Analiza 191 pacjentów z rakiem krtani w oparciu o nową klasyfikację otwartych poziomych laryngektomii częściowych według Europejskiego Towarzystwa Laryngologicznego z 2014 roku

Abstract

Aimof study was to present material of open partial horizontal laryngectomies (OPHL) in T1b, T2 and T3 larynx cancer treatment in single tertiary referral institution. Material and MethodsRetrospective analysis of operating protocols in patients treated in Poznań ENT University Department between 2000–2012 with glottis (T1b – 185, T2 – 185, T3 – 231) and supraglottis tumors (T1 – 80, T2 – 104, T3 – 206), potentially available for organ preservation treatment. Transoral laser microsurgery, OPHL, radiotherapy and total laryngectomy were treatment options in 210, 191, 271 and 326 patients respectively. OPHL was applied in glottic tumors: 21 – T1b, 103 – T2, 27 – T3 and in supraglottic tumors: 4 – T1, 29 – T2. All procedures were re-evaluated acc. to European Laryngogical Society working committee on nomenclature new classification presented in 2014. ResultsThere was no discrepancies in supraglottic laryngectomies (4 cases), classified as OPHL Typ I. All the rest: 84 transglottic, 96 supracricoid with CHEP and 7 supracricoid with CHP laryngectomies were re-classified into Typ II (172) and Type III (15) OPHL. Thus, revision of inferior incision changed classification of procedure into supratracheal laryngectomy in 15 cases. Transglottic laryngectomies, in which upper part of thyroid cartilage was preserved and crito-thyreo-pexy was performed (84 pts), have not been distinguished any more. In 7 cases superior incision included epiglottis; thus 165 patients were distinguished as Typ II a and 7 patients as Typ IIb OPHL. The most pronounced difference was stated in description of structures additionally included into surgical specimen: arytenoid (+ARY) in 24, crico-arytenoid-unit (+CAU) in 5 and piriform sinus (+PIR) in 17 cases; none had the base of tongue (+BOT) resected. ConclusionsIn 36/191 additional structures and in 15/191 the cricoid ring resection was re-evaluated and pointed out. All these data were available retrospectively in the operating protocols but not pronounced in surgery headlines. Thanks to the univocal, simple new classification all operation details can be included into operation title.