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OBJECTIVE: To investigate the effect of radiotherapy in the combined treatment of laryngeal cancer with partial laryngectomy. METHODS: One hundred and seventy-one cases of laryngeal cancer were randomly separated into three groups of partial laryngectomy, partial laryngectomy with preoperative radiotherapy (dose 40-50Gy) and partial laryngectomy with postoperative radiotherapy(dose 51-70 Gy). The surgical procedures included cordectomy, vertical partial laryngectomy, horizontal partial laryngectomy and near total laryngectomy. RESULTS: The overall 5-year survival rate was 82% (123/150). The 5-year survival rates for surgery alone group (56 cases), surgery with preoperative radiotherapy group(65 cases) and surgery with postoperative radiotherapy group(50 cases) were 85.7%, 80.7% and 79.5% respectively. There was no significant difference among the groups(chi 2 = 0.703, P = 0.704). Analysis of survival rates revealed a significant difference among the different stages(chi 2 = 12.248, P = 0.007). All 171 cases except 3 that had near total laryngectomy achieved satisfactory phonation. CONCLUSION: Neither preoperative radiotherapy nor postoperative radiotherapy can improve the 5-year survival rate of laryngeal cancer with partial laryngectomy. All patients with partial laryngectomy got satisfactory phonation.
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OBJECTIVE: To investigate the quality of life after partial laryngectomy versus total laryngectomy for recurrent laryngeal carcinomas after radiotherapy. STUDY DESIGN AND SETTING: A retrospective study performed at least one year after treatment. This study was performed in a university hospital. RESULTS: Twenty-three patients (N = 12 partial laryngectomy, N = 11 total laryngectomy) with recurrent laryngeal cancer after radiotherapy were included in the study. Three different questionnaires, 1) EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, 2) EORTC-H & N 35, and 3) the Voice Handicap Index, were sent to all patients. The only major difference in quality of life of patients after partial laryngectomy versus total laryngectomy was found to be smell and taste related. No other differences were found. CONCLUSION: We did not find much difference in quality of life after treatment with a partial laryngectomy or a total laryngectomy in patients with recurrent laryngeal cancer after radiotherapy.
Primitive T4 laryngeal neoplasms with anterior invasion and neoplasm recurring after partial and subtotal intervention often invade the soft prelaryngeal tissues and in these cases the neoplastic illness can be no longer be controlled be "organ surgery". The widened forwarding total laryngectomy, "squared" or "carrè" laryngectomy according to some Authors of French School, is a surgical procedure not "on an organ" but "in an area" or "region" which proposes to delete, in one step, the larynx, the bone hyoid, the fasciae and the prelaryngeal muscles, the thyroid gland and, if necessary, a more or less large quantity of anterior cervical skin. If the removal involves a vast cutaneous area, it is necessary to mend the loss of substance by wrapping around a miocutaneous flap of pectoralis mayor muscle. In the last five years, 4 male patients, between 48 and 73 years, were treated with widened forwarding total laryngectomy. They were all carriers of epidermoid laryngeal carcinomas with various degrees of differentation: primitive in one patients, recidivist after performance of partial (cordectomy) and subtotal (two Labayle) surgery in the other three patients. In the only case of T4 primitive laryngeal neoplasm it was necessary to carry out a functional neck dissection bilaterally. Loss of substance always required the use of a miocutaneous flap of pectoralis mayor muscle except in one patient in which the removal of the prelaryngeal tissues was limited and therefore it was possible to make a direct seam. We always completely removed the thyroid gland, the prelaryngeal muscular system and skin of the preceding stomy (in the Labayle) sparing, on the other hand, the hyoid bone. Only one patient, who died due to recurrence a year after surgery, underwent complemental percutaneous radiotherapy. At present, three patients are alive and NED: one after 5 years, the others are in excellent conditions although the follow-up is still brief. According to our experience, we can affirm that in selected cases, after an accurate general evaluation of the patient (exclusion of distant metastases, preparation from a metabolic and psychological point of view) a widened forwarding total laryngectomy is a valid procedure since surgery (together with other complementary therapies), is still today the best treatment in forms with anterior evolution.
OBJECTIVES/HYPOTHESES: Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL STUDY DESIGN: Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. METHODS: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma A computer program was written to classify whether the patient was amenable to SCPL. RESULTS: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). CONCLUSIONS: 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.
