Cricohyoidopexy Research Articles

Oncological outcomes of surgical management for T2N0M0 glottic laryngeal squamous cell carcinoma

AbstractObjectivesThe research aimed to evaluate the clinical treatment outcomes of T2N0M0 glottic laryngeal squamous cell carcinoma (LSCC) patients who underwent laryngectomy.MethodsRetrospective review of 533 T2N0M0 glottic LSCC patients.ResultsFive‐year cancer‐specific survival (CSS) rate was 90.0%, and the overall survival (OS) rate was 89.1%. No statistically difference was found between the patients who have undergone total laryngectomy (5‐year disease‐free survival[DFS] = 80.7%, and the CSS = 86.7%) and those who have had partial laryngectomy (the 5‐year DFS = 85.3%, and CSS = 91.1%). There was no difference in the CSS and DFS rates between patients with negative margins and those with positive margins following postoperative radiotherapy (PORT) ± chemotherapy (the CSS: 90.8% vs. 81.8%, p = 0.458 and 5‐year DFS: 84.6% vs. 79.5%, p = 0.371). Patients who underwent vertical partial laryngectomy (VPL) had better survival (5‐year OS was 91.9%, and the CSS was 92.8%) than those who underwent cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) (the 5‐year OS = 83.8%, p = 0.022 and CSS = 84.9%, p = 0.038).ConclusionsSurgery remains the gold standard for treating T2N0M0 glottic LSCC patients because it can achieve satisfactory oncological outcomes. Regarding the systemic conditions, the effect of partial laryngectomy is similar to that of total laryngectomy. Moreover, partial laryngectomy preserves the function of the larynx. VPL may be superior to CHP/CHEP, depending upon the invasiveness of the tumor.

Partial Horizontal Supracricoid Laryngectomy: Which Factors Impact on Post-decannulation Swallowing Outcomes? A Prospective Single-Center Experience.

Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term.

Laryngectomie partielle horizontale supra-cricoïdienne avec reconstruction : Technique, indications et résultats à l’Hôpital Principal de Dakar

OBJECTIVE: To report technique, indications and outcomes of supracricoid partial laryngectomy (SPL) with crico-hyoido-epiglottopexy (CHEP) or crico-hyoidopexy (CHP) for laryngeal cancers at Hôpital Principal de Dakar. MATERIALS AND METHODS: Retrospective study carried out from January 2009 to December 2016 in the ENT department of Hôpital Principal de Dakar including all patients who underwent SPL with reconstruction for laryngeal cancer. RESULTS: Six patients underwent SPL with CHEP or CHP for laryngeal squamous cell carcinoma. The lesions were classified as T1, T2 or T3. Functional outcomes were simple with normal swallowing and satisfactory voice quality. One patient presented with a local recurrence that motivated total salvage laryngectomy. CONCLUSION: SPL with reconstruction is a good alternative in the management of limited laryngeal cancers. It gives good oncological outcomes while preserving laryngeal functions. However, candidates must be selected and the technique rigorous. KEYWORDS: Cancer; Larynx; Partial laryngectomy; crico-hyoïdo-epiglottopexy; crico-hyoïdopexy.

COMPARISON OF SWALLOWING IN DIFFERENT TYPES OF PARTIAL LARYNGECTOMIES

Objective: We designed this study to assess and compare the effects of different partial laryngectomy (PL) techniques on swallowing. Material and Methods: Ten patients had laryngofissure with cordectomy, ten had frontal anterior laryngectomy with epiglottic reconstruction (FAL), ten had frontolateral laryngectomy (FLL), ten had cricohyoidopexy (CHP), ten had cricohyoidoepiglottopexy (CHEP), and ten had supraglotic laryngectomy. Swallowing was assessed with flexible endoscopy. Results: Mild or moderate dysphagia for solid foods was discovered significantly more often in CHP patients compared to FLL and FAL (p<0.05) patients. Dysphagia discoveries for semi-solid and liquid food didn’t significantly differ among PL’s (p>0.05). Compared to other PLs, the penetration-aspiration test with 10 ml of water was distinctly lower in cordectomy and FLL patients (p<0.05). Conclusion: Penetration and aspiration with 10 ml of water was marked lower in cordectomy and FLL patients matched to other PL patients. With studies involving more patients, it will be possible to increase the evidence value of our results.

