Outcome after supracricoid laryngectomies in the material of ENT Department, Poznan University of Medical Sciences

Abstract

All patients with T1 and T2 laryngeal cancer should be treated with the intent to preserve the larynx. In T3 glottic low-volume tumors, larynx preservation is an appropriate standard treatment option. Supracricoid partial laryngectomy remains a reasonable alternative to radiotherapy for patients with T2–T3 glottic cancer. Prospective clinical study aims to evaluate the oncological results of supracricoid partial laryngectomy as a treatment for selected glottic and supraglottic carcinoma, and to determine the different prognostic factors that may influence local control and survival. In the period of 2000–2007, 145 patients were treated at the academic tertiary referral medical center: ENT Department, University of Medical Sciences, Poznán, Poland. The ages of the analyzed group of patients ranged from 23 to 79, with mean 56.5 age for men and 25 for women. All of the patients had biopsy proven squamous cell carcinoma. Of the 145 patients 82 had glottic cancer and 63 had supraglottic cancer. The patients were staged according to the 2003 edition of the TNM classification established by the AJCC. The pathological TNM classification was additionally taken into consideration. All patients were treated by means of supracricoid and transglottic partial laryngectomy. The type of supracricoid partial laryngectomy was based on tumor localization and extension. Four patients underwent cricohyoidopexy, 57 cricohyoidoepiglottopexy, 65 reconstruction modo Calearo, and 19 modo Sedlacek-Tucker. We performed 21 unilateral selective neck dissections and none bilateral. A nasogastric feeding tube was inserted in all patients, and removed in patients that regained proper swallowing. As a result, we took into consideration the oncological and functional results. Histopathological examination of the operating specimen revealed the presence of dysplasia or invasive carcinoma at the margins, or a close margin of less than 5 mm from the edge of the resection (16 cases). The metastases were found on the neck in three cases, predominantly in the level II (2 cases) and III (1 case). Metastasis was found in one patient that had undergone CHP, Sedlacek-Tucker, and Calearo, respectively. Five patients received postoperative radiotherapy. The decision to use adjuvant radiotherapy was based on the presence of invasive carcinoma at the resection margin and on the presence of multiple positive neck nodes or extracapsular spread of the disease. The Kaplan–Meier estimated 3- and 5-year overall survival rates in the group of 122 because 23 patients did not report for medical check-ups.

Desvantagem vocal e estratégias de enfrentamento nas disfonias após laringectomias

“…Its results have been satisfactory either for the preservation of the organ as for the functional benefits (1,2,3,4,5,6,7) . However, despite such reports, the subjects' vocal self-assessment and the analysis related to the vocal handicap did not reveal differences between both groups.…”

“…Supracricoid partial laryngectomy (SCPL) has been pointed out as advantageous when compared to total laryngectomy (TL), especially considering that it aims to preserve part of the organ (1,2,3,4,5,6,7) . Survival rates of SCPL are similar to the TL ones (6,8) , although it may benefit the patient by not using permanent tracheostomy.…”

“…Survival rates of SCPL are similar to the TL ones (6,8) , although it may benefit the patient by not using permanent tracheostomy. The vocal quality after SCPL is characterized as hoarse and breathy (2) , however intelligible, allowing the patient to keep an effective voice for his communication (1) and has low impact on social activities, contributing for a better quality of life (1,3,4,5,9,10) . The TL, however, is still one of the main procedures in the treatment of laryngeal cancer and the patient needs to learn a new way of verbal communication and deal with breathing and swallowing changes, which will certainly interfere in his life (11) .…”

Laringectomias supracricóides: revisão de literatura em protocolos de qualidade de vida

“…The supracricoid partial laryngectomy (SCPL) was idealized aiming at avoiding the total laryngectomy 1 and it has been considered as a good alternative for T1 and T2 tumors and some T3 and T4 selected cases, once its results are found to be satisfactory for both, the laryngeal preservation and functions, when compared to total laryngectomy (TL) [2][3][4][5][6] . Several literature reports show local control, low recurrence rate 5,[7][8][9][10] and survival rates similar to TL [1][2][3] , besides allowing the nonuse of permanent tracheostomy, which enables the oral feeding, voice preservation and social functions, providing a better quality of life 5,6,[11][12][13][14] .…”

“…Several literature reports show local control, low recurrence rate 5,[7][8][9][10] and survival rates similar to TL [1][2][3] , besides allowing the nonuse of permanent tracheostomy, which enables the oral feeding, voice preservation and social functions, providing a better quality of life 5,6,[11][12][13][14] . Thus, the SPL justifies itself as an alternative of great value once it allows the maintenance of voice without the use of any device and without training 15 .…”