Horizontal Partial Laryngectomy Research Articles

The Chaperone System in Tumors of the Vocal Cords: Quantity and Distribution Changes of Hsp10, Hsp27, Hsp60, and Hsp90 during Carcinogenesis

Laryngeal squamous cell carcinoma (LSCC) constitutes a noteworthy subset of head and neck cancers, contributing to about 4.5% of all malignancies. Its clinical behavior and characteristics exhibit variations contingent upon the specific anatomical site affected, with the glottis, supraglottis, and subglottis emerging as the most prevalent locations. Notably, squamous cell carcinoma represents a predominant histological type, accounting for 85% to 95% of all laryngeal cancers. The gender disparity is evident, with a higher incidence among males, exhibiting a ratio of 3.9:1. Moreover, disparities among racial groups are observed, as African American patients tend to manifest the condition at a younger age, coupled with lower overall survival rates compared to their Caucasian, Hispanic, and Asian counterparts. The primary etiological factors implicated in the onset of laryngeal cancer are tobacco and alcohol consumption, with a direct correlation to the intensity and duration of usage. Importantly, the risk diminishes gradually following cessation, necessitating a substantial period of at least 15 years for a return to baseline rates. Given the diverse nature of laryngeal SCC, treatment modalities are tailored based on the specific site and stage of the disease. Therapeutic interventions, such as radiotherapy, transoral laser microsurgery, open horizontal partial laryngectomy, or total laryngectomy, are employed with the overarching goal of preserving organ function. This study delves into the intricate realm of laryngeal SCC, specifically exploring the involvement of heat shock proteins (HSPs) in disease progression. This research meticulously examines the expression levels of Hsp10, Hsp27, Hsp60, and Hsp90 in dysplastic and benign tissue samples extracted from the right vocal cord, utilizing immunohistochemistry analysis. The focal point of the investigation revolves around unraveling the intricate role of these molecular chaperones in tissue differentiation mechanisms and cellular homeostasis, particularly within the inflammatory milieu characteristic of the tumor phenotype. The findings from this study serve as a robust histopathological foundation, paving the way for more in-depth analyses of the underlying mechanisms governing the contribution of the four chaperones to the development of squamous cell carcinoma in the larynx. Additionally, the data gleaned from this research hint at the potential of these four chaperones as valuable biomarkers, not only for diagnostic purposes but also for prognostication and ongoing patient monitoring. As our understanding of the molecular intricacies deepens, the prospect of targeted therapeutic interventions and personalized treatment strategies for laryngeal SCC becomes increasingly promising.

Clinical analysis of 12 cases of laryngeal neuroendocrine carcinoma

Objective: To investigate the clinical and pathological features, treatments and prognosis of laryngeal neuroendocrine carcinoma (LNEC). Methods: We conducted the retrospective analysis of the clinical data of 12 patients with LNEC admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Second Hospital of Shanxi Medical University from May 2014 to December 2021, including 9 males and 3 females, aged 50-77 years. There were 4 cases of typical carcinoid tumour (highly differentiated), 5 cases of atypical carcinoid tumour (moderately differentiated) and 3 cases of neuroendocrine small cell carcinoma (hypofractionated). The clinical features, diagnosis, treatment and prognosis of LNEC were analysed. Results: The clinical manifestations of LNEC varied according to the tumour type but did not correlate with the pathological types. The supraglottic type was characterized by sore throat, foreign body sensation in the pharynx, coughing, obstructive sensation when eating and choking on water. The treatments were determined according to the pathological types, lesion location and invasion scope. Of 12 patients 4 underwent horizontal partial laryngectomy plus elective lymphatic dissection plus postoperative radiotherapy/chemotherapy, 4 underwent vertical partial laryngectomy (3 of them with cervical lymphatic dissection), 3 underwent supported laryngoscopic plasma laryngectomy for laryngeal cancer, and 1 abandoned for treatment. With the follow-up of 8 -78 months, 5 patients were alive, 1 died from chemotherapy reactions, 3 died from other diseases, 1 died from lung metastasis, 1 died from lung infection and 1 was lost to follow-up. Conclusion: LNEC is clinically rare, the clinical manifestations are less specificity, diagnosis relies on pathological and immunohistochemical examinations, and treatment modalities and prognoses are closely related to the pathological subtypes of LNEC.

