312. Is tumour thickness a better prognostic indicator than the TNM staging in the cancer oral tongue? Our experience

Abstract

S S123 Background: Near total laryngectomy (NTL), a voice preserving dynamic tracheopharyngeal shunt procedure, is an alternative to total laryngectomy in selected laryngeal & hypopharyngeal cancers, but has not gained wide acceptance due to perceived fear of surgical complexity. We report our institutional experience with NTL during last 16 years. Material & methods: A retrospective analysis was carried out from Feb 1998 to Apr 2014. We studied 63 patients who underwent NTL with respect to complications, functional results & survival outcome. Survival was analysed using Kaplan-Meier method. Results: Sixty two male patients & one female patient with median age of 56 years were studied. Two patients died in postoperative period (Postop day 6 & 26) due to cardiopulmonary event. Median hospital stay was 12 days (range 6-58 days). Pharyngocutaneous fistula was most common complication (25 of 63 patients, 39.6%) & most (20 of 25) were managed conservatively with five patients requiring surgical intervention. Other complications wereaspiration in eight patients (12.7%); wound infection or dehiscence in 5 patients (7.9%); shunt stenosis in 2 patients (3.2%); tracheostoma narrowing in 5 patients (7.9%) with four patients requiring stomal refashioning; chyle leak in one patient (1.6%). Good quality speech was attained by 43 patients (68.2%); 10 patients (15.8%) had fair quality voice; 4 patients (6.3%) obtained bad voice; 5 patients (7.9%) did not develop speech at all. Fifty patients (79.3%) developed normal swallowing function; 12 patients (19%) developed dysphagia due to neopharyngeal stricture but all were managed successfully with dilatation. Ten patients (15.8%) had neck recurrence (4 salvaged with surgery); 5 patients (7.9%) had local recurrence (one salvaged with surgery); 4 patients (6.3%) developed distant metastasis (3 pulmonary & one spinal); 2 patients (3.2%) developed new primary (1 base tongue & other tonsil/ soft palate). Two-year and 5-year disease free survival was 66.1% and 51.2% respectively. Conclusion: NTL is an oncologically acceptable alternative to total laryngectomy for selected group of lateralised laryngeal and hypopharyngeal cancer. It gives good functional results with normal swallowing and physiologic maintenance free speech in majority of patients. Most of the complications are well tolerated and can be managed conservatively. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.304 Table 1. Survival Analysis at 18 months