Vocal function after transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancer

Abstract

Conclusion: The resection of the medial and lateral pyriform sinus was associated with post-operative voice impairment after TOVS. Scar contracture around the cricoarytenoid joint lead to arytenoid fixation toward lateral position, and this wound healing process caused insufficient glottis closure. Although oncological and functional outcomes of TOVS was satisfactory, surgeons should mention the risk of post-operative voice impairment in pre-operative counseling.

Objectives: Transoral surgery is a minimally invasive treatment option for hypopharyngeal and supraglottic cancer. Post-operative vocal function was satisfactory in most cases, but in some cases vocal cord was fixed and occasionally voice impairment persists.

Methods: Vocal function of 55 patients who underwent transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancers was evaluated by the GRBAS perceptive scale, aerodynamic tests and acoustic analyses, and the Voice Handicap Index questionnaire. The risk factors for voice impairment were identified.

Results: Voice impairment (G score ≧2) was found in 16 cases (29.1%). Univariate analysis revealed that the resection of medial and lateral pyriform sinus (p?=?.0018) and neck dissection (p?=?.0421) were associated with post-operative voice impairment. Multivariate analysis revealed that the resection of medial and lateral pyriform sinus (p?=?.0021) was associated with post-operative voice impairment.     

The role of partial laryngeal resection in current management of laryngeal cancer: a collective review

A spectrum of treatment plans and surgical procedures is available for management of early and moderately advanced laryngeal cancer. While the approach of chemotherapy and irradiation, or irradiation alone, followed by total laryngectomy for failure is often employed in practice by present day clinicians, the options of conventional conservation surgery (CCS), transoral endoscopic laser surgery (TLS) and supracricoid partial laryngectomy (SCPL) provide a wide choice of treatments that may help attain the goal of cure with preservation of laryngeal function and integrity of the airway. While CCS has been supplanted for many early-stage lesions by TLS and for more advanced stages by SCPL, centres throughout the world have reported favourable results with CCS, which is often modified to include resection of more extensive tumours than was previously possible. During the past decade a number of extended CCS procedures have been developed for management of glottic tumours involving both vocal cords and the anterior commissure, the paraglottic space and with vocal cord fixation, and for supraglottic tumours involving the glottis or hypopharynx. TLS has proved an effective, minimally invasive and functionally satisfactory procedure for management of suitable T1 and T2 glottic cancers, and stage I-III supraglottic cancers. The procedure may be effectively employed in combination with neck dissection and postoperative radiotherapy when necessary, particularly for moderately advanced supraglottic carcinomas. SCPL has proven effective in management of glottic and supraglottic cancers of all stages, even with involvement of paraglottic space and thyroid cartilage, provided at least one arytenoid unit can be preserved with clear margins. Invasion of cricoid cartilage is the most significant limitation for this procedure. All three surgical approaches have been employed for irradiation failure, but with greatly increased failure and complication rates compared with the results of treatment of non-irradiated patients. Thus a decision to treat laryngeal cancer initially with irradiation may preclude a satisfactory result from partial laryngectomy should radiation fail. The treatment of laryngeal cancer should be individualized according to the size and extent of the tumour, the age and physical condition of the patient, and the skill and experience of the surgeon with various treatment modalities and surgical procedures.     