Characteristics of obstructive sleep apnea syndrome in patients with partial laryngectomy.

ObjectivesThe impacts of partial laryngectomy on sleep‐disordered breathing were rarely investigated and reported in a limited number of patients. The aim of this study was to assess the prevalence of obstructive sleep apnea‐hypopnea syndrome (OSAHS) in patients with partial laryngectomy.Study designCase series.MethodsAll patients undergoing partial laryngectomy by open approach (frontolateral vertical partial laryngectomy and supracricoid horizontal partial laryngectomy) for squamous cell carcinoma of the larynx between January 2006 and December 2019 were enrolled. Listed patients were contacted via telephone to propose participating in the study and plan a sleep study: self‐assessments of sleep quality using the Pittsburgh Sleep Quality Index (PSQI) following a home sleep recording using respiratory polygraphy. Daytime sleepiness was also self‐assessed by using the Epworth sleepiness scale.ResultsTwenty patients with sleep record were included to the analyses. There were 11/20 patients (55%) diagnosed with moderate to severe OSASH. No relationship between OSAHS severity and age as well as body mass index (BMI) was observed. The Epworth sleepiness score was not necessarily high in patients with moderate/severe OSASH. Type of partial laryngectomy did not influence apnea‐hypopnea index (AHI) results. There was no difference in terms of age, BMI, gender, type of partial laryngectomy, and the presence of adjuvant radiotherapy between two groups AHI < 15/h and AHI ≥ 15/h.ConclusionA sleep study screening for OSAHS should be considered in patients with partial laryngectomy in order to improve their sleep quality and quality of life even though they did not exhibit daily sleepiness and obesity.

Horizontal versus vertical partial laryngectomy: anatomic and functional differences

Horizontal versus vertical partial laryngectomy: anatomic and functional differences

Effects of different surgical treatment on swallowing function in partial laryngectomy patients

Objective To explore the effects of different surgical treatments on swallowing function in partial laryngectomy patients and to analyze the development trend of swallowing function. Methods From January 2019 to September 2019, this study selected 54 patients first diagnosed as laryngeal carcinoma with partial laryngectomy at a ClassⅢ Grade A hospital as subjects by convenience sampling. There were 25 patients with vertical partial laryngectomy (vertical group) , 12 patients with horizontal supra-glottic partial laryngectomy (horizontal group) and 17 patients with supra-cricoid partial laryngectomy (SCPL group) . This study observed the time of gastric tube extubation of patients, video-fluoroscopic swallowing study (VFSS) 15 days after surgery, score of Modified Penetration Aspiration Scale (MPAS) and scores of Gugging Swallowing Screen (GUSS) 15, 20 and 30 days after surgery, and compared the swallowing function of patients among three groups. Results There were statistical differences in the time of gastric tube extubation, scores of GUSS and VFSS+MPAS 15 days after surgery among three groups (P<0.01) . When taking time as main effect, the Roy maximum root test displayed F=460.693, P<0.001 which showed that time had influence on the score of GUSS; when taking surgery as the main effect, the Roy maximum root test displayed F=218.387, P<0.001 which showed that surgery type had influence on the score of GUSS. There were statistical differences in the development trends of swallowing at different times among three surgery types when time interacted with the surgery type (F=164.033, P<0.001) . Conclusions The vertical partial laryngectomy has the small impact on swallowing function and patients recovery quickly. However, horizontal supra-glottic partial laryngectomy and SCPL have great impact on swallowing function; swallowing function can't be well compensated by sphincter function of remnant larynx in a short time; besides, patients with horizontal supra-glottic partial laryngectomy need a long rehabilitation period. Key words: Laryngeal neoplasms; Partial laryngectomy; Deglutition disorders

