Quality of life and functional evaluation after supracricoid partial laryngectomy with cricohyoidoepiglottopexy in Mexican patients

Abstract

This study assessed the functional results in patients treated primarily through supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Fifteen patients with a diagnosis of epidermoid carcinoma of the glottis region admitted to the Instituto Nacional de Cancerología (México) between June 2001 and September 2002 were studied. Three patients were at stage I, five at stage II, six at stage III, and one at stage IV. Both cricoarytenoid units were preserved in 12 patients, and only one in three. Each case was assessed through the clinical grading postoperative aspiration (CGPA) scale, the performance status scale for head and neck cancer (PSS-HNC), and the Karnofsky Performance Scale (KPS). Likewise, voice quality of the patients was assessed regarding tone and intensity using the SpeechViewer version 1 (IBM) and data were obtained with the Cool Edit 2000 software. Twelve patients received phoniatric rehabilitation and three were left without rehabilitation. The average time for decannulation was 12 days and 23 days for removal of the nasogastric catheter. The degree of aspiration was 0 in four patients and one in 11. According to PSS-HNC, the mean for normalcy in the diet was 95 and the mean for those eating in public was 91. Intelligibility reached an average of 90. Karnofsky's assessment was related to the disease and not to the treatment, as it remained at 100 per cent in most patients and was never below 80 per cent. The mean intensity of quality of voice was -18 dB below normal; however, the mean frequency was 243.7 Hz. SCPL and CHEP allows the preservation of the basic function of the larynx; however, a clear alteration in voice occurs after the procedure, although normal frequency is kept when both arytenoids are preserved. Likewise, preservation of both arytenoids shortens the time needed for cannula and feeding catheter removal. PSS-HNC, Karnofsky, and CGPA assessments demonstrated that patients can reach an almost normal bio-psycho-social integration. It is recommended that all patients be subjected to phoniatric rehabilitation.

Supracricoid laryngectomy: Age influence on long‐term functional results

“…To our knowledge, this is the first report of a detailed functional evaluation in an aged population after SCL. The functional results after SCL have been reported by different authors around the world 1–9, 23–29. In all the series, patients aged over 65 years, frequently up to the late 70s, have been included, suggesting that SCL are routinely performed also on old patients.…”

“…Several investigators have demonstrated the SCL to be an oncologically sound alternative to total laryngectomy (TL), the standard technique for advanced‐stage laryngeal carcinoma, with similar local control and survival rates 2, 3. Since being first developed and adopted in Europe, SCLs have gained an increasing acceptance in North America and around the world 4–6. The advantage of SCL over TL is that a permanent tracheostoma is not required, since the main laryngeal functions (respiration, phonation, and swallowing) are preserved, when at least one functioning cricoarytenoid joint is maintained, facilitating neoglottal competency.…”

Quality of Life After Conservation Surgery for Laryngeal Cancer

“…46 Partial laryngectomy appeared in one report to have the lowest psychosocial impact of the most commonly used modalities, 47 and SCPL was even found to result in almost normal biopsychosocial integration in a given patient population. 48 Certain factors were found to limit the potential for QOL preservation after partial laryngectomy: SCPL with cricohyoidoepiglottopexy generally produces excellent QOL, but the rare scenario of inability to decannulate or comorbid association of radiotherapy or cervical lymphadenectomy seem to affect QOL scores negatively. 49 Nonetheless, salvage partial laryngectomy was noted to have acceptable functional-and oncologic-outcomes in carefully selected patients with stage I or II laryngeal disease not responding to definitive radiotherapy, making it a useful alternative to TL.…”

Comparative videostroboscopic analysis after different external partial laryngectomies

“…Good contact between the epiglottis and arytenoid with contact vibrations are the prerequisite for satisfactory voice function. The presence of one or both arytenoids does not affect the voice quality significantly 13 , but, on the other hand, preservation of both arytenoid shortens the time of swallowing rehabilitation 14 . After SCHLP, all types of laryngeal movements during phonation were recorded.…”