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Laccourreye O, Chambrin G, Garcia D, Troux C, Mirghani H, Giraud P. Successful 10-year outcomes after supracricoid partial laryngectomy for selected glottic squamous cell carcinoma classified as T3N0M0: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:165-170. [PMID: 36609114 DOI: 10.1016/j.anorl.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate long-term oncological outcome for patients with selected glottic squamous cell carcinoma (SCC) classified as T3N0M0 treated by supracricoid partial laryngectomy (SCPL). MATERIALS AND METHODS Analysis of an inception cohort of 46 patients with isolated untreated SCC classified as T3N0M0 and minimum 10-year follow-up, consecutively treated by SCPL between 1982 and 2012 in a French university teaching hospital. The main endpoint was 5- and 10-year actuarial survival and local control estimates. Accessory endpoints comprised cause of death, screening for variables decreasing survival and increasing risk of local recurrence, oncologic consequences of local recurrence, and laryngeal preservation rate. RESULTS Five- and 10-year actuarial survival was 78.1%, and 53.3%, respectively. The main causes of death were intercurrent disease and metachronous second primary, each in 33.3% of cases. Postoperative mortality (aspiration pneumonia) was 2.1%. There were no significant correlations between survival and any study variables. Five- and 10-year local control was 90.5%. Overall local recurrence varied significantly (P=0.003), from 2.3% with negative margins (R0) to 100% with positive margins (R1) and/or dysplasia. Local recurrence was associated with a significantly (P<0.005) increased risk of nodal failure and distant metastasis, and reduced survival. Overall laryngeal preservation was 89.1%. CONCLUSION The present results suggest that SCPL should continue to be taught and that this type of partial laryngeal surgery should be included in the various organ-sparing strategies considered in advanced laryngeal cancer.
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Affiliation(s)
- O Laccourreye
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale HEGP, université Paris Cité, AP-HP, 20-40 rue Leblanc, 75015 Paris, France.
| | - G Chambrin
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale HEGP, université Paris Cité, AP-HP, 20-40 rue Leblanc, 75015 Paris, France
| | - D Garcia
- Hôpital Français, SO1 Pho Phuong Mai, Dong Da District, Hanoi, Vietnam
| | - C Troux
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale HEGP, université Paris Cité, AP-HP, 20-40 rue Leblanc, 75015 Paris, France
| | - H Mirghani
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale HEGP, université Paris Cité, AP-HP, 20-40 rue Leblanc, 75015 Paris, France
| | - P Giraud
- Service d'oncologie-radiothérapie, université Paris Cité, HEGP, AP-HP, 20-40 rue Leblanc, 75015 Paris, France
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Nakayama M, Wada T, Isono Y, Sano D, Nishimura G, Oridate N, Holsinger FC, Orosco R. Narrow-field supracricoid partial laryngectomy: Procedure development and initial clinical experiences. Auris Nasus Larynx 2022; 50:403-409. [PMID: 36216666 DOI: 10.1016/j.anl.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the feasibility of narrow-field supracricoid partial laryngectomy with cricohyoidoepiglottopexy (NF-SCPL-CHEP). METHODS Between 2019 and 2020, five patients with glottic cancers underwent NF-SCPL-CHEP. The mean durations of surgical drains, tracheostomy canula, and nasogastric tube use were evaluated. Length of stay following NF-SCPL-CHEP was compared with that of our open SCPL historical controls. A case summary is provided for the first patients, with detailed information about postoperative management and function. RESULTS All five patients achieved uneventful postoperative recoveries without major complications. The average time for surgical drains, tracheostomy canula, and nasogastric tube use were 2, 15, and 46 days, respectively. The mean overall hospitalization period was 36 days for NF-SCPL-CHEP patients. The mean period of hospitalization based on our early experiences between 1997 and 2005 with classical open SCPL was 72 days. All patients were fully functional and local recurrences or distant metastases were not encountered during a mean observation period of 39 months. CONCLUSIONS NF-SCPL-CHEP with 6 cm cervical access appeared technically feasible and oncologically sound in this initial clinical experience. An extra 2 cm incision, which enabled lateral neck dissection, was not felt to detract from the overall minimally invasive basis of NF-SCPL-CHEP. The clinical results were encouraging with limited complications and predictable postoperative recovery. The length of stay for patients undergoing NF-SCPL was half that of open SCPL historical controls. Less damages to local circulation may associate with the positive influences. Further study with a large patient sample across multiple institutions are needed to carefully evaluate long-term functional and oncological outcomes.
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Affiliation(s)
- Meijin Nakayama
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan.
| | - Takashi Wada
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Yasuhiro Isono
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Daisuke Sano
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Goshi Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - Nobuhiko Oridate
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Ryan Orosco
- Division of Head and Neck Surgery, University of California San Diego, La Jolla, California, USA
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Succo G, Crosetti E. Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs. Front Oncol 2019; 9:408. [PMID: 31192120 PMCID: PMC6540733 DOI: 10.3389/fonc.2019.00408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022] Open
Abstract
The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.
