Surgical salvage for postoperative recurrence of laryngeal cancer and the limit of its possibility (author's transl)

Abstract

Local recurrence after partial laryngectomy is usually controled by total laryngectomy. Recurrence in the neck as a metastasis to the cervical lymph node is also to be salvaged by neck dissection. Besides these common types of local recurrence, there are some annoying cases such as; 1, recurrence in the hypopharyngeal cavity after total laryngectomy, 2. recurrence which is close to and invades into the hypopharyngeal wall after total laryn-gectomy, 3. recurrence combined with severe necrosis including the skin after total laryngectomy, 4. stomal recurrence, 5. stenosis in the subglottis and in the cervical trachea after hemilaryngectomy due to recur-rence mostly in the thyroid gland or in paratracheal lymph nodes, 6. recurrence in the base of the tongue after total or supraglottic laryngectomy, and 7. recurrence in the parotid region after neck dissection. For the treatment of these troublesome recurrences, radiation combined with chemotherapy is not indicated, since tissues containing tumor cells are cicatrically anoxic and do not respond well. Wide field resection and primary reconstruction of the defect should be advisable in as early stage as possible. Careful consideration to the possibility of complete resection, however, should be given in every case before decision of definitive surgery. Detailed examinations to qualify whether the tumor spreads into the mediastinum, prevertebral soft tissues or the oropharynx are essential for identifying the limit of surgical procedure. Some clinical problems are shown and discussed with several case reports.