Evaluation of clinical outcomes after partial horizontal laryngectomy

Introduction: The laryngeal squamous cell carcinoma (LSCC) is a prevalent disease, with 7670 cases estimated in Brazil during 2018-2019. The preferred treatment for early LSCC is either surgery or radiotherapy. Horizontal partial laryngectomy (HPL) is one of the forms of surgical treatment. Objective: Evaluate the oncological and functional outcomes of patients submitted to HPL for the treatment of LSCC. Methods: A retrospective descriptive study of patients submitted to HPL, performed at a cancer referral center, between January 2011 and December 2017. Results: We evaluated 37 patients. The major pathological staging of the primary tumor was pT3 (35.1%), followed by pT2 (32.4%). Five patients required adjuvant radiotherapy; 62.2% of the patients were decannulated by the end of the treatment; 10.8% weren`t decannulated; 8.1% underwent a retracheostomy, and 18.9% had total laryngectomy. From the patients submitted to total laryngectomy, 3 cases were due to rehabilitation failure, 2 due to recurrence and 2 cases due to postoperative suture dehiscence. About 89% of the patients resumed oral feeding following the procedure; 86.4% didn`t present disease recurrence; 31 patients survived without disease; 3 died from disease-related causes, and 3 from unrelated causes. Conclusion: HPL is an alternative procedure to total laryngectomy, presenting adequate rates of local control and overall survival while also maintaining laryngeal function. The main challenge to HPL remains achieving an ideal selection of patients.

Clinical analysis of neuroendocrine carcinoma of the larynx

Objective:To evaluate the clinical manifestation, therapy and prognosis of neuroendocrine carcinoma of the larynx. Method:Twenty-six cases with neuroendocrine carcinoma of the larynx were analyzed retrospectively. Four pathological types were found in our series: typical carcinoid (1/26), atypical carcinoid (15/26), small cell carcinoma, neuroendocrine type (9/26) and combined small cell carcinoma, neuroendocrine type (1/26). In this series, 12 cases were received total laryngectomy, 2 cases supracricoid partial laryngectomy-cricohyoidopexy (SCPL-CHP), 4 cases horizontal partial laryngectomy, 5 cases vertical partial laryngectomy, 1 case transoral CO₂ laser microsurgery, and 2 cases radiotherapy and/or chemotherapy. Result:Three-year and five-year overall survival rates were 76.9% and 69.2% respectively. Conclusion:The neuroendocrine carcinoma of the larynx was rare, which was more common in the supraglottis. Atypical carcinoid was the most common pathological type. Compared to SCC, the clinical feature of neuroendocrine carcinoma of the larynx was non-specific. The clinical behavior, treatment,and prognosis were correlative to the tumor pathological.The diagnosis depended on comprehensive immunohistochemistry examination.

Usage of piezoelectric instruments in larynx surgery.

The aim of the study was to estimate usability of the piezoelectric knife in larynx surgery. Prove that the piezoelectric staff can be used to do any different shape incision within the larynx cartilages. 35 patients hospitalized in our Department in 2014-2016 were enrolled in our study. 24 patients went vertical partial laryngectomy and 1 patient went horizontal partial laryngectomy because of larynx cancer. 5 patients went partial laryngectomy because of low stage of piriformis recess cancer. Piezoelectric staff was used to do thyroidectomy and resection of thyroid cartilage suspected of carcinomatosis infiltration. The rest 4 patients had done widening of larynx lumen due to larynx stenosis or slenderness. The piezoelectric tool was used to do different incision or resection within the larynx cartilages in case of widening lumen of the larynx. The larynx cartilages, especially thyroid cartilage could be cut in different shapes using piezoelectric tools. The usage of this equipment causes the minimal loss and small destruction of local healthy tissues. The Piezoelectric instrument is useful instrument suit to operate within larynx cartilages. Exchangeable tip available in different shapes enables different resections of cartilages. Using the piezoelectric staff we can remove pathological tissue with minimal local destruction. Our observation shows that larynx operation with a usage of the piezoelectric knife is safe and effective. Current English literature does not describe usage piezoelectric tools in larynx surgery. It is essential to do more observation about that type of operations.

