Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience

Abstract

To evaluate the long-term oncologic results of supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) for laryngeal cancer. A 35-year retrospective study concerning 291 patients treated by supracricoid laryngectomy with CHEP for laryngeal cancer was performed. The following postoperative data were studied: recurrence rates (lymph node and laryngeal), distant metastases and second cancer. The mortality rate and overall survival were estimated by the Kaplan-Meier method. The postoperative mortality was 1.03 %. 23 patients were lost to follow-up. The 3-year survival rate was 84 % and the 5-year survival rate was 80 %. 12 patients developed distant metastasis. 31 patients developed a second cancer. The local (laryngeal) control rate was 93.94 % and the regional (cervical lymph node) control rate was 92.05 %. In multivariate analysis, the occurrence of a second non-ENT cancer and metastasis as well as margins involvement were reliable to mortality. Supracricoid laryngectomy with CHEP appears to be associated with very good long-term oncologic results and still has a place in the management of T1, T2 and selected T3 glottic cancers.

Expression of Th1- Th2- and Th17-associated cytokines in laryngeal carcinoma

“…We hypothesize that in laryngeal carcinoma, the expression of Th2-associated cytokines is inhibited due to the production of Th1-associated cytokines, particularly at the early clinical stage of the disease, which may explain the increased immune response against tumors observed in these patients. The results of the present study were consistent with those of a report on supracricoid laryngectomy, which showed good management of laryngeal cancer (44,45).…”

Oncologic outcomes of surgical treatment for T3 glottic laryngeal squamous cell carcinoma

“…Surgical margins are generally recognized as a risk issue responsible for the survive rate. Positive margins and borderline margins that are <0.1 cm or the presence of dysplasia are risk factors for the local control rate . A positive association exists between mortality and positive surgical margins .…”

“…Positive margins and borderline margins that are <0.1 cm or the presence of dysplasia are risk factors for the local control rate . A positive association exists between mortality and positive surgical margins . The prospective prognostic role of radical surgery is highlighted by Hinerman et al, who found a 5‐year locoregional control rate of 56% and 89% ( P = .075) for negative and positive surgical margins, respectively.…”

Management of Advanced Laryngeal Cancer

“…Conservation surgery (transoral laser or robotic surgery, or open partial laryngectomy) is an excellent option for many patients with early (T1/2N0) larynx cancers, offering excellent oncologic control and functional outcomes 18–20. For advanced cancers, the role of conservation surgery is much more limited to cases which are either early T stage, but with concurrent cervical metastases, or select small-volume T3 cases.…”