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Affiliation(s)
- Giovanni Succo
- Oncology Department, University of Turin, Turin, Italy.,Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
| | - Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
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Arytenoid Fixation in Laryngeal Cancer: Radiological Pictures and Clinical Correlations with Respect to Conservative Treatments. Cancers (Basel) 2019; 11:cancers11030360. [PMID: 30871238 PMCID: PMC6468473 DOI: 10.3390/cancers11030360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of this retrospective study was to identify different radiological features in intermediate–advanced laryngeal cancer (LC) associated with arytenoid fixation, in order to differentiate cases still safely amenable to conservative treatment by partial laryngectomy or chemoradiotherapy. Methods: 29 consecutive patients who underwent open partial horizontal laryngectomies (OPHLs), induction chemotherapy followed by radiotherapy in the case of >50% response (IC + RT) or total laryngectomy were classified as: pattern I (supraglottic LC fixing the arytenoid due to weight effect), pattern II (glottic LC involving the posterior paraglottic space and spreading toward the crico-arytenoid joint and infraglottic extension <10 mm), pattern III (glottic—infraglottic LC involving the crico-arytenoid joint and infraglottic extension >10 mm) and pattern IV (transglottic and infraglottic LC with massive crico-arytenoid unit involvement, reaching the hypopharyngeal submucosa). All glottic cancers treated with surgery were studied by a cross sectional approach. Results: A substantial agreement between the work-up and the pathology results has been obtained in each of the subcategories. Three-year disease-free survivals, local control and freedom from laryngectomy were significantly better in pattern II compared to pattern III–IV. Conclusions: LC showing fixed arytenoid due to weight effect or posterior paraglottic space involvement with infraglottic extension <10 mm assessed at the true vocal cord midline are still safely manageable by OPHL or IC + RT.
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The senile functional evolution of the larynx after supracricoid reconstructive surgery. Eur Arch Otorhinolaryngol 2016; 273:4359-4368. [DOI: 10.1007/s00405-016-4177-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Schindler A, Pizzorni N, Fantini M, Crosetti E, Bertolin A, Rizzotto G, Succo G. Long-term functional results after open partial horizontal laryngectomy type IIa and type IIIa: A comparison study. Head Neck 2015; 38 Suppl 1:E1427-35. [PMID: 26560504 DOI: 10.1002/hed.24254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare long-term swallowing, voice results, and quality of life (QOL) after open partial horizontal laryngectomy (OPHL) type IIa and type IIIa. METHODS Twenty-three patients after OPHL type IIa and 18 patients after OPHL type IIIa were involved. Swallowing skills and neoglottis' motility and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic voice-related and swallowing-related QOL were assessed. Data were statistically compared using Mann-Whitney U test or Fisher exact tests, as appropriate. RESULTS Significant differences were found only for the residue with solids and for the intelligibility (I) parameter of the overall quality impression and intelligibility, additive and unnecessary noise, speech fluency, and presence of voiced segments scale with patients of the OPHL type IIIa group showing worse performances than the OPHL type IIa group. CONCLUSION Patients who underwent OPHL type IIa and type IIIa show comparable long-term functional outcomes. OPHL type IIIa represents a valid surgical alternative to OPHL type IIa. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1427-E1435, 2016.
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Affiliation(s)
- Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Marco Fantini
- Department of Otorhinolaryngology, Ospedale San Luigi Gonzaga, University of Turin, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, Ospedale Martini, Turin, Italy
| | - Andy Bertolin
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Giuseppe Rizzotto
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Giovanni Succo
- Department of Otorhinolaryngology, Ospedale San Luigi Gonzaga, University of Turin, Italy
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Schindler A, Pizzorni N, Mozzanica F, Fantini M, Ginocchio D, Bertolin A, Crosetti E, Succo G. Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know? Eur Arch Otorhinolaryngol 2015; 273:3459-3475. [DOI: 10.1007/s00405-015-3822-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Mourad M, Sadoughi B. Transcervical Conservation Laryngeal Surgery: An Anatomic Understanding to Enhance Functional and Oncologic Outcomes. Otolaryngol Clin North Am 2015; 48:703-15. [PMID: 26233793 DOI: 10.1016/j.otc.2015.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The goal of this review is to facilitate an improved understanding of the indications and contraindications to transcervical conservation laryngeal surgery in the treatment of glottic and supraglottic carcinoma. An overview of seminal anatomic principles is presented to provide guidance for clinicians contemplating open partial laryngectomy options.
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Affiliation(s)
- Moustafa Mourad
- Department of Otolaryngology, New York Eye and Ear Infirmary, Mount Sinai Health System, 310 East 14 Street, New York, NY 10003, USA
| | - Babak Sadoughi
- Department of Otolaryngology - Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College, 1305 York Avenue, 5th Floor, New York, NY 10021, USA.