Reconstruction of Tracheal Defect by Sternocleidomastoid Muscle Flap Covered with Skin Graft: A Case Report

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft. Key Words: Tracheal defect, Reconstruction, SCM muscle flap

The oncologic and functional outcomes of supracricoid partial laryngectomy for the treatment of laryngeal cancer

Objective: To evaluate the oncologic and functional outcomes of laryngeal squamous cell carcinomas treated by supracricoid laryngectomy. Methods: The clinical data of 134 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) between July 2005 and April 2014 at Shandong Provincial ENT Hospital were retrospectively reviewed. Ninety-one patients including 31 cases of stage Ⅰ, 36 of stage Ⅱ, 18 of stage Ⅲ and 6 of stage Ⅳ underwent CHEP and 43 patients underwent CHP. Two patients received CHEP due to recurrence after open surgery and laser surgery. Three patients received CHP due to the recurrence of disease after open surgery and postradiotherapy persistence of disease. The Kaplan-Meier method was used to calculate the 3-year and 5-year survival rates. The Chi-square test was used to compare the survival rates between different surgical procedures. Results: All 91 patients who underwent CHEP had successful removals of PEG tubes, and 88 (96.7%) of them had tracheostomy tube decannulation. Among 43 patients with CHP, 42(97.6%) cases removal of PEG tubes(97.6%), including and 40(93.0%) cases with tracheostomy tube decannulation. There was one patient with local recurrence in all cases. In CHEP group, 3-year local control rate was 98.2%; 3-year and 5-year overall survival rate were 94.5% and 93.9%, respectively. In CHP group, 3-year local control rate was 97.6%; 3-year and 5-year overall survival rates were 86.0% and 83.3%, respectively. Pharyngeal fistula appeared in 2 cases of CHEP group and 4 cases of CHP group, and all of them were cured by conservative treatment. Conclusion: Supracricoid laryngectomy shows excellent oncologic and functional results for treatment of laryngeal cancer while maintaining laryngeal functions, especially in terms of local control rate and tracheostomy tube decannulation.

Outcome of supracricoid laryngectomy in moderately advanced cancer larynx

Objective To assess the oncological outcomes of supracricoid laryngectomy in moderately advanced laryngeal cancer. Background Recently supracricoid partial laryngectomy (SCPL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) and other surgical laryngeal preservation protocols have undergone major advancement to treat early and moderately advanced laryngeal tumors. SCPL with CHEP and CHP preserves the airway and laryngeal sphincter function with considerable decrease in the amount of risk of aspiration. Patients and methods A total of 10 patients with moderately advanced laryngeal squamous cell carcinoma (T2b toT4a) who were fit for surgery were recruited from two different specialized care centers in Egypt and India from January 2017 to January 2018. Patients with interarytenoid area involvement, cricoarytenoid joint involvement, pre-epiglottic space invasion, or subglottic extension were excluded. Results Patients were mainly T3 (four patients). They underwent SCPL with CHP in four cases and with CHEP in six cases. Preservation of one arytenoid was done in nine patients. The local control rate was 100%. Aspiration occurred in two cases. Both pexy rupture and salivary fistula occurred in one case. Removing of nasogastric tube and decannulation of tracheostomy were done in seven and six cases, respectively, before 1 month. Conclusion SCPL with CHEP and CHP was an effective treatment option with excellent oncological outcomes for T2b–T4a laryngeal cancer. Specific efficacy was revealed in cases with anterior commissure or paraglottic space involvement. Low rate of complications was reported in our study.

Renesans of supracricoid partial laryngectomy with crico-epiglotto-hyoidopexy or with crico -hyoidopexy – is it possible? Literature rewiev

Supracricoid partial laryngectomy (SCPL) with crico-epiglotto-hyoidopexy (CHEP) or crico- hyoidopexy (CHP) is technically difficult. Although SCPL is effective in patients with laryngeal cancer, postoperative rehabilitation of speech and swallowing is needed for good functional outcomes. We discuss what patients can benefit from SCPL, with CHEP or CHP, and when these procedures are contraindicated.

