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Yang L, Li W, Zheng Y, Ji L. [Repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:133-139. [PMID: 38385223 PMCID: PMC10882235 DOI: 10.7507/1002-1892.202311062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective To explore the feasibility to restore pronunciation function by repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer. Methods A retrospective study of 5 male patients with advanced laryngeal cancer between August 2019 and October 2022, aged 56-73 years, with an average age of 65 years were reviewed. The disease duration ranged from 3 to 24 months, with an average of 8 months. Tumor classification by location: 2 cases of glottic type, 2 cases of supraglottic type, and 1 case of subglottic type; TNM staging: 3 cases of T 4N 0M 0 stage, 1 case of T 4N 1M 0 stage, and 1 case of T 4N 2M 0 stage; American Joint Committee on Cancer (AJCC) staging (2017): stage Ⅳ. Near total laryngectomy with partial suprahyoid epiglottis-preserved and selective bilateral neck dissection were performed before the anterior medial thigh flap was used to repair the circumferential defects. The flap size ranged from 6 cm×5 cm to 8 cm×6 cm. Four patients underwent adjuvant radiotherapy and chemotherapy after operation, while 1 patient did not receive any other adjuvant treatment such as radiochemotherapy. Results The flaps of all 5 patients survived without obvious neck infection. One patient developed a slight pharyngeal fistula after oral feeding at 1 month after operation, which healed after another week of gastric feeding. Primary healing also achieved in the thigh donor area. One patient had bilateral cervical lymph node metastasis, and 1 patient had lymph node metastasis on one side. The remaining 3 patients had no cervical nodes metastasis on both sides. All 5 patients were followed up 12-36 months, with an average of 27.6 months. Four patients had clear, audible, and hoarse voice while 1 patient (case 3) had pronunciation similar to whispering. Laryngoscopy showed that the reconstructed laryngeal inlet was fissure-shape and the reconstructed laryngo-trachea canal below the laryngeal inlet was gradually enlarged. At 1 month after operation, the gastric tube was withdrawn and the food was taken orally. There was no obvious aspiration pneumonia. The tracheostomy tube could be blocked in 4 patients for from 30 seconds to 3 minutes. Among them, 3 patients were able to make a noticeable pronunciation even when the tube was not blocked, and they were able to engage in barrier-free language communication; the tracheostomy tube could not be blocked in 1 patient who had a pronunciation similar to whispering. Preliminary voice analysis showed that the patients have a relaxed and natural pronunciation, without obvious breath-holding or air-swallowing movement, compared to patients with esophageal pronunciation. Decannulation did not achieved until the last follow-up in all 5 patients. Conclusion The anterior medial thigh flap can repair circumferential defects after near total laryngectomy in advanced laryngeal cancer patients and achieve satisfactory pronunciation, thus can serve as an effective pronunciation rehabilitation method. The preserved part of epiglottis may play a role to prevent postoperative aspiration.
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Affiliation(s)
- Liu Yang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Wen Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Yitao Zheng
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Lin Ji
- Department of Radiology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
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Xie J, Wu P, Liu H, Zhang S, Lu Z. Thyroid gland invasion in total laryngectomy: A systematic review and meta-analysis. Int J Surg 2022; 99:106262. [PMID: 35172203 DOI: 10.1016/j.ijsu.2022.106262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical indications remain controversial. Some researchers believe that thyroid invasion is uncommon and that thyroid preservation should be considered in most cases. OBJECTIVE This study aimed to identify the incidence and predictors of thyroid invasion in patients with laryngeal cancer to facilitate decision-making regarding whether to perform thyroidectomy during total laryngectomy. MATERIALS AND METHODS The author conducted a systematic review and meta-analysis of all published articles retrieved from a search of the MEDLINE (1982-2020) and EMBASE (1971-2020) databases. The published studies of advanced laryngeal cancer with total laryngectomy and partial or total thyroidectomy for laryngeal cancer were selected. The incidence and predictors of thyroid invasion were analyzed. RESULTS We analyzed 25 studies (2177 cases), of which 176 people (8.08%) had thyroid invasion. Subglottic tumors (odds ratio [OR], 3.74; 95% CI, 1.75-7.99), T4 stage tumors (OR, 2.39; 95% CI, 1.20-4.75), subglottic extension (OR, 3.85; 95% CI,2.09-7.11), and thyroid cartilage invasion (OR, 3.98; 95% CI, 1.47-10.75) are risk factors for thyroid invasion, and no statistically significant difference was noted between recurrent tumor and thyroid invasion. CONCLUSION The risk of thyroid invasion was significantly higher when advanced laryngeal cancer involved subglottic tumors, T4 stage tumors, subglottic extension, and thyroid cartilage invasion. The overall incidence of thyroid gland invasion was low; therefore, thyroidectomy may be performed for cases deemed risky rather than as a routine measure of total laryngectomy. RESEARCH REGISTRY UIN: reviewregistry1226.
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Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China Shantou University Medical College, Shantou, Guangdong, China The Second School of Clinical Medicine, Southern Medical University, China
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de Vincentiis M, Greco A, Campo F, Candelori F, Ralli M, Di Traglia M, Colizza A, Cambria F, Zocchi J, Manciocco V, Spriano G, Pellini R. Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals. Eur Arch Otorhinolaryngol 2022; 279:2997-3004. [PMID: 34978589 DOI: 10.1007/s00405-021-07238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. METHODS A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. RESULTS Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. CONCLUSION The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.