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Lips M, Speyer R, Zumach A, Kross KW, Kremer B. Supracricoid laryngectomy and dysphagia: A systematic literature review. Laryngoscope 2015; 125:2143-56. [DOI: 10.1002/lary.25341] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Marieke Lips
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Renée Speyer
- Department of Otorhinolaryngology and Head and Neck Surgery; Leiden University Medical Center; Leiden The Netherlands
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; James Cook University; Townsville Queensland Australia
| | - Anne Zumach
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Kenneth W. Kross
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
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A pyriform sinus cancer organ preservation strategy comprising induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil, followed by potentiated radiotherapy: a multicenter, retrospective study. Anticancer Drugs 2015; 25:970-5. [PMID: 24849707 DOI: 10.1097/cad.0000000000000126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
No specific study has evaluated the role of neoadjuvant DCF (docetaxel, cisplatin, 5-fluorouracil) followed by radiotherapy in pyriform sinus cancer, which are often included in studies focusing on laryngeal and hypopharyngeal cancer. We assessed the proportion of patients treated sequentially for a pyriform sinus cancer with a preserved larynx. Overall survival, event-free survival (EFS), survival with 'local control', and treatment tolerance were assessed as well. We retrospectively reviewed 88 patients with advanced pyriform sinus squamous cell carcinoma treated with DCF between 2005 and 2010. After induction, radiation could be potentiated with cetuximab or cisplatin. Most patients (82%) had been treated with organ preservation intent. The response rate to DCF was 85%, including 42% with complete response. Primary tumor was operated in 13 patients (eight with total laryngectomy). Radiotherapy had been delivered to 78 (89%) patients (30 with cisplatin, 39 with cetuximab). Potentiation had been achieved as planned in 52 and 79% of patients treated with cisplatin and cetuximab, respectively. Twenty-three local and three neck recurrences were found. Median overall survival was 16.8 months and 38.3% at 3 years. EFS at 3 years was 29.1% with a hazard ratio for partial responders versus nonresponders of 0.18 (P<0.001), and 0.13 (P<0.001) for complete responders versus nonresponders. Thirty-five percent of patients were alive with their larynx preserved at 3 years. This study confirms the efficacy of induction followed by chemoradiation for pyriform sinus cancer and that response to DCF is predictive of EFS.
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Moon HS, Choi YW, Koh HJ, Chon JY, Park MR. Awake Glidescope® intubation in patients with severe arytenoid swelling after laryngeal surgery with radiation therapy. Korean J Anesthesiol 2014; 65:S34-5. [PMID: 24478863 PMCID: PMC3903851 DOI: 10.4097/kjae.2013.65.6s.s34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ho Sik Moon
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Yong Woo Choi
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Hyun Jung Koh
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Jin Young Chon
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Mi Ran Park
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
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Canis M, Martin A, Ihler F, Wolff HA, Kron M, Matthias C, Steiner W. Transoral laser microsurgery in treatment of pT2 and pT3 glottic laryngeal squamous cell carcinoma - results of 391 patients. Head Neck 2013; 36:859-66. [DOI: 10.1002/hed.23389] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/21/2013] [Accepted: 05/15/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Martin Canis
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Göttingen; Germany
| | - Alexios Martin
- Department of Audiology and Phoniatrics; University of Berlin; Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Göttingen; Germany
| | - Hendrik A. Wolff
- Department of Radiation Oncology; University of Göttingen; Germany
| | - Martina Kron
- Institute of Epidemiology and Medical Biometry; University of Ulm; Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Göttingen; Germany
| | - Wolfgang Steiner
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Göttingen; Germany
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Canis M, Ihler F, Martin A, Wolff HA, Matthias C, Steiner W. Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery. Head Neck 2013; 36:652-9. [PMID: 23596018 DOI: 10.1002/hed.23338] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 01/09/2013] [Accepted: 04/05/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the feasibility of transoral laser microsurgery (TLM) in treatment of pT3 laryngeal cancer. METHODS We conducted a retrospective case series study of 226 patients with pT3 glottic (n = 122; 54%) or supraglottic laryngeal carcinoma (n = 104; 46%). All patients were treated by TLM in combination with neck dissection (63%) and with postoperative radiotherapy (18%). Our main outcome measures were local control, organ preservation, functional outcome, overall survival, recurrence-free survival, and disease-specific survival. RESULTS Median follow-up period was 57.8 months. The 5-year organ-preservation and local control rates for all patients were 87% and 71.4%, respectively. The 5-year overall, recurrence-free, and disease-specific survival were 64.4%, 63.0%, and 83.3%, respectively. CONCLUSION Results are comparable to partial or total laryngectomy, while being superior to primary chemo(radio)therapy. TLM results in low morbidity, rapid recovery, and good function and can be a valid option for organ-preserving surgery of pT3 glottic and supraglottic cancer.
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Affiliation(s)
- Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Germany
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Saloura V, Langerman A, Rudra S, Chin R, Cohen EEW. Multidisciplinary care of the patient with head and neck cancer. Surg Oncol Clin N Am 2013; 22:179-215. [PMID: 23453331 DOI: 10.1016/j.soc.2012.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Head and neck cancer is a heterogeneous group of cancers, which require a multidisciplinary approach to achieve excellent treatment results. This article focuses on current treatment guidelines and controversies in the management of head and neck cancer. It also provides insight into future directions and newest advances in the treatment of head and neck cancer.
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Affiliation(s)
- Vassiliki Saloura
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637-1470, USA.
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Goessler UR. Traditional transcutaneous approaches in head and neck surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc06. [PMID: 23320058 PMCID: PMC3544212 DOI: 10.3205/cto000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing.In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool.In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.