Supracricoid laryngectomy for recurrent laryngeal cancer after chemoradiotherapy: a systematic review and meta-analysis.

SUMMARYResidual or recurrent laryngeal cancer after irradiation is a difficult clinical problem with a rate that ranges from 13% to 36% of cases. Supracricoid laryngectomy (SCL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) provide reliable oncological and functional results for selected primary and recurrent patients with glottic and supraglottic carcinomas. We conducted a systematic review and meta-analysis to assess the oncological and functional outcomes of patients treated with open partial horizontal laryngectomy types IIa and IIb (CHEP, CHP) in terms of the recurrence of squamocellular cancer of the larynx after radiotherapy failure. The databases searched included MEDLINE, PubMed and EMBASE (from January 1990 to December 2015, English language). The meta-analysis was performed with a mixed random effects model using the DerSimonian and Laird method. The heterogeneity was measured with the I2 statistic. Fourteen papers out of 276 were included and comprised a total of 291 patients. The five-year overall survival was 80.2% (CI 0.719-0.885; I2 = 62%; p = 0.003), and the 5-year disease-free survival was 89.5% (CI 0.838-0.952; I2 = 52%; p = 0.022). The indications for SCL after the failure of radiation therapy (RT) were similar to those specified for previously untreated patients. We therefore hypothesised that careful assessment of tumour extension might be responsible for the high 5-year OS and 5-year DFS. The early postoperative recovery outcomes indicated that the mean time until decannulation was 35.6 days (CI 24.3-46.9; I2 = 95%; p < 0.001), and the mean time until nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) removal was 28.3 days (CI 22.7-33.8; I2 = 86%; p< = 0.001). These data are according to authors who prefer the initial removal of the NGT and the initiation of oral alimentation with a tracheostomy tube to protect and clean the airways and permit the suction of any residual food that might be present.

Re-Evaluation of Open Partial Horizontal Laryngectomies at Our Institution According to the New Classification Recommended by the European Laryngological Society.

The aim of this study was to re-evaluate the open partial horizontal laryngectomies (OPHLs) performed at our institution in terms of the new classification of the European Laryngological Society and compare the differences with the new classification system. A retrospective analysis of 45 patients diagnosed with T1b, T2, and T3 laryngeal carcinoma who were treated with OPHLs in our department between 2010 and 2016 were conducted. All supraglottic laryngectomies (31 operations) were classified as OPHL Type 1. Among these, 11 operations required a resection of an additional structure including arytenoid (ARY) in five operations, piriform sinus (PIR) in four operations, the base of tongue (BOT) in one surgery, and ARY + PIR in one patient. Five supracricoid laryngectomies with cricohyoidoepiglottopexy (CHEP), five supracricoid laryngectomies with cricohyoidopexy (CHP), and four near-total laryngectomy operations constituted Type 2 OPHL (7 operations) and Type 3 OPHL (7 operations). Among these operations, two were classified into Type 2b OPHL and four into Type 3b OPHL as the superior margin of incision included epiglottis. We consider that, this new classification, because it allows understanding the content of the surgery from the related title, will be useful in comparing different series and techniques.

Post-Surgical and Oncologic Outcomes of Supracricoid Partial Laryngectomy: A Single-Institution Report of Ninety Cases

Objective: The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). Methods: 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Results: Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Conclusions: Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.

Phonatory Activity after Supracricoid Partial Laryngectomy

Phonatory Activity after Supracricoid Partial Laryngectomy Aim of this study is to evaluate the phonatory activity following reconstructive laryngectomy and the real recovery possibilities offered by rehabilitation techniques. We examined 24 patients treated with partial laryngectomy (14 males and 10 females, between the ages of 50 and 64 years, mean age of 56) with deglutition and voice difficulties after surgery. 14 patients had undergone cricohyoidoepiglottopexy (CHEP), with preservation of a single arytenoids. 10 subjects had undergone cricohyoidopexy (CHP), with preservation of a single arytenoid. Before and after speech therapy, each subject underwent laryngostroboscopy with flexible endoscope, spectography and aerodynamic evaluations. Each subject was asked to complete the questionnaire of voice perceptual self-evaluation: Voice Handicap Index (VHI). Our experience shows how substitution voice in supracricoid laryngectomy is characterized by remarkable noise quality (in the CHEP the phonatory duration was 8.8 sec, subglottic pressure 14.21 cm H2O, phonatory flow 0.336 l/sec instead in the CHP the phonatory duration was 8.5 sec, the subglottic pressure 6.46 cm H2O and the phonatory flow 0.289 l/sec). This causes a clearly difficult voice recovery, especially from a psychological point of view. In addition to evaluate verbal intelligibility, the speech therapist has to consider that it can be difficult for the patient to accept his/her new vocal timbre.