A Case of Horizontal Partial Laryngectomy for Laryngeal Trauma

Received August 11, 2013 Revised October 31, 2013 Accepted October 31, 2013 Address for correspondence Hyun Jun Hong, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, 25 Simgok-ro 100beon-gil, Seo-gu, Incheon 404-834, Korea Tel +82-32-290-3051 Fax +82-32-290-3050 E-mail hyunjun.hong@gmail.com *Current affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Korea Laryngeal trauma is rare compared to other head and neck traumas, but it occurs, it can be life threatening. As for treatment, a laryngeal fracture that involves displacement of cartilage or extensive injury requires appropriate surgical treatments. For severe laryngeal fractures, conservative management is usually preferred with placing a stent to prevent laryngeal stenosis. But the downside of placing stents in the larynx includes the risk of granulation and infection. In this report, the authors describe a 35-year-old patient, who was diagnosed with blunt laryngeal trauma and treated by Horizontal partial laryngectomy. The patient’s post-operative breathing and voice were fair, and airway stenosis did not occur afterwards. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(2):120-3

喉頭水平部分切除術後の嚥下リハビリテーションの経験

喉頭水平部分切除術後の嚥下リハビリテーションの経験

The Influence of the ‘Patient-to-Patient Model' on Swallowing Problems in Patients with Supraglottic Laryngeal Cancer

Aims: To evaluate the patient-to-patient model and swallowing problems in Chinese patients with supraglottic laryngeal cancer (SLC), and to find a solution to help SLC patients with swallowing problems. Methods: Eighty-nine patients who had undergone operation for horizontal partial laryngectomy were chosen and divided randomly into two groups. The European Organization for Research and Treatment of Cancer (EORTC), Swallow Quality-of-Life (SWAL-QOL) and Visual Analogue Scale (VAS) questionnaires were used to measure the quality of life and swallowing situation of those patients. Results: At 0.5 and 1 months after eating, the scores of the EORTC QLQ-C30 and SWAL-QOL of the participant group were significantly higher than those of the nonparticipant group (p < 0.05). One week after eating, the VAS score for swallowing improved significantly from 4.9 to 7.9 in the participant group. However, in the nonparticipant group, the VAS score showed no obvious change (from 4.5 to 4.1). Conclusions: We concluded that the patient-to-patient model may be utilized in clinical cases to solve swallowing problems of SLC patients, and infered that swallowing problems mainly appeared in 60 to 70-year-olds, and 1 week after eating was a critical time point of communication.

Comparative videostroboscopic analysis after different external partial laryngectomies

After external partial laryngectomias, videostroborscopy is very usefull in evaluation of postoperative phonatory mehanisms showing the "slow motion" of the vibrations of the remaining laryngeal structures. The aim of this paper was to compare the videostroboscopic characteristics of the vibration and to establish the differences in the phonation mechanisms depending on the type of external partial laryngectomy performed. This prospective study was conducted during the period 2003-2009 at the Ear, Nose and Throat Clinic, Clinical Center of Vojvodina, Novi Sad, including 99 patients with laryngeal carcinoma, treated with open surgical approach using different types of vertical and horizontal partial laryngectomy. Videostroboscopy was used to analyse vibrations of the remaining laryngeal structures. The dominant vibration structure after partial horizontal laryngectomy, chordectomy, frontolateral laryngectomy and three quarter laryngectomy was the remaining vocal fold, after hemilaryngectomy it was the false vocal fold and after subtotal and near total laryngectomy it was the arythenoid. In patients with supracricoid hemilaryngopharyngectomy performed, many different structures were involved in the vibration. After most of the partial laryngectomies, vibrations can be found in the reconstructed part of the defect. In both horizontal and vertical partial laryngectomies movements of the larynx during phonation were mostly medial, while in cricohyoidoglottopexies they were anterior-posterior. Most of the operated patients (72.7%) had insufficient occlusion of the neoglottis during the phonation. Videostroboscopy is a useful method in examining the phonation mechanisms of reconstructed laryngeal structures after partial laryngectomy as well as in planning postoperative voice therapy.