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Supracricoid partial laryngectomy cricohyoidoepiglottopexy (SCPL-CHEP) versus vertical partial laryngectomy for the treatment of glottic carcinoma. Eur Arch Otorhinolaryngol 2012; 270:1027-34. [DOI: 10.1007/s00405-012-2241-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/19/2012] [Indexed: 11/30/2022]
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Abstract
The main issue in the management of glottic squamous cell carcinoma, as for all cancers, is adequate disease control while optimizing functional outcomes and minimizing morbidity. This is true for early-stage disease as for advanced tumors. This article evaluates the current evidence for the diagnostic and pretherapeutic workup for glottic squamous cell carcinoma and the evidence concerning different treatment options for glottic carcinoma, from early-stage to advanced-stage disease.
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Affiliation(s)
- Dana M Hartl
- Department of Head and Neck Oncology, Institut Gustave Roussy, Villejuif, France.
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Ambrosch P, Fazel A. Functional organ preservation in laryngeal and hypopharyngeal cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc02. [PMID: 22558052 PMCID: PMC3341579 DOI: 10.3205/cto000075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology - Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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Hartl DM, Ferlito A, Brasnu DF, Langendijk JA, Rinaldo A, Silver CE, Wolf GT. Evidence-based review of treatment options for patients with glottic cancer. Head Neck 2011; 33:1638-48. [PMID: 21990228 DOI: 10.1002/hed.21528] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 11/08/2022] Open
Affiliation(s)
- Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France.
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Sun DI, Cho KJ, Cho JH, Joo YH, Jung CK, Kim MS. Pathological validation of supracricoid partial laryngectomy in laryngeal cancer. Clin Otolaryngol 2009; 34:132-9. [PMID: 19413611 DOI: 10.1111/j.1749-4486.2008.01854.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To validate pathologically whether supracricoid partial laryngectomy is an oncologically sound procedure in cases with invasion of the thyroid cartilage, paraglottic space, pre-epiglottic space, anterior commissure, or subglottis. DESIGN A retrospective review of case notes was performed. SETTING Patients treated at a single institute in the Republic of Korea. PARTICIPANTS Sixty-three patients who underwent supracricoid partial laryngectomy for laryngeal squamous cell carcinoma between June 1994 and May 2005 who were followed for at least 2 years. MAIN OUTCOME MEASURES Local control and overall survival rates. Pathological invasion of the thyroid cartilage, anterior commissure, pre-epiglottic space, paraglottic space, or subglottis was also investigated as a cause of recurrence. Prognostic factors for local control and survival were evaluated with univariate and multivariate models. RESULTS Invasion of the anterior commissure, paraglottic space, thyroid cartilage, pre-epiglottic space, or subglottis had no significant impact on the recurrence or overall survival rates. The presence of a positive resection margin was significantly associated with recurrence in the univariate and multivariate analyses (P = 0.026, 0.028, respectively). When considering the prognostic factors influencing survival, the univariate analysis showed that N stage, a positive resection margin and recurrence had significant influences on the overall survival rate (P = 0.010, 0.0004 and 0.000 respectively). In the multivariate analysis, only recurrence affected the survival rate (P = 0.002). CONCLUSION Supracricoid partial laryngectomy can be used with oncological safety in selected cases of laryngeal cancer with invasion of the anterior commissure, thyroid cartilage, pre-epiglottic space, paraglottic space, or subglottis.
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Affiliation(s)
- D-I Sun
- Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seocho-Gu, Seoul, Korea
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Sun DI, Kim BS, Jung SL, Ahn KJ, Kim MS. The CT evaluation of neoarytenoid soft tissue after an arytenoidectomy during a supracricoid partial laryngectomy. Korean J Radiol 2009; 10:8-11. [PMID: 19182497 PMCID: PMC2647169 DOI: 10.3348/kjr.2009.10.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the postoperative laryngeal CT findings of neoarytenoid soft tissue at an arytenoidectomy site during a supracricoid partial laryngectomy, and to compare its thickness to the mucosa over the spared arytenoid cartilage. Materials and Methods Thirty-one patients underwent a supracricoid partial laryngectomy with (n = 14) or without (n = 17) an arytenoidectomy. A postoperative laryngeal CT examination was performed to statistically compare the thickness of the neoarytenoid soft tissue to the mucosa over the spared arytenoids. Results The neoarytenoid soft tissue revealed an eccentric prominence in all 14 arytenoidectomy sites. Further, the neoarytenoid soft tissue was consistently thicker than the mucosa over spared arytenoids cartilage (p < 0.01), however did not exceed 11 mm. Conclusion The eccentric prominence of neoarytenoid soft tissue at the arytenoidectomy site during a supracricoid partial laryngectomy should be identified and distinguished from a recurrent mass when compared to spared arytenoid cartilage on a postoperative laryngeal CT.