喉癌患者喉部分切除术后的嗓音声学分析

目的 探讨喉癌患者喉部分切除术术式、喉功能重建方法与术后嗓音质量的关系。方法 采用Dr．Speech嗓音分析软件，对116例不同术式喉部分切除术患者分别于术后1、2年进行发声功能测试，对测得的基频微扰（jitter）、振幅微扰（shimmer）、标准化噪声能量（NNE）进行比较分析，判断受试者嗓音质量。结果 所测得的声学参数jitter、shimmer、NNE值，以喉声门上水平部分切除术组最低，嗓音质量相对最好（P〈0．01）；喉次全切除术组最高，嗓音质量相对最差（P〈0．01）。声带切除术组和声带癌激光切除术组与其它各组比较，其差异均有显著统计学意义（P〈0．05或0．01），但这两组间比较，差异无统计学意义。各组术后嗓音质量效果从好到差依次为：喉声门上水平部分切除术组、声带切除术组、声带癌激光切除术组、喉垂直部分切除术组、喉额侧部分切除术组、喉次全切除术组。结论 喉癌患者喉部分切除术后，发声功能的恢复与手术方式及重建方法密切相关，其中，喉声门上水平部分切除术组术后嗓音质量相对最佳，喉次全切除术组术后相对最差。     

The Role of Partial Laryngeal Resection in Current Management of Laryngeal Cancer: a Collective Review

A spectrum of treatment plans and surgical procedures is available for management of early and moderately advanced laryngeal cancer. While the approach of chemotherapy and irradiation, or irradiation alone, followed by total laryngectomy for failure is often employed in practice by present day clinicians, the options of conventional conservation surgery (CCS), transoral endoscopic laser surgery (TLS) and supracricoid partial laryngectomy (SCPL) provide a wide choice of treatments that may help attain the goal of cure with preservation of laryngeal function and integrity of the airway. While CCS has been supplanted for many early-stage lesions by TLS and for more advanced stages by SCPL, centres throughout the world have reported favourable results with CCS, which is often modified to include resection of more extensive tumours than was previously possible. During the past decade a number of extended CCS procedures have been developed for management of glottic tumours involving both vocal cords and the anterior commissure, the paraglottic space and with vocal cord fixation, and for supraglottic tumours involving the glottis or hypopharynx. TLS has proved an effective, minimally invasive and functionally satisfactory procedure for management of suitable T1 and T2 glottic cancers, and stage I-III supraglottic cancers. The procedure may be effectively employed in combination with neck dissection and postoperative radiotherapy when necessary, particularly for moderately advanced supraglottic carcinomas. SCPL has proven effective in management of glottic and supraglottic cancers of all stages, even with involvement of paraglottic space and thyroid cartilage, provided at least one arytenoid unit can be preserved with clear margins. Invasion of cricoid cartilage is the most significant limitation for this procedure. All three surgical approaches have been employed for irradiation failure, but with greatly increased failure and complication rates compared with the results of treatment of non-irradiated patients. Thus a decision to treat laryngeal cancer initially with irradiation may preclude a satisfactory result from partial laryngectomy should radiation fail. The treatment of laryngeal cancer should be individualized according to the size and extent of the tumour, the age and physical condition of the patient, and the skill and experience of the surgeon with various treatment modalities and surgical procedures.     

喉部分切除术后发音功能的微机检测分析

应用ＨＧＦ－Ｉ型喉发音微机分析系统对２８例不同术式喉部分切除术后患者的发音功能进行了观察和分析，结果显示各患者间的发音部位及发音功能差异有显著性，发音功能与发音部位密切相关，“新声带”形成的患者和水平半喉切除术的患者发音功能接近正常人；声门上结构参与发音者和发音管发音者发音功能明显受损，声波曲线周期不明显，频谱曲线噪音水平高，共振峰出现蜂族现象。此微机系统包括频谱分析、自相关、互相关分析和声图，可用于喉部分切除术后发音功能的研究。     

胸舌骨肌瓣或舌骨-胸舌骨肌瓣用于垂直喉部分切除术后声带重建

目的：探讨垂直喉部分切除术后改善发声，恢复喉功能的修复手段，以提高喉癌患者术后的生存质量。方法：垂直喉部分切除术后，用患侧甲状软骨外膜修复上半喉腔缺损，取健侧胸舌骨肌瓣（或舌骨－胸舌骨肌瓣）修复下半喉腔缺损并重建声带。结果：修复的新喉腔呈三角形，重建的声带具有一定的张力并参与发声，恰似一侧居于正中位麻痹的声带，发声时由健侧声带代偿运动与新声带前2／3相互靠近。93．4％的患者发声近乎正常或自觉发声质量较术前明显好转。结论：垂直喉部分切除术后采用患侧甲状软骨外膜和健侧胸舌骨肌瓣（或舌骨－胸舌骨肌瓣）修复缺损并重建声带，方法简单，取材方便，创伤小，效果满意，可作为垂直喉部分切除术后声带重建的首选方法。     

Results of treatment of 584 laryngeal cancers at the Ear-Nose-Throat Clinic of Marburg University

The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.     

