[Cricohyoidopexy (CHP) and Cricohyoidoepiglottopexy (CHEP). Indication, complications, functional und oncological results]

Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy

Open partial horizontal laryngectomies (OPHLs) represent a valuable therapeutic option for tumors of the intermediate T-category and, in selected cases, for locally advanced tumors with low-volume extra-laryngeal extension. The eligibility of patients treated with this type of surgery has increased with the introduction of the modular approach to OPHL planning. This strategy follows the introduction of the classification proposed by the European Laryngological Society, based on the extent of horizontal resection. Optimization of the selection is the result of a meticulous work-up process involving close cooperation between experienced surgeons and radiologists, followed by final quality control by pathologists. Computed tomography and magnetic resonance imaging are study methods whose pearls and pitfalls are well known, especially when performed at a high level of expertise. In this paper, based on the experience of two high-volume centers, a checklist of 20 questions addressed by the surgeon to the radiologist before planning an OPHL was proposed. Considerations regarding case selection are reported for each of the questioned parameters. A very simple question-and-answer process is easy to understand and mainly addressed by less experienced colleagues who wish to increase their knowledge and skills in performing this type of surgery.

[The value of supracricoid partial laryngectomy in moderately advanced laryngeal cancer (T3-T4a)]

BACKGROUND

Transoral laser microsurgery (TLM) is the method of choice for partial laryngectomy in Germany. In advanced stages, chemoradiotherapy is increasingly indicated for organ preservation.

OBJECTIVE

This report considers the indications for and outcomes of supracricoid partial laryngectomy (SPL), also known as crico-hyoido-(epiglotto)-pexy, as an option for surgical organ preservation in moderately advanced laryngeal cancer (T3-T4a), in the well-defined gap between TLM and chemoradiotherapy protocols in Germany.

METHODS

Retrospective evaluation of functional and oncological outcomes of all SPLs conducted between 2008 and 2014. During this period, 17 SPLs with resection of rpT2 (n = 2), (r)pT3 (n = 11), and (r)pT4a (n = 4) were performed with resection of one arytenoid. Mean age was 58 years (range 47-75 years). In 5 patients, SPL was for a first or second local recurrence after TLM or open partial laryngectomy. Adjuvant radiotherapy was received by 7 patients staged pT4a or pN+.

RESULTS

Salvage laryngectomy with adjuvant radiotherapy was required by 2 patients. The remaining patients (n = 15) had a mean tumor-free follow-up of 4 years with a functional intact larynx: these patients can eat and drink, have a closed tracheotomy, and a good voice. After 3 years tumor-free follow-up with a functional intact larynx, 2 patients died due to cardiac comorbidity at the age of 76 years.

DISCUSSION

SPL is a rare but valuable option for surgical larynx preservation in stage pT3-4a laryngeal cancer.

[Surgical treatment options in laryngeal and hypopharyngeal cancer]

In Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses. Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options: Local tumour, no systemic metastasis Tumour has to be resectable in healthy margins mortality/morbidity Surgery must not lead to unreasonable mutilation Lack of other therapeutic alternatives having an equal or lesser impact In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.