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Affiliation(s)
- Dong Il Sun
- Department of Otolaryngology-HNS, The Catholic University of Korea, Seoul, Korea
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Graça Caminha Vidal MD, Cervantes O, Abrah Ão M, Carneiro Hojaij F, Amar A. Prognostic factors in the treatment of squamous cell carcinoma of the larynx: partial surgery x radical surgery. Braz J Otorhinolaryngol 2008; 73:816-825. [PMID: 18278228 PMCID: PMC9450597 DOI: 10.1016/s1808-8694(15)31178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 02/08/2007] [Indexed: 11/21/2022] Open
Abstract
The present study aimed at assessing the other sites as the carcinoma spreads, as well as therapeutic results, in larynx preservation and patient survival. Study type: It is a Longitudinal Historical Cohort Study, a retrospective clinical study. Materials and Methods A hundred and sixty (160) patients treated at 'Escola Paulista de Medicina' ('Paulista' Medical School) - São Paulo Hospital, from January 1988 to December 2004 were examined as for the spreading of their larynx carcinoma. Those patients whose evaluations were at least two years old after treatment were the only ones accepted. The parametric tests used were: Test X2, Fisher's test, and Kaplan-Meier's curve. Results The posterior commissure and the infraglottis were significant in terms of the laryngectomy: glottal tumors AC: (p=0.03) AP: (p=0.0001); AC: (p=0.0007) AP: (p<0.0001), respectively. The infraglottis was significant in G+SG tumors in AP: (p=0.04) and in death rate AP: (p=0.03). Conclusion total laryngectomy is the treatment of choice in the presence of total involvement of the posterior commissure and the infraglottis. The latter may compromise survival, according to local invasion, even in the presence of free surgical margins.
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Affiliation(s)
- Maria da Graça Caminha Vidal
- Graduate student from the Escola Paulista de Medicina SP, Head of the SCCP - Hospital da Universidade Federal de Santa Maria - RS
| | - Onivaldo Cervantes
- Professor of the Head and Neck Surgery Department /Otorhinolaryngology of the Escola Paulista de Medicina de São Paulo, Head of the SCCP of the Escola Paulista de Medicina - SP
| | - Marcio Abrah Ão
- Professor of the Head and Neck Surgery Department /Otorhinolaryngology of the Escola Paulista de Medicina de São Paulo, Head physician of the SCCP of the Escola Paulista de Medicina - SP
| | - Flávio Carneiro Hojaij
- PhD in Head and Neck Surgery from the Hospital das Clínicas - Faculdade de Medicina da Universidade de São Paulo, Assistant Physician of the SCCP of the Escola Paulista de Medicina
| | - Ali Amar
- PhD in Head and Neck Surgery from the Escola Paulista de Medicina de São Paulo, Assistant Physician at the Hospital Heliópolis São Paulo
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Laudadio P, Presutti L, Dall'olio D, Cunsolo E, Consalici R, Amorosa L, Cancellieri A, Bocciolini C. Supracricoid laryngectomies: long-term oncological and functional results. Acta Otolaryngol 2006; 126:640-9. [PMID: 16720450 DOI: 10.1080/00016480500469024] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS Our results confirm that supracricoid laryngectomies (SL) are reliable techniques for glottosupraglottic tumors, even for selected T3 and T4 cases, if the indications are correct. These surgical techniques allow a good quality of life with the preservation of the larynx. OBJECTIVE SL with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP) have been popular over the last 20 years for the treatment of the glottic and/or supraglottic squamous cell carcinoma due to demonstrated good oncological and functional results. We report our experience with these techniques, with special focus on long-term oncological and functional results. PATIENTS AND METHODS We retrospectively reviewed 206 patients who had undergone SL with CHEP or CHP technique between 1987 and 1998 for glottosupraglottic squamous cell carcinoma in our department. The long-term results for 206 patients with T1-T4 laryngeal carcinomas treated with SL are reported: 90.8% CHEP and 9.2% CHP. The mean follow-up was 62 months. RESULTS Oncological results: the 5-year actuarial disease-free survival was 85%; the 5-year determinate actuarial survival was 88.3%. Functional results: organ preservation rate was 97%. Phonation was assessed according to the GRBAS scale.
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Affiliation(s)
- Pasquale Laudadio
- Department of Otolaryngology-Head and Neck Surgery, Ospedale Maggiore, Bologna, Italy
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Peretti G, Piazza C, Bolzoni A. Endoscopic treatment for early glottic cancer: indications and oncologic outcome. Otolaryngol Clin North Am 2006; 39:173-89. [PMID: 16469662 DOI: 10.1016/j.otc.2005.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Giorgio Peretti
- Department of Otolaryngology, University of Brescia, Piazza Spedali Civili 1, Brescia 25123, Italy.
