Laryngectomy Group Research Articles

Prognostic analysis of surgical treatment for T3 glottic laryngeal cancer based on different tumor extension patterns.

To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. We conducted a retrospective analysis of clinical data of 91 patients with T3 glottic laryngeal cancer. We found that the posterior invasion being significantly associated with involvement of the lamina of cricoid cartilage (P < 0.001), arytenoid cartilage (P = 0.001), and subglottic (P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy (TL) group and the partial laryngectomy(PL) group, but in the PL group, tumors with anterior invasion were associated with a better 5-year DFS than tumors with posterior invasion (HR: 4.681, 95% CI: 1.337-16.393, P = 0.016), and subglottic involvement was associated with worse LRRFS (HR: 3.931, 95% CI: 1.054-14.658, P = 0.041). At the same time, we found that involvement of the lamina of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in PL patients (HR: 11.67, 95% CI: 1.89-71.98, P = 0.008). Selectively performed PL can also achieve favorable oncological outcomes comparable to those of TL. Posterior invasion and subglottic involvement are independent prognostic factors for recurrence after PL in T3 glottic laryngeal cancer, and involvement of the lamina of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of patients with laryngeal cancer should be further subdivided to allow for selection of a more individualized treatment plan.

Prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer

Objective:To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. Methods:A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer. Results:Among the 91 patients, 58 cases （63.7%） had anterior invasion and 33 cases （36.3%） had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage （P<0.001）, arytenoid cartilage （P= 0.001）, and subglottic region（P = 0.001）. There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival（DFS） of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors （HR: 4.681, 95%CI 1.337-16.393, P=0.016）, and subglottic invasion was associated with worse loco-regional recurrence-free survival（LRRFS）（HR: 3.931, 95%CI 1.054-14.658, P=0.041）. At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients （HR:11.67, 95%CI 1.89-71.98,P=0.008）. Conclusion:Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.

Assessing Tongue Strength and Swallowing Function Following Hyoid Bone Resection Surgery.

The tongue and hyoid bone are responsible for the oral phase of swallowing. The purpose of this study was to assess tongue strength and endurance, and to evaluate swallowing functions in patients who underwent hyoid bone resection surgery. This was an experimental, non-randomized trial. It included participants who underwent hyoid bone resection surgery, divided into 2 groups; post-Sistrunk procedure and post-total laryngectomy. Swallowing problem history was recorded, and tongue strength and endurance were measured using the Iowa Oral Performance Instrument (IOPI). Post-Sistrunk procedure participants also underwent flexible endoscopic evaluation of swallowing (FEES) to assess objective swallowing function. Descriptive and bivariate statistics were used to analyze the association between the tongue strength and endurance, and the type of surgeries. The study involved 26 participants, including 16 males and 10 females, with a mean age of 58.4 ± 12.8 years. A total of 10 subjects underwent the Sistrunk procedure and 16 underwent total laryngectomy surgery. The average tongue strength of all participants was 40.8 ± 11.7 kPa and the average tongue endurance was 30.6 ± 13.2 s. The difference in average tongue strength between the post-Sistrunk procedure group and post-total laryngectomy group was not significantly different (37.5 ± 11.6 kPa vs. 44.1 ± 11.3kPa, P = .153). However, there was a statistically significant difference in average tongue strength between male and female participants (46.3 ± 10.0 kPa vs. 32.0 ± 8.5 kPa, P = .001). FEES did not reveal any evidence of objective swallowing abnormalities in the post-Sistrunk group. The resection of the hyoid bone, whether partial or total, did not significantly affect tongue strength and swallowing functions.

The Usefulness of Total Laryngectomy in Sarcopenic Patients With Hypopharyngeal and Laryngeal Cancer.

Sarcopenia has an adverse effect on postoperative complications and prognoses in head and neck cancer. This study focused on hypopharyngeal and laryngeal cancer patients with sarcopenia and analyzed the body composition following treatment when the larynx was preserved and when total laryngectomy was performed to examine the usefulness of laryngectomy. We retrospectively reviewed 88 primary hypopharyngeal and laryngeal cancer patients aged 65 years or older with cT2N0M0 or higher who visited our department. There were no significant differences in the 3-year overall survival rate and the 1-year local control rate between the laryngeal preservation group and laryngectomy group. The average change one year following treatment in the laryngeal preservation group, when compared to prior to treatment, was a significant decrease in the body weight (BW) of -0.035, skeletal muscle mass (SMM) of -0.030, skeletal muscle mass index (SMI) of -0.026, body mass index (BMI) of -0.034, and grip strength (GS) of -0.066. The average change one year following treatment in the laryngectomy group, compared with prior to treatment, was an increase in BW of +0.028, SMM of +0.026, SMI of +0.008, BMI of +0.032, and GS of +0.026. Although no changes in serum biochemical testing after treatment were observed in the laryngeal preservation group, albumin, transferrin, and transthyretin all exhibited significant improvement or a tendency toward improvement in the laryngectomy group. The patients with sarcopenia before treatment in the laryngeal preservation group had a significantly higher incidence of aspiration pneumonia. The presence or absence of sarcopenia before starting treatment is considered to be an index for selecting total laryngectomy.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

A survey of the clinical outcomes of cervical esophageal carcinoma surgery focusing on the presence or absence of laryngectomy using the National Clinical Database in Japan.