Analyses of functional and oncologic outcomes following supracricoid partial laryngectomy.

To review the functional and oncologic outcomes of patients who received supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) in our institution. A total of 208 patients who received SCPL with CHEP or CHP from our institution from 1995 to 2007 were involved. Among them, 190 cases were patients with squamous cell carcinoma of the larynx (T1-T4, N0-N2), 14 cases were patients with recurrent larynx cancer and 4 cases were patients with laryngeal stenosis. Forty-four patients also received unilateral neck dissection, and 41 patients received a bilateral neck dissection. All patients were assessed at functional outcome and complications of their treatment. Also, the oncologic outcomes, such as disease-specific survival, total survival, and local recurrence, were measured for patients with tumor. Decannulation was achieved in nearly all patients, with the average time to decannulation being 20 ± 11.52 days in CHEP patients and 28 ± 8.92 days in CHP patients (P < 0.05). The average nasogastric tubes were removed, days postoperation, was 18 ± 7.39 days in CHEP patients and 25 ± 13.87 days in CHP patients (P < 0.05). The 5-year local recurrence rate was 5.77%, the 5-year disease-specific survival was 82.7%, and the 5-year overall survival was 84.1%. The patients with CHEP had a better recovery than the patients with CHP. SCPL was a well-tolerated procedure with generally good functional outcomes for patients with advanced laryngeal cancer, also for some patients with laryngeal stenosis.

Relationship between preepiglottic space invasion and lymphatic metastasis in supracricoid partial laryngectomy with cricohyoidopexy.

ObjectivesThe aim of this study was to determine the role of preepiglottic space (PES) invasion in lymph node metastasis and prognosis in patients undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidopexy (CHP).MethodsA retrospective review of 42 previously untreated patients with squamous cell carcinoma of the larynx that underwent surgery was performed. The mean age of the subjects was 61.3 years, and the male-to-female ratio was 38:4. Regarding their pathological stages, there were 3, 8, 22, and 9 cases of stage T1 to T4, respectively. Concerning the disease stage of the cervical lymph nodes, there were 30, 5, 6, and 1 cases with N0 to N3, respectively.ResultsThe PES invasion rate was 23.8% (10/42). Significant correlations were found between PES invasion and cervical lymph node metastasis (P=0.002). Seven of the 10 patients (70.0%) with PES invasion had cervical lymph node metastasis, whereas only 5 of the 32 patients (15.6%) without any evidence of PES invasion had lymph node metastasis. There was also a significant correlation of PES invasion with age (P=0.002) and T stage (P=0.030). However, there was no significant relationship between gender, primary tumor site, anterior commissure invasion, subglottic extension, paraglottic space invasion and PES invasion. There was a 5-year disease-specific survival of 70%. PES invasion served as a statistically significant prognostic factor for disease-specific survival (P=0.004). Cervical nodal metastasis (P=0.003) and subglottic extension (P=0.01) were also statistically significant prognostic factors associated with disease-specific survival.ConclusionThe PES invasion was significantly related to the cervical lymph node metastasis and prognosis in patients undergoing SCPL with CHP.

