not find significant differences in LCR, DSS, and OS rates between LCAHF and CF groups. Although in a small number of patients with supraglottic cancer, LCAHF may improve the LCR compared with CF.     

The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy

Abstract

Background: Dysphagia is a complication following radiation therapy (RT) for head and neck cancers (HNC). Radiologic findings of posterior pharyngeal wall thickening (PPWT) after RT has not been quantified and correlated to swallowing outcomes.

Aims/objective: To evaluate PPWT and its impact on swallowing function following RT.

Material and methods: Retrospective analysis of pre- and three-month post-RT PPWT, demographics, oncologic history, and swallowing parameters of patients undergoing RT for HNC. Multivariate analysis of variance was performed to evaluate the effect of PPWT on swallowing outcomes.

Results: The mean age of the cohort (n?=?207) was 61.8 (± 11.29) years. The mean PPWT increased by 0.28 (± 0.19) cm (p?=?.00) three-months after RT. A significant difference in PPWT score between tumor subsites, χ²(2) = 45.883, p?=?.00, with the highest mean rank score of 135.97 for nasopharynx and 103.46 for oropharynx. PPWT was significantly associated with increased pyriform sinus retention, higher Penetration-Aspiration Scale (PAS) scores and post-deglutitive aspiration (p?<?.05).

Conclusions and significance: PPWT increase significantly after RT for HNC. Increased PPWT was associated with mean radiation dose to the nasopharynx and oropharynx and was an independent risk factor for increased pharyngeal residue, higher PAS scores, and timing of aspiration (p?<?.05).     

Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis

Injection laryngoplasty is one of the procedures for treating unilateral vocal fold paralysis. This is a preliminary report on modified injection laryngoplasty, ie, injection of liposuctioned autologous fat into the larynx and hypopharynx of patients who have aspiration and voice disorders after vocal fold paralysis. Lipoinjection was performed in 3 patients with these complaints with the endolaryngeal microsurgical technique under general anesthesia. The locations of fat injection were the vocal fold, the false vocal fold, the aryepiglottic fold of the larynx, and the medial wall of the pyriform sinus of the hypopharynx. Lipoinjection into the vocal fold, false vocal fold, and aryepiglottic fold strengthened laryngeal closure. Lipoinjection, performed into the thyroarytenoid muscle lateral to the oblong fovea of the arytenoid cartilage, made arytenoid cartilage rotation possible, and consequently strengthened laryngeal closure. Lipoinjection into the medial wall of the pyriform sinus of the hypopharynx reduced its capacity; consequently, the amount of residual food retained in it was reduced and pharyngeal clearance on the affected side was improved. The longest follow-up among the 3 patients has been 24 months. Their aspiration and glottal incompetence have been improved by this operation. We conclude that modified injection laryngoplasty (laryngohypopharyngoplasty) is one of the surgical options for preventing aspiration after vocal fold paralysis.     

Bipolar dissection technique in parotid gland surgery

Background: Parotid gland surgery (PGS) has to manage the balancing act between sufficient radicality and preservation of functional structures. While many studies evaluate post-therapeutic complication due to different extent of surgery, the current study introduces bipolar dissection (BP) being a fast and safe preparation technique.

Methods: Analysis of clinical parameters (age, sex, tumour entity, treatment modalities, facial nerve palsy, bleeding, saliva fistula and Frey’s syndrome) of 319 consecutively included patients who underwent extracapsular dissection and superficial/total/radical parotidectomy. Subgroup analysis was done according to the preparation technique (cold vs BP).

Results: Facial nerve palsy rate increased with the extent of PGS (p?p?=?.04), postoperative bleeding (p?=?.001) and salivary fistula (p?=?.045) when compared with cold preparation.

Conclusions: Ubiquitous available BP allows fast and safe PGS regardless its extent.     

“End to Side Technique”: More organ preservation with less morbidity in patients with pyriform sinus apex SCC

IntroductionHypopharyngeal squamous cell carcinoma (SCC) is rare, but highly aggressive. Due to the advanced stage of this cancer at the time of diagnosis, radical surgery with reconstruction of pharynx is the standard care with high morbidity and mortality rate. A safer partial pharyngectomy could also be used for invasive hypopharyngeal cancer. In this study, we investigated the short and long-term outcomes in patients with SCC of the pyriform sinus apex undergoing standard partial pharyngectomy using a new suturing technique, called end to side technique.MethodsThis case series was performed on 8 patients with SCC of the pyriform sinus apex at the otorhinolaryngology clinic. All participants underwent standard partial pharyngectomy using “end to side technique”. Post-operative evaluations included 6 and 12 months CT scan and 1-year barium swallow.ResultsOf 8 patients, 7 were male (87.5%) and 1 was female (12.5%) with a mean age of 60 years old. All patients were diagnosed at stage III of hypopharyngeal cancer and cervical lymph node involvement was reported in 3 patients (37.5%). Tumor margins were negative in all patients. Fistula was reported in 2 patients (25%) which was managed using conservative treatments.ConclusionsAccording to our study, the standard partial pharyngectomy with end to side technique is a safe and feasible method for the surgical resection of the squamous cell carcinoma of the pyriform sinus apex with good short-term and long-term outcomes.     

Concomitant diseases and their effect on disease prognosis in Meniere’s disease: diabetes mellitus identified as a negative prognostic factor

Objective: To study comorbidities and their effect on the disease progression in Meniere’s disease (MD).

Methods: Retrospective study on 350 definite MD patients diagnosed according to AAO-HNS 1995 criteria using hospital records and postal questionnaire.