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Lima RA, Freitas EQ, Dias FL, Barbosa MM, Kligerman J, Soares JR, Santos IC, Rocha RM, Cernea CR. Supracricoid laryngectomy with cricohyoidoepiglottopexy for advanced glottic cancer. Head Neck 2006; 28:481-6. [PMID: 16470876 DOI: 10.1002/hed.20361] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Supracricoid laryngectomy with cri-cohyoidoepiglottopexy (CHEP) is a conservative surgical procedure indicated in selected cases of advanced glottic carcinoma. METHODS This study is a review of our experience with 43 patients with T3/T4 glottic squamous cell carcinoma who underwent CHEP in our institution. All but two patients underwent selective neck dissections. All patients were staged on the basis of the 2002 TNM classification. Rates of recurrence and death were estimated by the Kaplan-Meier method. RESULTS The 5-year disease-specific survival and 5-year relapse-free survival rates were 78% and 83%, respectively. Neck metastases were found in three patients. Cartilage invasion occurred in 11 cases. The average length of hospital stay was 5.7 days. The mean time of enteral feeding tube was 33.8 days, and the mean time for tracheotomy was 29.6 days. Overall, normal swallowing was achieved in 74.4% of patients. Eleven patients had mild and major complications. Laryngeal stenosis emerged as the most frequent major complication. Three patients (6.9%) had local recurrences. Two patients (4.6%) had neck metastases. CONCLUSIONS On the basis of this study, over a 7-year period with 43 patients with advanced glottic cancer, a successful on-cologic outcome is confirmed.
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Affiliation(s)
- Roberto A Lima
- Head and Neck Surgery Service, Brazilian National Cancer Institute/INCA, Avenida Armando Lombardi, 1000 Bloco 2/107, Barra, 22640-000, Rio de Janeiro, RJ, Brazil.
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26
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Weber RS, Forastiere A, Rosenthal DI, Laccourreye O. Controversies in the management of advanced laryngeal squamous cell carcinoma. Cancer 2004; 101:211-9. [PMID: 15241816 DOI: 10.1002/cncr.20231] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Randal S Weber
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Sessions DG, Lenox J, Spector GJ, Newland D, Simpson J, Haughey BH, Chao KSC. Management of T3N0M0 glottic carcinoma: therapeutic outcomes. Laryngoscope 2002; 112:1281-8. [PMID: 12169914 DOI: 10.1097/00005537-200207000-00026] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The best therapeutic approach for the treatment of T3N0M0 (stage III) glottic carcinoma is controversial. METHOD A retrospective study of Tumor Research Project data were performed using patients with T3N0M0 glottic squamous cell carcinoma treated with curative intent by seven different treatment modalities from January 1950 to December 1996 at Washington University School of Medicine/Barnes-Jewish Hospital. RESULTS Two hundred patients with T3N0M0 glottic carcinoma were treated using seven modalities: total laryngectomy (TL, n = 30), TL with neck dissection (TL/ND, n = 40), conservation surgery alone (CS, n = 22), radiation therapy alone (RT, n = 29), TL combined with RT (TL/RT, n = 31), TL and ND combined with RT (TL/ND/RT, n = 36), and CS combined with RT (CS/RT, n = 12). The overall 5-year observed survival rate (OS) was 54% and the 5-year disease-specific survival rate (DSS) was 67%. The 5-year DSS for the individual treatment modalities included TL, 65.4%; TL/ND, 76.5%; CS, 71.4%; RT, 56.5%, TL/RT, 51.9%; TL/ND/RT, 71.4%; and CS/RT, 80%. There was no significant difference in DSS for any individual treatment modality (P =.375). The overall local and regional control rate was 74% (148 of 200). The overall recurrence rate was 37.5% with recurrence at the primary site and in the neck of 19.5% and 11%, respectively. Recurrence was not related to treatment modality. The 5-year DSS after treatment of recurrent cancer (salvage rate) was 35.8%. The incidence of distant metastasis was 11% and for second primary cancers it was 19.5%. There was no statistically significant difference in survival between necks initially treated (72%, 5-y DSS) versus necks observed and later treated if necessary (70%, 5-y DSS) (P =.797). CONCLUSIONS The seven treatment modalities had statistically similar recurrence, complication, and survival rates. Patients with clear surgical margins have a significant survival advantage compared with patients with close and involved margins. Because postoperative radiation therapy in patients with positive margins did not improve survival, formal re-resection of the site of the positive margin should be considered. In patients whose N0 neck was not treated electively, close follow-up observation with meticulous examinations combined with appropriate treatment for subsequent neck disease resulted in a similar survival rate compared with those patients whose N0 necks were treated initially. Six-year minimum follow-up is recommended for early identification of primary and neck recurrence and for discovering expected second primary cancers. Patients treated with RT and CS had statistically similar rates of survival, maintenance of voice, and acquired permanent tracheal stoma. CS is a valid alternative to RT in treating highly selected patients with T3N0 glottic carcinoma.
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Affiliation(s)
- Donald G Sessions
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Rifai M, Heiba MH, Salah H. Anterior commissure carcinoma II: the role of salvage supracricoid laryngectomy. Am J Otolaryngol 2002; 23:1-3. [PMID: 11791241 DOI: 10.1053/ajot.2002.28779] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Supracricoid laryngectomy (SCL) was performed for 45 cases of recurrent anterior commissure carcinoma (ACC). The procedure involves excision of the thyroid cartilage with the tumor-bearing mucosa and subsequent anastomosis between the thyroid and cricoid cartilage. It is therefore called cricohyoidopexy, or cricohyoidoepiglottopexy if the epiglottis is also included in the excision. Rate of control of local spread at 2 years was 95.4%. Oncologic and functional results also indicate that SCL is a suitable alternative to total laryngectomy in selected cases of ACC.
