Endoscopic treatment of supraglottis and hypopharynx cancer

Abstract

Transoral excision of supraglottic and hypopharynx cancer as a single modality is effective when lesions are selected for small size and endoscopic accessibility. Excisional biopsy with clear margins of larger supraglottic tumors in combination with postoperative radiotherapy provides an excellent treatment alternative for selected lesions in patients who are not candidates for open surgery. In this preliminary report, 45 cases using this minimally invasive approach are reviewed outlining oncologic rationale and functional advantages. A large bore tubed laryngoscope or the adjustable bivalve supraglottiscope was used along with a carbon dioxide laser in all cases. In 22 of the 45 patients (mostly TI), local en bloc excision of the primary cancer was performed as sole treatment on selected lesions of the supraglottis and hypopharynx. There were no local recurrences, however, 1 patient developed a neck recurrence and was salvaged by neck dissection. Twenty‐three of the 45 patients had more extensive primaries (mostly T2, T3) and N0 necks. Transoral excisional biopsy was followed by full‐course radiation therapy to the primary site and both necks. All 23 were followed a minimum of 2 years, and the median follow‐up period was 58 months. Clear margins were obtained in 16 of 23, and there were no recurrences in the larynx. Two of 16 did fail in the neck and died despite neck dissection. Seven of 23 patients had positive margins and, despite full‐course radiotherapy to the primary site and both necks, 5 of 7 failed locally or regionally. Two of the 7 died of their disease despite open salvage surgery. Therefore, 4 of 23 patients who underwent transoral excision of larger lesions followed by full‐course radiotherapy died of recurrent cancer.

Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynx

“…1,23,24 During preoperative counseling, patients with voluminous tumors of the piriform sinus or the supraglottis should be informed that they are more likely to need a feeding tube and that temporary or permanent PEG, tracheostomy, or even a total laryngectomy 2 might also be required. Aspiration is a common complication after partial pharyngolaryngeal resections, 4,24,25 and a high incidence of pneumonia might had been expected in our patients because of the absence of postoperative prophylactic tracheotomies. In fact, there was no increase in postoperative pneumonia in our series compared with patients treated by the external approach.…”

“…As in small tumors, the preservation of the laryngeal framework and the avoidance of tracheotomy with maintenance of normal laryngeal elevation have also been considered favorable points. 4,20,22 A historical comparison with reports in the literature shows that external supraglottic laryngectomies display a range from 0% to 19% of aspiration pneumonia and a rate of 0.4% to 9.8% of total laryngectomies for permanent dysphagia. The need for a feeding tube is definitely greater and the mean time of maintenance longer Table 5.…”

Management of the Patients with Hypopharyngeal Cancer: Eight-Year Experience of Miyagi Cancer Center in Japan

“…In the present study, results of PP for laryngeal preservation were unsatisfactory. Indications for PP and procedures including transoral resection or pharyngotomy are controversial (Zeitels et al 1994;Steiner et al 2001). When a patient needs to undergo partial resection of a primary tumor, indication for PP must be carefully evaluated and additional therapies, including postoperative radiotherapy, are thought to be necessary.…”

Transoral Laser Surgery for Supraglottic Carcinoma

“…23 Nineteen patients with T1 or T2 tumors treated with laser microsurgery alone were cured. Of 23 patients, mostly with T2 tumors, who received both surgery and postoperative irradiation, 4 developed local recurrences and were salvaged by total laryngectomy.…”