Endoscopic CO(2) Laser Horizontal Partial Laryngectomy in Larynx Carcinosarcoma.

Background. Carcinosarcoma is an extremely rare malignant neoplasm, with both a malignant epithelial and mesenchymal component, that rarely affects the larynx. Aim. Aim of this paper is to describe the case of a patient affected by a larynx carcinosarcoma treated by endoscopic horizontal partial laryngectomy with CO(2) laser and particularly discuss the histogenetic hypothesis as well as the possible treatment modalities of this rare lesion. Methods. Case report and literature review. Discussion and Conclusion. Still little is known about the biology of carcinosarcoma and there is still no consensus in the literature on the treatment of these tumors. Endoscopic horizontal partial laryngectomy could represent another treatment option in selected cases.

Middle Frontal Horizontal Partial Laryngectomy (MFHPL): A Treatment for Stage T1b Squamous Cell Carcinoma of the Glottic Larynx Involving Anterior Vocal Commissure

ObjectiveThe therapeutic effect of middle frontal horizontal partial laryngectomy (MFHPL) in treating stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure (AVC) was compared with that of the anterior frontolateral vertical partial laryngectomy (AFVPL). The feasibility and practical significance of MFHPL in clinical application was discussed in the present study.MethodsFrom January 1996 to January 2010, a total of 65 patients diagnosed with stage T1bN0M0 glottic laryngeal cancer were treated with MFHPL or AFVPL. The postoperative complications, glottic reconstruction, recurrence rate, voice quality and survival rates were evaluated and compared between two treatments.ResultsAFVPL and MFHPL were performed in 34 and 31 patients, respectively. Flexible fiberoptic laryngoscopy revealed that in the MFHPL-treated patients the reconstructed glottis was spacious and symmetric. In contrast, AFVPL treatment resulted in irregular glottic area with poor symmetry and tubular glottis. The incidence of postoperative laryngeal stenosis significantly differed between the MFHPL- and AFVPL-treated groups (P = 0.025). No significant difference was detected in the 3- and 5-year overall- or tumor-free survival rates between two treatments. The Voice Handicap Index (VHI) and maximum phonation time (MPT) after surgery were 51.0±12.99 and 12.42±3.44 sec in the AFVPL-treated group; while in the MFHPL-treated patients they were 31.81±7.48 and 7.65±1.98 sec, respectively. Both differences in VHI (P = 0.012) and MPT (P = 0.024) were significant between two treatments.ConclusionsMFHPL was comparable to AFVPL with respect to postoperative complications, recurrence rate and survival rates, but possessed advantages over AFVPL in terms of the incidence of laryngeal stenosis and voice quality. Our study indicated that MFHPL has a potential value in clinical practice of treating stage T1b squamous cell carcinoma of the glottic larynx involving AVC.

Analysis of multicentricity in supraglottic laryngeal carcinoma treated with partial laryngeal surgery

