Results of supraglottic partial horizontal laryngectomies

Abstract

Supraglottis is a part of larynx comprising two subregions: epilarynx (suprahyoid epiglottis--including lingual and laryngeal surface, aryepiglottic folds--laryngeal surface, and arytenoids) and supraglottis without epilarynx (infrahyioid epiglottis and ventricular folds). A total of 234 patients with supraglottic squamous cell carcinoma undergoing primary surgery were analyzed in the period 1976-1996. The tumor was localized in epilarynx in 84 (25%) patients, and in supraglottis without epilarynx in 261 (75%) cases. T1 tumor was present in 145 (42%) patients, T2 tumor was found in 178 (52%) patients, while T3 was reported in 22 (6%) cases. Clinically negative neck (N0) was found in 290 (84%) patients, and palpable metastases (N1) manifested in 55 (16%) cases. Local recurrences were established in 18 (5%) patients, and subsequent postoperative cervical metastases were found in 45 (13%) cases. Five-year disease-free survival was reported in 76% (262/345) of patients. Nasogastric tubes were removed in all patients approximately 12 days following surgery. 27 patients developed laryngeal stenosis and only 2 patients were not decannulated. Voice and speech functions were satisfactory. Supraglottic laryngectomy, extended supraglottic laryngectomy is fully justified from oncological and functional aspects. Selective neck dissection in N0 cervical findings provides detection of occult metastases and indicates need for postoperative radiotherapy. Oncological and functional results of supraglottic laryngeal surgery, along with simultaneous treatment of neck by selective, modified radical neck dissection and postoperative radiotherapy offer hope for treatment of supraglottic laryngeal cancer.