喉部分切除术后不同声源振动模式转换与代偿研究

目的研究喉部分切除术后喉的振动源变化及声带振动模式的代偿、转归,以探讨嗓音功能保留情况. 方法研究93例喉部分切除术患者(28例水平喉部分切除、35例垂直喉部分切除、30例3/4喉部分切除)及50例健康对照者不同嗓音声学、气流动力学及频闪喉镜下喉功能特点. 结果水平喉部分切除术后声带对称、表层肥厚,粘膜波活跃,嗓音声学参数与正常差异有显著性(P<0.05).垂直喉部分切除患者为非声门源振动发音,新振动体为健侧室带与对侧修复肌瓣或修复肌瓣与喉前庭粘膜(杓区、会厌根粘膜)振动发音,健侧声带未参与,嗓音声学参数与正常差异有极显著性(P<0.01).3/4喉部分切除后为部分非声门源振动发音,代偿振动模式为修复肌瓣与健侧声带振动发音和修复肌瓣与健侧杓区肥厚粘膜形成振动体颤动发音2种,嗓音声学参数与正常差异有显著性(P<0.01).3/4喉部分切除与垂直喉部分切除比较后者嗓音声学参数略差,但无统计学意义. 结论在喉部分切除术中,水平喉部分切除术后嗓音功能最佳,而垂直喉部分切除术后最差;修复体形态、功能特性直接影响术后效果.手术修复过程应充分利用机体的代偿功能,使术后声音质量有所提高.     

Oncological outcomes of surgical treatment for T3 supraglottic laryngeal squamous cell carcinoma patients

Abstract

Background: T3 supraglottic laryngeal carcinoma (LC) is a common advanced laryngeal cancer.

Objective: This study was conducted to assess the clinical results of pathological T3 (pT3) supraglottic LC patients who were amenable to laryngectomy treated with primary surgery and postoperative therapy.

Methods: Retrospective review of 202 pT3 cases of supraglottic laryngeal squamous cell carcinoma.

Results: The five-year cancer specific survival (CSS) rate was 63.7% and the overall survival rate (OS) was 62.8%. For T3 supraglottic patients who underwent total laryngectomy, the five-year disease-free survival (DFS) was 51.8%, and the CSS was 62.5%. For patients who underwent partial laryngectomy, the five-year DFS was 72.2%, and the CSS was 79.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in the DFS and CSS rates between patients with negative margins and those with positive margins following postoperative radiotherapy and chemotherapy.

Conclusion: Surgical treatment of T3 supraglottic LC patients achieved satisfactory results. Postoperative radiotherapy and chemotherapy are an effective method of treatment for T3 supraglottic LC patients, especially for those with a positive margin.     

Study on vibration mode of different phonatory source and compensation after partial laryngectomy]