From an inception cohort of 204 patients with squamous cell carcinoma of the true vocal cord classified as T2N0 and a minimum of 3 years of follow-up, the authors compare the oncological and functional outcomes following vertical partial laryngectomy (group 1; 85 patients) and supracricoid partial laryngectomy (group 2; 119 patients). The 10-year actuarial survival estimate was 46.2% for group 1 and 66.4% for group 2. Survival was statistically more likely to be reduced (p = .019) in group 1 than in group 2. The 10-year actuarial local control estimate was 69.3% for group 1 and 94.6% for group 2. Local recurrence was statistically more likely to occur (p < .0001) in group 1 than in group 2. Salvage treatment resulted in an overall 94.1% local control rate and a 78.1% laryngeal preservation rate for group 1 and an overall 99.2% local control rate and a 94.9% laryngeal preservation rate for group 2. The 10-year actuarial nodal control estimate was 81.7% for group 1 and 93.7% for group 2. Nodal recurrence was statistically more likely to occur (p = .028) in group 1 than in group 2. The 10-year actuarial estimate for patients without distant metastasis was 84.6% for group 1 and 95.1% for group 2. Distant metastasis was statistically more likely to occur (p = .05) in group 1 than in group 2. The hospital mortality rate was 1.2% for group 1 and 0.8% for group 2. The incidence of permanent gastrostomy was 0% for group 1 and 2.4% for group 2. The incidence of permanent tracheostomy was 1.2% for group 1 and 2.4% for group 2. The incidence of completion laryngectomy due to functional problems was 1.2% for group 1 and 0.8% for group 2.
The indications are exactly fixed and critically screened in 110 cases of supraglottic laryngectomy. Comparison with more radical surgical methods yields the same results with functional advantages of supraglottic laryngectomy. The limitations of resection are: the foramen coecum at the base of tongue, the arytenoids and the vocal cord at the entrance of the larynx, the piriform recessus in cases of extension to the hypopharynx.
From 1981 to 1985, 35 patients (34 male, 1 female), mean age, 56 years, underwent salvage total laryngectomy and pharyngo laryngectomy after full course radiotherapy. 13 cases have been closed primarily. 22 cases underwent reconstructive surgery using 15 musculo cutaneous and 7 muscular flaps. Complications occurred in 46% of the patients closed primarily and required further reconstruction by musculocutaneous flap. 90.7% of the cases where a flap was used initially had no post operative complications. This study confirms that the use of muscular and musculocutaneous flaps improve healing in salvage surgery.
Radiological examinations of the vertebral column neck segment were done in 41 patients after total laryngectomy (n = 29) and laryngopharyngectomy (n = 12). Degeneration changes of different degree (from I degree to IV degree) were stated in 37 cases. Criteria of assessment were as follows: a) the width of the intervertebral space b) appearance and degree of the exostoses c) the length of the degenerative process in vertebral segment of the neck. The advanced degenerative changes in the vertebral column (IV degree) included all neck segment and were characterized by significant narrowing of the intervertebral spaces and exostoses longer than 0.5 cm. These changes were seen statistically more often in the patients after 50. The pharyngoesophageal sphincter's (p.e.s.) rest pressure was statistically rising significantly with the degree of the degeneration changes in the vertebral column. The high pressure in p.e.s. (5.7 + 2.85 kPa--43 + 21 mm Hg) was seen only in the cases of the IV degree degree. In the patients with the IV degree degree of degenerative changes in 67% retention of saliva in the hypopharynx was seen. Probably it was due to irritation of the sympathetic part of the autonomic system. The statistically significant correlation between the degree of the degenerative changes and the complains like pain during the head movement and limitation of the neck motion was also observed. In IV degree degree these complains were noted in 57% cases. The results of the investigations prove the hypothesis of influence of the sympathetic part of the autonomic system on the pharyngoesopghageal sphincter rest pressure.
The practice of Pearson's (1981) technique of near total laryngectomy with speech shunt is evaluated acoustically in 11 subjects using matched esophageal speakers. Not only do these patients vocalize earlier with effortless cease, analysis of their speech both subjectively & by acoustic analysis of the parameters seems definitely to be of superior quality. The functional utility of this technique is addressed in this study justifying its more frequent practice in unilateral lesions of larynx and hypopharynx which defy satisfactory control by conventional conservation laryngeal surgery or radiation therapy. The Oncological outcome will be taken up as a part of a future report when follow up of adequate duration occurs in sufficient number of cases.
The preliminary results achieved in a series of 10 patients consecutively managed at our department with Pearson's subtotal pharyngolaryngectomy, during the year 1995, are presented. The surgical procedure is described. Follow up varied from 6 to 13 months. None of the patients were lost to follow-up. None of the patients recurred locally or died from surgical-related complications. Nine patients achieved successful rehabilitation of speech and voice. One patient refused to use a functional shunt. Speech and voice parameters achieved by the third postoperative month are presented. Postoperative swallowing impairment was not encountered. The preliminary data achieved and the review of the medical literature suggested that Pearson's subtotal pharyngolaryngectomy should be discussed in patients conventionally managed with total laryngectomy or pharyngolaryngectomy and tracheosophageal puncture with voice prosthesis insertion.
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