Factors associated with supracricoid laryngectomy functional outcomes

Supracricoid partial laryngectomy (SCPL) is an option for laryngeal cancer resection that preserves laryngeal function; however, little information exists regarding factors that are associated with functional outcomes. A medical chart review was performed on patients that underwent SCPL at our institution between 2006 and 2011. Data were collected on surgical, voice, and swallowing outcomes. Eighteen patients were identified. Thirteen underwent cricohyoidoepiglottopexy (CHEP) and 5 had a cricohyoidopexy (CHP). Mean follow-up was 737 days. On average, decannulation occurred at 27.4 days and feeding tube removal at 87.9 days postoperatively. Sixty-seven percent of patients tolerated an unrestricted diet at follow-up. Increased age and a CHP procedure were associated with negative outcomes. Age may be a proxy for more extensive disease and prior treatments. Patients who undergo an SCPL require extensive rehabilitation after surgery. Those who have undergone multiple cancer interventions and have more extensive surgery may be at risk for poorer outcomes.

Comparison of total laryngectomy with surgical (cricohyoidopexy) and nonsurgical organ‐preservation modalities in advanced laryngeal squamous cell carcinomas: A multicenter retrospective analysis

Functional outcome and quality of life (QOL) have become relevant endpoints in the field of laryngeal oncology, leading to the emergence of organ-preserving strategies. The medical records of 166 patients with advanced (stages III and IV) laryngeal squamous cell carcinoma (SCC) who were treated with a total laryngectomy, radiochemotherapy, or cricohyoidopexy (CHP) were reviewed. In the whole series, no statistically significant differences among the 3 treatment arms with respect to the overall survival (OS) and disease-specific survival (DSS) rates were observed. The organ-preservation rate was 45% for radiotherapy and 76.7% for CHP (p = .0002). Among the cT4a cases, a longer survival was observed for the patients treated with total laryngectomy (3 yr-OS = 78% vs 68% for CHP and 54% for radiochemotherapy, p = .031). In advanced laryngeal SCC, CHP shows survival rates comparable to those of radiochemotherapy and a higher larynx-preservation rate, although it may not replace radiochemotherapy because it can be recommended only in selected cases.

Ｓｕｐｒａｃｒｉｃｏｉｄ ｌａｒｙｎｇｅｃｔｏｍｙ５０症例の臨床的検討

An analysis of clinical data on 50 patients undergoing supracricoid laryngectomy (SCL) between 1997 and 2008 i.e., cricohyoidoepiglottopexy (CHEP) in 47 and cricohyoidopexy (CHP) in 3 cases showed that the number of SCL cases operated on within a year surpassed that of Total Laryngectomy after 2003. Selection criteria included performance status 0-1 and blood gas PO2>80 torr, especially in those patients over 70-years-old. Postoperative wound infection occurred in 16 patients (32%), with four requiring additional surgical intervention (two ruptured pexis and two chondritis induced by C3-C4 osteophytes). A history of radiotherapy and systemic complications, i.e., diabetes and renal failure, added to the risk of wound infection. Introducing a clinical pathway shortened hospitalization. Vocal function was achieved in 96% and swallowing function in 89% of patients. Five-year crude survival in CHEP was 69% and in TL 51%. Laryngeal preservation was 70%, increasing to 89% after the introduction of SCL. SCL-CHEP is thus indicated for unfavorable T2 (ASCO 2006), well-selected T3, T4, and rT1-4 (radiation failures). Effort should emphasize a good balance in prognosis and function in organ preservation for laryngeal cancer.

Supracricoid partial laryngectomies after radiation failure: A multi‐institutional series

Radiation therapy (RT) is one of the gold standard treatments for early laryngeal cancer, and total laryngectomy is still the most applied surgical procedure after failure. Selected recurrences can be managed by supracricoid partial laryngectomies (SCPLs). A multi-institutional retrospective analysis was carried out in 78 consecutive patients treated by SCPLs for the recurrence of glottic-supraglottic cancer after RT. Cricohyoidoepiglottopexy was performed in 62, and cricohyoidopexy (CHP) in 16 cases. Disease-free survival at 3 and 5 years were 95.5%. Early and late postoperative complications occurred in 27% and 17.9% of cases. Decannulation and satisfactory swallowing were achieved in 97.4% of cases. SCPLs represent effective surgical organ-preservation strategies in the treatment of selected recurrences after RT failure, resulting in a good local control as well as functional recovery with acceptable morbidity, despite a complication rate which is not negligible.