OBJECTIVE: To investigate the nature of pathological voice production and compensatory mechanism after partial laryngectomy. METHODS: Vocal function of 93 cases following partial laryngectomy (28 cases of horizontal partial laryngectomy, 35 vertical partial laryngectomy, 30 horizontal-vertical partial laryngectomy) were examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination. RESULTS: Horizontal supraglottic laryngectomy(HL) resulted in slight dysphonia after operation. The cover of vocal fold was hypertrophic and edematous. Mucosa wave was increased. Acoustic analysis showed significant difference between normal and horizontal laryngectomy groups(P < 0.05). Vertical laryngectomy(VL) resulted in moderate-severe dysphonia. Acoustic analysis was significantly worse in VL than in normal group(P < 0.01). The nonglottic phonatory source was the contralateral ventricular fold or contralateral vestibular mucosa (arytenoid mucosa, root mucosa of glottis) to approximate the reconstructed flap. It was noted that contralateral vocal fold did not participate in vibration. Horizontal-vertical partial laryngectomy (HVL) resulted in moderate-severe dysphonia. Acoustic analysis of HVL was significantly worse than that of normal phonation(P < 0.01). The site of compensatory mucosa vibration upon phonation was the contralateral vocal fold or contralateral hypertrophic arytenoid mucosa. The thinner the flap, the better the vocal quality was. Vocal quality of VL was worse than that of HVL in regard to shimmer, jitter, normalized noise energy, maximal phonation time and harmonic-noise ratio, but there was no significant difference between them. CONCLUSIONS: Partial laryngectomy has different vibrating compensatory modes: Voice function of horizontal partial laryngectomy was the best as it preserved the normal vibration mode; vertical partial laryngectomy was the worst with the nonglottic vibrating source of reconstructed flap-ventricular fold. The reconstructed flap, ventricular fold, mucosa of epiglottis and arytenoid take predominantly part in neoglottal vibration. The situation, volume and pliability characteristic of reconstructed flap was also important to vocal quality.     

Early vocal cord carcinoma in obese patients: A surgical lesion

Early epidermoid carcinoma of the vocal cord is treated successfully by radiation therapy with high 5-year survival rates, low morbidity, and preservation of excellent voice quality in most cases. Typically, surgery is reserved for salvage of radiation failure and provides overall 5-year survival rates of 98% and 90% for T1 and T2 lesions, respectively. The extremely obese patient, often with a short neck and excessive amounts of subcutaneous fat, is difficult for both radiotherapist and surgeon to diagnose and treat. The recent observation of an unusually high rate of radiotherapy failure in a cluster of obese patients with early vocal cord cancer called attention to this problem. Because the larynx is near the thoracic inlet in obese patients, they are not suitable for administration of radiotherapy by accurate opposed lateral portals. The patients reported herein were treated entirely with anterior oblique portals. Of the five obese patients who underwent primary radiation therapy for early vocal cord cancer, three developed recurrent disease (60%) and a fourth developed a severe perichondritis requiring tracheostomy. Two patients with recurrent disease were successfully salvaged with total laryngectomy, while the third patient refused surgery and died 2 years later. The sixth patient was treated by partial laryngectomy with imbrication reconstruction and is alive and without evidence of disease 2 years following surgery. Recurrence rates and complication rates following primary radiation therapy for early vocal cord cancer appear to be unacceptably high in obese patients treated with anterior oblique portals. Therefore, we recommend primary conservation laryngeal surgery for obese patients with early vocal cancer who cannot undergo “standard” radiotherapeutic techniques.     

Contralateral laryngoplasty. An update on reconstruction of the larynx following supraglottic laryngectomy with vertical extension

Twenty patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord underwent supraglottic laryngectomy with vertical extension that included the resection of an arytenoid. In these patients, the contralateral superior thyroid cornu was used to reconstruct the resulting defect. In this technique, the thyroid cornu is mobilized and greenstick fractured across the posterior commissure, thus maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor muscles attached. This muscle-cartilage pedicle provides bulk for the posterior glottis and can be anchored anteriorly to form a new hemilarynx. This reconstruction has provided excellent anteroposterior diameter and bulk in the laryngeal remnant, resulting in preservation of airway and voice and prevention of aspiration comparable with that achieved following supraglottic laryngectomy without vertical extension or resection of an arytenoid. It is a reliable technique for reconstructing extended laryngeal defects and is herein presented with long-term follow-up.     