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Affiliation(s)
- Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.,Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Candelori
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Mario Di Traglia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Böttcher A, Betz CS, Bartels S, Schoennagel B, Münscher A, Bußmann L, Busch CJ, Knopke S, Bibiza E, Möckelmann N. Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas. J Cancer Res Clin Oncol 2021; 147:549-59. [PMID: 32809056 DOI: 10.1007/s00432-020-03352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Controversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY). METHODS Thirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival. RESULTS There was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001). CONCLUSIONS This work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.
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Subramaniam N, Balasubramanian D, Reddy R, Thankappan K, Iyer S. Organ Preservation Protocols in T4 Laryngeal Cancer: a Review of the Literature. Indian J Surg Oncol 2019; 10:149-155. [PMID: 30948891 DOI: 10.1007/s13193-018-0840-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022] Open
Abstract
Population-based studies indicate that chemoradiation has become the most popular treatment for advanced laryngeal cancers; however, by extrapolating trial results to the general population, several issues have emerged, such as reduced overall survival, non-functional laryngeal preservation, and poor response to treatment. Although included in these trials, T4 laryngeal and hypopharyngeal cancers with cartilage invasion formed a small percentage of these patients and questions over whether they were appropriately staged remain unanswered. Literature on the use of chemoradiation in this set of patients, including the challenges, treatment considerations, and factors predicting response to treatment and outcomes, was reviewed. Current evidence indicates that all patients of T4 laryngeal and hypopharyngeal cancer are not suitable candidates for organ preservation; this modality should be offered only to select patients with good performance status and access to rehabilitative care and regular follow-up in order to achieve good results.
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Affiliation(s)
- Narayana Subramaniam
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rithvik Reddy
- 2Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Krishnakumar Thankappan
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Eskander A, Blakaj DM, Dziegielewski PT. Decision making in advanced larynx cancer: An evidenced based review. Oral Oncol 2018; 86:195-9. [PMID: 30409301 DOI: 10.1016/j.oraloncology.2018.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
Organ preservation versus total laryngectomy for advanced laryngeal cancer continues to be hotly debated. This review presents evidence-based decision making points for these patents.
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Sanabria A, Chaves ALF, Kowalski LP, Wolf GT, Saba NF, Forastiere AA, Beitler JJ, Nibu KI, Bradford CR, Suárez C, Rodrigo JP, Strojan P, Rinaldo A, de Bree R, Haigentz M Jr, Takes RP, Ferlito A. Organ preservation with chemoradiation in advanced laryngeal cancer: The problem of generalizing results from randomized controlled trials. Auris Nasus Larynx 2017; 44:18-25. [PMID: 27397024 DOI: 10.1016/j.anl.2016.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The primary goal of treatment in advanced laryngeal cancer is to achieve optimal oncologic outcomes while preserving function and quality of life. Combination of chemotherapy and radiation has been popularized as an alternative to surgery for patients facing total laryngectomy. However, survival analyses from large, population-based databases have not duplicated results reported from randomized trials. METHODS A comprehensive literature review was undertaken to try to better understand the reasons why results differ among randomized trials and population cohort studies. RESULTS A variety of reasons are discussed, including differences in patient staging, selection bias, complexity bias, inconsistent terminology, patient compliance and treatment expertise. CONCLUSIONS Personalized treatment considering all factors is critical for optimal outcomes. In general, evidence supports total laryngectomy for patients with T4 cancers. Definitive chemoradiotherapy strategies are acceptable alternatives for T3 cancers, provided that all resources for the administration of the treatment, follow-up and surgical salvage are available.
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Abstract
Background: Advanced laryngeal cancers presenting with upper airway obstruction are a common scenario in Sub-Saharan Africa, requiring operative intervention as a priority. Objective: To assess outcome of total laryngectomy as a treatment option in the surgical management of advanced laryngeal cancers in a tertiary health institution in northwestern Nigeria. Materials and Methods: A retrospective analysis of total laryngectomies for laryngeal cancers carried out by one surgeon from December 2000 to August 2009. Results: Out of 30 patients with histologically diagnosed laryngeal cancer, 18 were treated with total laryngectomy Fourteen (77.8%) were males, while 4 (22.2%) were females, with a male-to-female ratio of 3.5:1. The age range was 20-70 years with a mean age of 47years for males and 33.8 years for females. Total laryngectomy was carried out on T4 lesions (100%), with preoperative tracheostomy (100%) carried out as an emergency measure to relieve upper airway obstruction. Two female patients had safe vaginal deliveries after their surgeries. Although all patients were referred for radiotherapy, only 6 (33.3%) patients could afford postoperative radiotherapy, with a 5-year survival rate of 33.3%; while all others could not afford the cost of radiotherapy treatment, which was to be carried out at a center about 5 hours drive away from our center. Seven (38.9%) patients presented with recurrent neck nodal disease, while 3 (16.7%) had carotid blow-out hemorrhage that was fatal. Conclusion: Total laryngectomy remains an important surgical modality of treatment for advanced laryngeal cancers, as it affords the patient an opportunity of longer survival when combined with postoperative radiotherapy. It is superior to ‘radiotherapy only’ or ‘surgery only’ or nothing.
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Affiliation(s)
- Kufre Iseh
- Department of Otorhinolaryngology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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