A clinicopathological analysis of multicentricity in patients treated with either supraglottic horizontal laryngectomy or supracricoid partial laryngectomy for supraglottic squamous cell carcinoma of the larynx was conducted. This study included 63 patients who underwent supracricoid partial laryngectomy or supraglottic horizontal laryngectomy for T2 or T3 supraglottic laryngeal squamous cell carcinoma. The patients were divided into two groups: Group 1 included patients with one focus of the tumor (monocentric), and Group 2 included patients who had more than one focus of the tumor (multicentric) diagnosed after pathology examination. Forty-eight (76.2 %) of the patients had one focus of the tumor (Group 1) and 15 (23.8 %) of the patients had more than one focus of the tumor (Group 2). The rates of lymph node metastasis in Group 1 and Group 2 were 12.5 and 60 %, respectively. The second focus was invasive in seven (46.6 %) of the patients, carcinoma in situ in six (40 %) of the patients, and both invasive and carcinoma in situ in two (13.3 %) patients. The overall 3- and 5-year survival rates of Groups 1 and 2 were 77.1-66.7 % and 56.2-46.7 %, respectively. With regard to survival rates, no statistically significant difference was observed between Group 1 and Group 2 (p = 0.576). The lack of statistical significance might have been associated with the low sample size. Although multicentric tumors of the supraglottic larynx have high incidence of nodal metastasis, no significant increase in the rate of recurrence was determined.

Investigation about remote quality of life of patients with tumor of larynx when abscised by differ-ent type

Objective To know the remote quality of life of patients with tumor of larynx when ab-scised by different type, and then summarize proper countermeasures of nursing. Methods Selected 82 laryngocarcinoma patients with exacte]y diagnosis. There were 40 cases had received total laryngectumy, 42 cases had received partial laryngectomy. Evaluated the level of remote quality of life of 82 patients by QLQ-H&N65, and then analyzed the datum. Results The level of quality of life of patients with total laryn-gectomy were worse than those in patients with partial laryngectomy in the aspects such as general health, swallow, language, emotional function, social function, body fuction and so on. Conclusions The quality of life of patients with tumor of larynx is influenced by several factors, their remote quality of life should be emphasised by nurses. Key words: Tumor of larynx; Total laryngectomy; Horizontal partial laryngectomy; Vertical par-tial laryngectomy; Quality of life

Results after supracricoid horizontal partial laryngectomy

Objectives This study analyzed oncological and functional results of supracricoid horizontal partial laryngectomy. Methods A retrospective study was conducted involving 20 patients with squamous cell carcinoma (SCC) of the larynx who underwent SCPL between 1996 and 2005 in Faculty of Medical Sciences of Santa Casa Hospital of Sao Paulo, Brazil. There were 18 male and 2 female patients with ages ranging from 39 to 74 years (median = 58 years), of whom 19 were smokers and 14 alcoholics. The tumors were present in the glottis in 16 cases and supraglottis in 4; 5 were stage I or II and 15 were stage III or IV. We analyzed treatment given when rehabilitation was unsuccessful, oncological results of SCPL, including local and regional recurrences, time to recurrence and treatment given, distal metastases, global survival, survival free of disease, and appearance of second primary tumors. We also calculated the index of functional preservation of the larynx. Results Rehabilitation of swallowing capabilities and speech was achieved in 18 patients. Removal of the tracheostomy varied between 1 and 9 months. Rehabilitation was unsuccessful in two patients. Three patients required a total laryngectomy, two for unsuccessful rehabilitation and one for recurrence. The preservation of a functional larynx was 85%, with 10% of patients requiring a total laryngectomy after failed rehabilitation. Conclusions Supracricoid horizontal partial laryngectomy is an efficient surgical oncology technique that yields good functional results for the treatment of laryngeal cancer.

Endoscopic horizontal partial laryngectomy by CO2 laser in the management of supraglottic squamous cell carcinoma

The objective of this study was to evaluate the results of endoscopic horizontal supraglottic laryngectomy (EHSL) by CO(2) laser. Between 1996 and 2005, 78 patients underwent a horizontal supraglottic laryngectomy operation (HSL) with an external approach and 70 underwent laser EHSL, as treatment for supraglottic laryngeal squamous cell carcinoma (LSCC). We evaluated oncological endpoints, comparing the external and the endoscopic approach. Among patients primarily treated by EHSL, the 5-year disease-specific survival (DSS) was 89% (vs 80% in the external approach group). Statistical analysis did not reveal significant differences between the 2 groups as for survival nor for organ preservation. The most significant clinical predictor for DSS is neck relapse (p < .0001). This study confirms the effectiveness of laser EHSL in which oncological outcome is similar to the external approach and functional results are probably better. Neck management in this setting is fundamental to warrant the best survival.