Results: The prevalence of migraine, hypothyroidism, allergies, coronary heart disease and autoimmune diseases was more common in MD patients than reported in the general population of Finland. Diabetes mellitus was associated with both more severe hearing impairment (p?=?.033) and more frequent vertigo (p?=?.028) in MD patients. The number of concomitant diseases was associated with more frequent vertigo (p?=?.021).

Conclusions: A patient’s concomitant diseases, especially diabetes, should be treated effectively because they might affect the progression of MD. Further studies on the effects of concomitant diseases on MD prognosis are needed.     

Characteristics and prognosis of idiopathic sudden sensorineural hearing loss in aged people: a retrospective study

Abstract

Background: Few studies focused on the prognosis of sudden sensorineural hearing loss (ISSHL) of aged people.

Objectives: The aim of this study is to analyze the characteristics, treatment, and prognostic factors of ISSHL in aged people.

Material and methods: A total of 278 patients diagnosed of ISSHL in aged people from 2014 to 2019 were retrospectively analyzed. Univariates were analyzed by univariate and multivariate logistic analysis.

Results: Among the 13 univariates, the patients’ age was younger in the overall recovery group ORG (p?=?.018), while onset days was shorter in ORG (p?=?.000). The percentage of DM and HTN comorbidities were higher in ORG (p?=?.026 and .038). Meanwhile differences were significant in audiogram configurations (p?=?.037), the degree of hearing loss (p?=?.033), and types of lipid treatment (p?=?.020). Then these seven independent risk factors were included in the multivariate analysis, final results indicated that hypertension (p?=?.028), lipid control groups (p?=?.009), age (p?=?.000), and onset days (p?=?.001) were related to the treatment outcome of ISSHL.

Conclusions: The prognosis of ISSHL in aged patients was closely related to age, the onset days of treatment, and good control of complications such as hypertension and hyperlipidemia, so vascular factors were considered as the main causes of morbidity.     

喉外侵犯对声门上型喉癌部分喉切除术的影响

本文回顾分析了中国医学科学院肿瘤医院1979年至1990年168例声门上型喉癌行部分喉切除术患者的临床资料,研究了喉外侵犯对声门上型喉癌水平部分喉切除术的影响,发现舌根受侵切除部分舌根使水平部分喉切除术的拔管率由92.10％降为58.82％,梨状窝受侵者切除部分梨状窝使3/4部分喉切除术的拔管率由67.39％降为33.33％(P<0.05)。梨状窝内壁受侵组的生存率低于舌根受侵组(P<0.01)。因此,将声门上型喉癌梨状窝内壁受侵定为T_4病变更合适。结论:声门上型喉癌侵及舌根及梨状窝内壁时部分喉切除术后的拔管率降低,梨状窝内壁受侵时生存率也明显降低。     

Treatment and outcomes of endoscopic surgery and traditional open resection in sinonasal mucosal melanoma

Objective: The optimal surgical approach for sinonasal mucosal melanoma (SNM) remains under debate. We aimed to compare the therapeutic efficacy of traditional open resection and endoscopic surgery for patients with SNM treated at a single center.

Methods: Thirty-three patients diagnosed with SNM who underwent surgery between January 1995 and June 2014 at a single institution were retrospectively analyzed; 18 patients were treated using an open resection approach and 15 using an endoscopic resection approach for the primary tumor. The associations between open resection and endoscopic resection with treatment-related survival outcomes were assessed using the Kaplan–Meier method and log-rank test.

Results: The most common presenting symptoms were epistaxis and abstraction; the nasal cavity was the most common anatomic location. The open resection and endoscopic resection groups did not have significantly different demographic or tumor characteristics. Overall survival (p?=?.66) and disease-free survival (p?=?.73) were modest and did not differ significantly between the open resection and endoscopic resection groups.

Conclusions: This retrospective study indicates that the endoscopic endonasal approach is an effective treatment for SNM in selected cases and, when performed by a skilled surgeon, can enable successful radical resection with a similar efficacy as traditional open resection.     

Oncologic and functional outcomes of salvage supracricoid partial laryngectomy

Abstract

Background: Supracricoid partial laryngectomy (SCL) can have a positive impact on patients’ quality of life by circumventing dysphagia and voice problems resulting from creation of a permanent stoma after conventional total laryngectomy (TL) surgery.

Aims/Objectives: The aim of this study was to investigate the oncologic and functional outcomes of salvage SCL for recurrent laryngeal carcinoma.

Material and methods: Forty-five patients that underwent salvage surgery for recurrent laryngeal carcinoma between January 2004 and May 2015 after initial treatment failure were included in this retrospective study.

Results: Overall survival and disease free survival were non-significantly higher in the salvage SCL group (n?=?14) than in the salvage TL group (n?=?31) (87.5 versus 56.5%, 53.4 versus 41.9%). Multivariate analyses showed only positive resection margin to be significantly associated with survival and recurrence (HR 9.974, p?=?.007, and HR 9.196, p?=?.002, respectively). In the salvage SCL group, 92.8% achieved successful decannulation and all patients returned to an oral diet. All patients in the salvage TL group sustained a permanent stoma and conversation was possible only through esophageal voice or a voice prosthesis. 74.2% of patients in the group were able to tolerate an oral diet.

Conclusions and significance: Salvage SCL showed comparable oncologic outcomes and favorable functional outcomes relative to the classic salvage TL. This study could provide a sufficient basis of SCL as salvage treatment for recurrent laryngeal carcinoma in selected patients.