Supracricoid laryngectomy with cricohyoidoepiglotto-pexy or cricohyoido-pexy: Experience on 32 patients

Objective Supracricoid laryngectomy (SCL) with Cricohyoidoepiglotto-pexy (CHEP) or Cricohyoido-pexy (CHP) is an organ preservation surgery indicated for early and selected advanced laryngeal cancers. To verify the clinical usefulness of supracricoid laryngectomy versus total laryngectomy, a retrospective review was conducted. Methods We summarized the clinical and postoperative data of 32 patients who received SCL over the past 9 years (1997–2005). Five-year survival rate of the SCL patient group (29 cases) was compared with that of the patient group receiving total laryngectomy (35 cases) within the same period. Results Wound infection was detected in 12 patients (38%). Those with severe infection, which required surgical intervention, included two cases of ruptured pexis and two cases showing cricoid cartilage necrosis induced by Forestier disease. There were two T4 cases that resulted in extensive excision. In one case, excision involved the posterior part of the cricoid cartilage resulting in insufficient closure of the neoglottis; the patient received total laryngectomy 30 months after SCL–CHEP because of persistent aspiration of liquid diet. In the other T4 case, the tumor invaded the thyroid and arytenoid cartilages but not the cricoid cartilage. Reposition of the remaining corniculate cartilage resulted in sufficient closure of the neoglottis; this patient subsequently acquired satisfactory laryngeal function. The 5-year overall survival rate was 86% for SCL group and 61% for the total laryngectomy group (limited to Stages III and IV glottic cancers). The causes of the four deaths were distant metastasis, neck metastasis, and intercurrent disease, respectively. Two patients are alive with distant disease. Conclusion Through our experience in this series, the functional and oncological results of SCL showed certain advantages over those of total laryngectomy. Particularly, the clinical impact of SCL–CHEP was impressive; this technique needs is recommended to both head and neck surgeons and patients.

Supracricoid Laryngectomy Outcomes: The Johns Hopkins Experience

To report the oncologic and functional results from our experience in performing supracricoid laryngectomy (SCL) for selected patients with laryngeal cancer. Retrospective chart review. Twenty-four consecutive patients who underwent SCL for laryngeal cancer in our institution from December 2000 to March 2006 have been reviewed. Reports of the site and extent of tumor, type of reconstruction, preoperative or postoperative radiotherapy, and the final histopathologic examination were reviewed. In addition, the reports of the preoperative examination, inpatient course, and postoperative follow-up were reviewed. A total of 24 patients were involved in the study; 19 had tumors involving the glottic region, and 5 patients had tumors involving both the glottic and supraglottic regions (transglottic). Ten patients had their SCL for postradiotherapy recurrence/persistence of disease. Eighteen patients underwent reconstruction through cricohyoidoepiglottopexy (CHEP), whereas six patients had cricohyoidopexy (CHP). Eleven patients had an arytenoid cartilage resected; 8 of 11 had CHEP, and 3 of 11 had CHP. All patients had a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement performed at the same time as the SCL. The median hospital stay period was 6 days. Twenty-three of 24 had successful tracheostomy tube decannulation, with a median time to decannulation of 37 days. The median time to removal of the PEG tube was 70 days. The complications with SCL were postoperative wound infection in two patients (SCL/CHP) and the need for completion total laryngectomy secondary to intractable aspiration in one patient with SCL/CHP. One patient with SCL/CHEP had a ruptured pexy and subsequently underwent a second reconstruction with successful tracheostomy and PEG tube removal. One of 24 patients is still PEG tube dependant, and he had postoperative radiotherapy. Fifteen patients underwent concurrent neck dissection. None of the patients had any local or regional recurrence, with a median follow-up period of 3 years. All final surgical margins were negative for tumor invasion. Three patients had postoperative radiotherapy, two patients because of nodal metastases in the excised lymph nodes and one because of perineural invasion on final histopathologic examination of the SCL specimen. There were no perioperative deaths. SCL with CHEP or CHP represents an effective technique that can be taught and effectively used to avoid a total laryngectomy while maintaining physiologic speech and swallowing in selected patients with advanced stage primary laryngeal cancer or recurrent/persistent laryngeal cancer after radiotherapy. There is a good functional recovery with acceptable morbidity and an excellent oncologic outcome when strict selection criteria are applied and a formal swallowing rehabilitation program is followed.