Horizontal partial laryngectomy in mucoepidermoid carcinoma of the larynx after failure of laser surgery followed by radiotherapy: a case report

IntroductionTumors of the minor salivary glands in the larynx are rare and represent <1%. They usually appear between the 4th and 7th decades of life. The most common site of occurrence is the supraglottis; however, these neoplasms can appear at any location in the larynx. Pulmonary metastases are the most frequent site for distant disease.Case presentationWe present the case of a 34-year-old Hispanic male with a history of cigarette smoking. He was admitted to our Institution in 2002 with a 1-year evolution of odynophagia, initially to solids and then to liquids. The patient was referred to our Institution for an undifferentiated carcinoma of the epiglottis treated one week earlier with laser surgery and positive surgical margins. Upon admittance, the patient did not demonstrate any tumor activity. A review of the slides confirmed undifferentiated carcinoma. Chemo-radiotherapy was proposed to the patient, but he accepted only radiotherapy and received a total dose of 70 Gy. The patient was followed-up every 3 months. Two years later, follow-up nasofibrolaryngoscopy demonstrated clear evidence of tumor activity at the site of the primary tumor (supraglottis). No cervical adenopathies were found either clinically or radiologically. Biopsy of the lesion was inconclusive; hence, the patient was scheduled for a suspension microlaryngoscopy with transoperative study, performing afterwards a supraglottic horizontal laryngectomy. Histological diagnosis reported ulcerated, high-grade supraglottic mucoepidermoid carcinoma with lymphatic permeation and invasion to the striate muscle and adipose tissue. The borders and surgical bed were free of neoplasm. The patient evolved satisfactorily. At 4 years following treatment, the patient is disease free.ConclusionRecurrence must be considered when planning treatment, and organ preservation surgery is justified, especially in young patients.

Horizontal supraglottic partial laryngectomy for selected squamous carcinoma of the vallecula

Our aim was to determine the incidence of local control in patients with selected squamous carcinoma of the vallecula treated with horizontal supraglottic laryngectomy; to analyze the consequences of local recurrence in terms of nodal recurrence, distant metastasis, survival, causes of death, overall local control, and laryngeal preservation; and to identify any clinical factors predictive of these outcomes. This was a retrospective nonrandomized case series in a university teaching hospital. An inception cohort of 95 previously untreated patients were followed until death or for a minimum of 5 years. According to the 2002 Union Internationale Contre le Cancer (UICC) staging classification system, the tumor was classified as T1, T2, and T3 in 13, 60, and 22 patients, respectively, while disease in 67 patients was considered to be in stages III to IV. All patients underwent a horizontal partial supraglottic partial laryngectomy. Ninety-four patients had an associated neck dissection. An induction chemotherapy regimen was used in 91 patients; postoperative radiation therapy was given for 49 patients. The main outcome measures were local recurrence, nodal recurrence, distant metastasis, and survival. The 1-, 3-, and the 5-year actuarial survival estimates were 86.3%, 64.2%, and 47.4%, respectively. Overall, the main causes of death were as follows: metachronous second primary tumor (47.2% of patients), intercurrent disease (16.7%), distant metastasis (15.3%), local recurrence (6.3%), and nodal recurrence, (4.2%). The 1-, 3-, and 5-year actuarial local recurrence rates were 4.5%, 11%, and 11%, respectively. Nine patients developed a local recurrence; 3 were successfully salvaged. Using multivariate analysis, no single variable was found to increase the risk for local recurrence. The overall laryngeal preservation rate and local control rate were 89.5% (85/95) and 93.4% (89/95), respectively. Local recurrence was associated with a significant increase in nodal recurrence (p <.04) and distant metastasis (p = .03). Based on this experience, horizontal partial supraglottic laryngectomy appears to be a valid approach for functional organ-preservation in patients with selected T1-T3 SCC of the vallecula.