T3 Supraglottic Cancer: Treatment Results and Prognostic Factors

Objective—A retrospective study was performed in order to analyze the treatment results and prognostic factors in patients with T3 supraglottic carcinoma and to differentiate between the treatment results obtained for T3 transglottic carcinoma and T3 pure supraglottic carcinoma. Material and Methods—Thirty-two patients who underwent surgery with or without postoperative radiation therapy between 1990 and 2000 were studied. Neck dissection was performed in 27 patients and 24 received postoperative radiation therapy. Results—The 3-year overall survival rate was 81.7%. The 3-year overall survival rates for T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). Univariate analysis revealed a prognostic significance for vocal cord fixation. T3 transglottic carcinoma was significantly correlated with vocal cord fixation. Conclusions—We suggest that surgery, either alone or in combination with postoperative radiation therapy, provides acceptable cancer control and survival rates for patients with T3 supraglottic carcinoma. Vocal cord fixation detected during preoperative fiberoptic laryngoscopy is a significant prognostic factor. T3 transglottic cancer needs more aggressive management.     

Epiglottic reconstruction after supraglottic laryngectomy.

It has been well established that supraglottic laryngectomy is an effective treatment of laryngeal cancer arising above the vocal cords with cure rates equaling total laryngectomy. Although there is preservation of a near normal voice after supragloltic laryngectomy, chronic aspiration occurs in some patients particularly after extended supraglottic laryngectomy or when there is associated compromised pulmonary function. During normal deglutition, the epiglottis serves to divert food to the pyriform fossae and partially covers the inlet to the airway. These important functions can be accomplished after supraglottic laryngectomy by reconstructing a neoepiglottis from an epiglottic remnant whenever one third or more of the epiglottis can be preserved which is microscopically free of tumor. Our results in 14 patients have shown no clinically significant aspiration after epiglottic reconstruction.     

前联合上喉室入路在声门上型喉癌中的应用

目的 探讨前联合上喉室入路行喉声门上水平部分切除的适应证。方法 8例选择性喉鳞状细胞癌巨大外生型声门上型T2~3N0~2c患者,无声带固定,无环后区受侵,行前联合上喉室入路切除原发病灶及水平半喉,常规修复。结果 所有患者无切缘阳性,术后发音好,无咽瘘发生,进食时间8~26d,随访存活2年以上5例。结论 对于喉癌声门上巨大外生型,无喉室及声带受侵的患者,前联合上喉室入路是比较好的选择,符合肿瘤切除原则。     

Multidimensional Assessment of Voice Characteristics After Radiotherapy for Early Glottic Cancer

Objectives/Hypothesis: To assess voice characteristics of patients following radiotherapy for early glottic cancer through a multidimensional analysis protocol including vocal function and voice quality measures. Methods: Voice analyses were performed for 60 patients treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, or 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers. There was a longitudinal group of 10 patients for whom data were collected before as well as 6 months and 2 years after radiation. Furthermore, data were collected for five separate groups of 10 patients each, before, 6 months after, 2 years after, 3 to 7 years after, and 7 to 10 years after radiation. Vocal function was investigated by means of videolaryngostroboscopy, phonetography, maximum phonation time, and phonation quotient measures. Voice quality was assessed by means of objective acoustical analysis and subjective perceptual ratings by trained raters. Results: Voice characteristics of patients were decreased before radiotherapy, improved after treatment, and became comparable to the voice characteristics of control speakers in at least 55% of the patients. Following radiotherapy, deviant voice quality was mainly negatively affected by increased age and stripping the vocal cord for initial diagnosis. Stroboscopy revealed that next to increasing age and stripping the vocal cord, continued smoking after treatment decreased vocal function following radio-therapy. Conclusion: Voices of patients diagnosed with early glottic cancer improved but did not normalize fully after radiotherapy. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased voice characteristics. A multidimensional analysis protocol including perceptual and acoustical analysis of voice quality and stroboscopic analysis of vocal function is recommended to investigate voice characteristics following treatment for early glottic cancer.     