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Affiliation(s)
- Mohamed Rifai
- Otorhinolaryngology Department, Kasr El-Aini School of Medicine, Cairo University, 8 Hoda Shirawi Street, Bab El Louk, Postal Code 1111, Cairo, Egypt
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Lima RRMA, Freitas EDQ, Kligerman J, Sá GMD, Santos IC, Farias T. Laringectomia supracricóide (chep) para câncer glótico. Rev Col Bras Cir 2001. [DOI: 10.1590/s0100-69912001000400004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: Com a intenção de se avaliar os resultados funcionais e terapêuticos da laringectomia supracricóide com crico-hióide-epiglote-pexia (CHEP) foram estudados 50 casos de pacientes com carcinoma epidermóide da glote classificados como T2/T3 submetidos a esta técnica em nossa instituição. MÉTODOS: Foi realizada uma análise retrospectiva entre 1996 e 1999. Classificamos 18 pacientes como T2N0M0 e 32 pacientes como T3N0M0. Quarenta e um pacientes foram submetidos a esvaziamento cervical seletivo lateral bilateralmente, quatro foram submetidos ao mesmo esvaziamento unilateralmente, e cinco não foram esvaziados. Analisamos as complicações e a sobrevida livre de doença pelo método de Kaplan-Meyer. RESULTADOS: Dez pacientes tiveram complicações pós-operatórias, dois foram tratados com complementação da laringectomia. Os 48 pacientes restantes mantiveram a via aérea normal, deglutição e a voz. Três pacientes no grupo submetido a esvaziamento cervical apresentaram linfonodo metastático. Quatro pacientes tiveram recidiva da doença, três com recidiva local, sendo dois tratados com laringectomia total e estão vivos e sem doença, o outro com doença avançada alcançou o óbito pela doença. O paciente que teve recidiva no pescoço foi tratado com esvaziamento cervical mais radioterapia e morreu com doença. Dois pacientes tiveram um segundo tumor primário em orofaringe, sendo um tratado com radioterapia paliativa e morreu com doença e o outro tratado com cirurgia está vivo e sem doença. A sobrevida livre de doença em três anos foi de 88% para pacientes T2 e 72% para pacientes T3. CONCLUSÕES: Esta técnica é útil no tratamento de casos selecionados de carcinoma epidermóide da glote T2/T3 sempre se considerando a extensão da doença. A incidência de complicações necessitando laringectomia total de resgate não compromete a funcionalidade desta técnica. A sobrevivência é comparável aos pacientes submetidos a laringectomia total e laringectomia "near-total".
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Teknos TN, Hogikyan ND, Wolf GT. CONSERVATION LARYNGEAL SURGERY FOR MALIGNANT TUMORS OF THE LARYNX AND PYRIFORM SINUS. Hematol Oncol Clin North Am 2001; 15:261-76. [PMID: 11370492 DOI: 10.1016/s0889-8588(05)70211-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conservation surgery for cancers of the larynx and pyriform sinus is an expansive and complicated subject. A great deal of technical expertise and clinical judgement are required for appropriate surgical and oncologic outcomes. In the appropriate setting, surgery continues to play an important role in voice preservation for patients with laryngeal and hypopharyngeal carcinoma. Perhaps most importantly, options for organ preservation surgery have expanded, and the number of patients requiring total laryngectomy as primary surgical management has decreased. The medical surgical decision making is complex and requires precise delineation of tumor extent, careful patient evaluation, and thorough interdisciplinary discussion to select an optimal course of treatment for the individual patient.
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Affiliation(s)
- T N Teknos
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan, USA.
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Hotz M. Should chemotherapy alone be the initial treatment for glottic squamous cell carcinoma? Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)00130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND The authors present their study on oncologic and functional results of supracricoid partial laryngectomies (SPL) performed on 149 patients between January 1984 and December 1995. METHODS Cricohyoidopexy (CHP) was carried out on 98 patients and cricohyoidoepiglottopexy (CHEP) on 51 patients. The patients were divided into two groups. The first group included those operated on between January 1984 and December 1992 and who therefore had a minimum follow-up period of 3 years. The second group included those operated on after December 1992 and who therefore had a follow-up period of less than 3 years. The statistical evaluation of this second group was carried out using an actuarial method according to Kaplan-Meier. RESULTS In the first group, survival rate (regarding disease-related deaths) was 94% (95/101), whereas in the second group, survival rate was 95%. There were 9 recurrences in the 149 patients (6.71%), B of which occurred after CHP (6 for tumor [T] and 2 for node [N]) and 1 (for T) after CHEP. Three of the 6 recurrences for T after CHP occurred in the hypopharynx, 2 in the peristomal area, and 1 in the arytenoid area. The only recurrence for T after CHEP occurred in the paraglottic area. Decannulation was carried out in 85.7% of CHP patients (84/98) and in 98% of CHEP patients (50/51). The nasogastric tube was kept in position for an average of 28 days (range, 15-90 days) in the CHP patients and 15 days (range, 9-90 days) in the CHEP patients. Swallowing was excellent; only a small number of patients (n = 21) were forced to assume a particular posture during meals. Phoniatric controls performed on 104 patients also showed adequate speech recovery. CONCLUSIONS If the indications are applied scrupulously, CHEP is a valid alternative to partial laryngeal surgery and CHP is a possible alternative to total laryngectomy in the treatment of glottic and supraglottic tumors.