The role of laser microsurgery in the treatment of laryngeal cancer

PURPOSE OF REVIEW: Transoral laser microsurgery has developed in recent years into a surgical method that combines a minimally invasive approach with the surgical precision of laser and microscope. The outcomes of laser microsurgical treatment of laryngeal carcinomas are reviewed and compared with the results of competitive standard procedures. RECENT FINDINGS: Laser microsurgery is widely acknowledged to have advantages in the treatment of early glottic carcinoma. In the treatment of glottic carcinoma causing impaired mobility or fixation of the vocal cord the role of laser surgery has not yet been definitively assessed. Based on published results, primary laser therapy can achieve local tumor control with a functional residual larynx in approximately 70-80% of cases. In patients with early or moderately advanced supraglottic carcinoma, laser microsurgery is comparable to open supraglottic laryngectomy in terms of local control and survival. With regard to organ preservation, laser microsurgery is comparable to open supraglottic laryngectomy but superior to radiotherapy. Microsurgery can preserve functionally important structures, allowing for early swallowing rehabilitation while avoiding tracheotomy. SUMMARY: This review elucidates the role of laser microsurgical partial resections of the larynx in comparison with other treatment modalities.     

声门上型喉癌声带不同活动情况组织病理学分析

目的 :探讨声门上型喉癌声带不同活动情况下的组织病理学特点 ,为喉部分切除术提供理论依据。方法 :84例声门上型喉癌喉切除标本 ,经火棉胶包埋 ,制成连续切片 ,苏木精 伊红染色 ,光学显微镜下观察。结果 :声带固定 2 6例中杓状软骨、声门旁间隙下区以及两者同时受侵率分别为 4 6 .2 %、15 .4 %、38.5 % ;声带活动受限 30例中杓状软骨、声门旁间隙下区以及两者同时受侵率分别为 4 6 .7%、6 .7%、13.3% ;声带活动良好 2 8例中杓状软骨及声门旁间隙下区无受侵。声带固定、声带活动受限、声带活动良好 3组之间杓状软骨及声门旁间隙下区的受侵率差异有统计学意义 (P <0 .0 5 ) ;侵犯声门旁间隙下区的肿瘤均侵犯了喉室 ,声带活动受限及声带固定者中 ,肿瘤组织侵犯声门旁间隙下区占侵犯喉室比例分别为 4 0 .0 % (6 / 15 )、73.7% (14 / 19) ,两者之间差异有统计学意义 (P <0 .0 5 )。结论 :肿瘤侵犯杓状软骨及声门旁间隙下区是声门上型喉癌引起声带活动受限或固定的主要原因 ,观察声带活动及喉室的受侵情况 ,可为喉部分切除术提供参考依据。     

Comparative voice quality evaluation after laser surgical versus fronto-lateral partial laryngectomy in T1b and T2 vocal cord carcinoma]

BACKGROUND: We conducted a study to compare the voice quality after transoral endolaryngeal laser surgery versus anterolateral partial laryngectomy in terms of ability to communicate effectively. MATERIAL AND METHODS: Two groups each of 8 patients were reexamined at least 6 months after either a laser surgical or a partial anterolateral laryngectomy for a T1b or T2 vocal chord carcinoma was performed by the same surgeon. The following examinations were conducted: video-laryngoscopy, video-stroboscopy, phonetogram when reading a standard text or when speaking and shouting, voice load test, respiratory flow measurement, auditive voice rating following the RBH model, and auditive rating of the voice by the patients according to a questionnaire. RESULTS: A voice disorder with a medium-grade dysphony and an essential limitation of the speaking and shouting voice function and voice quality was detected in both groups of patients. No significant differences were observed in any of the parameters evaluation in both groups of patients. CONCLUSIONS: Both surgical techniques appear to be equivalent in terms of postoperative voice function. However, the tracheotomy was avoided in the patients undergoing laser surgery.     

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.