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Biacabe B, Gleich LL, Laccourreye O, Hartl DM, Bouchoucha M, Brasnu D. Silent gastroesophageal reflux disease in patients with pharyngolaryngeal cancer: further results. Head Neck 1998; 20:510-4. [PMID: 9702537 DOI: 10.1002/(sici)1097-0347(199809)20:6<510::aid-hed4>3.0.co;2-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease is associated with various head and neck manifestations. The aim of this retrospective study was to determine the incidence of asymptomatic, or "silent," gastroesophageal reflux disease (GERD) in patients treated for pharyngolaryngeal squamous cell carcinoma. METHODS Twenty-four-hour pH monitoring was performed in 72 consecutive patients without digestive manifestations (pyrosis, retrosternal heartburn) of GERD treated for pharyngolaryngeal carcinoma. Statistical analysis of the relationship between reflux scores achieved and various patient parameters (age, tobacco and alcohol consumption, gastric ulcers, medications which decrease esophageal sphincter pressure), tumor parameters (staging), and therapeutic parameters (drugs administered during neo-adjuvant chemotherapy) was performed. RESULTS Incidence of silent GERD varied from 36% to 37% according to the reflux scores. No relationship was found between the reflux scores and the patient or tumor parameters. Among the therapeutic parameters, a statistical relation was noted between the total dose of Cisplatin and the reflux scores (p = .005). CONCLUSIONS Silent GERD is a common finding in patients treated for squamous cell carcinoma of the pharyngolarynx. Additionally, chemotherapy including Cisplatin may aggravate GERD during the course of therapy.
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Affiliation(s)
- B Biacabe
- Department of Otorhinolaryngology-Head & Neck Surgery, Laennec Hospital, University Paris V, France
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Laccourreye O, Laccourreye L, Muscatello L, Périé S, Weinstein G, Brasnu D. Local failure after supracricoid partial laryngectomy: symptoms, management, and outcome. Laryngoscope 1998; 108:339-44. [PMID: 9504604 DOI: 10.1097/00005537-199803000-00006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The medical files of 15 patients with local recurrence after supracricoid partial laryngectomy consecutively managed at Laënnec Hospital were reviewed. The clinical symptoms and the laryngeal computed tomography appearance of local recurrence, as well as the salvage treatment performed, are presented. The main presenting symptom was dyspnea. None of the local recurrences was considered to be unresectable. One patient refused any form of salvage treatment. Radiation therapy and salvage total laryngectomy were the options retained for local salvage. A minimum 5-year follow-up was always achieved. In patients who underwent salvage total laryngectomy, perioperative or postoperative death and postoperative pharyngocutaneous fistula were not encountered. The 5-year survival was 33.3%. The local control rate was 66.6%. The percentage of patients who experienced nodal recurrence was 26.6%, and the distant metastasis estimate was 53.3%. The cause of death was distant metastasis in eight patients, local recurrence in two, and intercurrent disease in one. Peristomal recurrence was not encountered. Overall, 80% local control and 6.6% laryngeal preservation rates were achieved.
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-Head & Neck Surgery, Laënnec Hospital, University of Paris V, France
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Laccourreye O, Brasnu D, Périé S, Muscatello L, Ménard M, Weinstein G. Supracricoid partial laryngectomies in the elderly: mortality, complications, and functional outcome. Laryngoscope 1998; 108:237-42. [PMID: 9473075 DOI: 10.1097/00005537-199802000-00015] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A review of the postoperative course, complications, and functional outcome of 69 elderly patients (older than 65 years of age) consecutively managed with a supracricoid partial laryngectomy between 1977 and 1993 is presented. The tumors were glottic and supraglottic in origin in 53 and 16 patients, respectively. A cricohyoidoepiglottopexy, a tracheo-cricohyoidoepiglottopexy, and a cricohyoidopexy were performed in 48, five, and 16 patients, respectively. Immediate laryngeal, cervical, and medical complications were noted in 5.8%, 10.2%, and 10.2% of patients, respectively. Supracricoid partial laryngectomies never resulted in perioperative or postoperative death. The 5-year actuarial survival and local control estimates were 68%, and 93.9%, respectively. Late surgical complications included laryngocele, laryngeal stenosis, and pneumonia from aspiration-related death in 4.3%, 4.3%, and 1.4% of patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 1.4%, 1.4%, and 2.91% of patients, respectively. Overall a 92.8% laryngeal preservation rate was achieved. Univariate analysis of the potential correlation of different factors with the mortality incidence and causes, the incidence and type of the various complications, and the incidence for postoperative aspiration is presented.
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, Assistance Publique des Hôpitaux de Paris, University Paris V, France
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Naudo P, Laccourreye O, Weinstein G, Jouffre V, Laccourreye H, Brasnu D. Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg 1998; 118:124-9. [PMID: 9450842 DOI: 10.1016/s0194-5998(98)70388-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.
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Affiliation(s)
- P Naudo
- Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, Assistance Publique des Hôpitaux de Paris, University Paris V, France
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