One upside of cervical esophageal carcinoma is that radical surgery can be performed by laryngectomy, even for tumors with tracheal invasion. However, this approach drastically reduces the quality of life, such as by losing the vocal function. Cervical esophageal carcinoma is rare, and no comprehensive reports have described the current state of surgery. Using a Japanese nationwide web-based database, we analyzed the surgical outcomes of cervical esophageal carcinoma to evaluate the impact of larynx-preserving surgery. Based on the Japan National Clinical Database, 215 surgically treated cases of cervical esophageal carcinoma between January 1, 2018, and December 31, 2019, were enrolled. Clinical outcomes were compared between the larynx-preserved group and the laryngectomy group. Ninety-four (43.7%) patients underwent larynx-preserving surgery. A total of 177 (82.3%) patients underwent free jejunum reconstruction. More T4b patients and more patients who underwent preoperative radiotherapy were in the laryngectomy group. There were no significant differences in the frequency and the severity of morbidities between the two groups. However, in the laryngectomy group, in-hospital death within 30days after surgery was observed in 1 patient, and the postoperative hospital stay was significantly longer (P = 0.030). In the larynx-preserved group, recurrent nerve paralysis was observed in 24.5%. Re-operation (35.3%, P = 0.016), re-intubation (17.6%, P = 0.019) and tracheal necrosis (17.6%, P = 0.028) were significantly more frequent in patients who underwent pharyngolaryngectomy with total esophagectomy and gastric tube reconstruction than in others. Larynx-preserving surgery was therefore considered to be feasible because it was equivalent to laryngectomy regarding the short-term surgical outcomes.

Complications and predisposing factors from a decade of total laryngectomy.

Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period. A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts. A shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development. Complications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.

Nasal Symptoms Following Laryngectomy: A Cross-sectional Analysis.

Background After total laryngectomy, the severe reduction in nasal airflow alters the function and physiology of the nasal cavity. These anatomic and physiologic changes may in turn impact sinonasal quality of life. Objective This study sought to characterize the degree of postoperative sinonasal symptoms experienced by laryngectomees. Methods Two groups of subjects were recruited in this cross-sectional analysis: patients who previously underwent laryngectomy with or without chemoradiation for laryngeal or hypopharyngeal cancer and a comparison group treated with radiation but not laryngectomy. Patients underwent assessment of sinonasal symptoms using the Reflective Total Nasal Symptom Score (rTNSS), 22-item Sinonasal Outcome Test (SNOT-22), and visual analog scales (VASs). Patients also underwent nasal endoscopy recorded and graded by blinded reviewers using the Modified Lund–Kennedy (MLK) scale. Results Thirty-six laryngectomees and 12 controls were enrolled. The total SNOT-22 was similar between the 2 groups (27.3 vs 20.3, P = .16), but the laryngectomy cohort had higher rhinologic ( P &lt; .01), extranasal ( P = .01), and ear/face ( P = .01) subdomain scores. VAS scores were worse in the laryngectomy group for nasal congestion ( P &lt; .01), rhinorrhea ( P &lt; .01), postnasal drip ( P &lt; .01), and smell ( P &lt; .01) but not for nasal fullness ( P = .11). rTNSS (4.7 vs 2.8, P = .04) and MLK scores (2.8 vs 0.8, P &lt; .01) were higher in the laryngectomy group. In addition, 44% and 83% of patients in the laryngectomy and nonlaryngectomy groups, respectively, subjectively reported well-controlled nasal symptoms. Conclusion Laryngectomees are likely to experience a higher degree of subjective and objective nasal disease than nonlaryngectomized patients. Postlaryngectomy nasal dysfunction may be an important aspect of quality of life impairment in the laryngectomee population.

A Questionnaire to Assess Phonation and Problems in Daily Living for Provox® Voice Prosthesis Users in Japan.

The aim of this study was to investigate the problems in daily life of Provox® users in Japan with the use of a questionnaire survey and to consider future guidance methods for these patients. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group. We received 118 questionnaires with valid responses. The total voice handicap index (VHI) score was 44.1. Patients were allocated to two groups based on the type of surgery they underwent-laryngectomy or jejunum reconstruction. The VHI score was significantly lower in the simple laryngectomy group than that in the free jejunum reconstruction group (p < 0.01). Only 55.9% of the patients reported having received voice rehabilitation therapy. For other problems of daily life, many patients answered "bad/very bad" for the "smelling," "eating/drinking hot foodstuffs," "blowing nose," and "quantity of sputum" categories. Based on our results, there is a requirement for an effective rehabilitation therapy and appropriate guidance for patients with the Provox® voice prosthesis.

Pretreatment predictive factors for feasibility of oral intake in adjuvant concurrent chemoradiotherapy for patients with locally advanced squamous cell carcinoma of the head and neck.

Prophylactic percutaneous endoscopic gastrostomy (PEG) has been widely performed before concurrent chemoradiotherapy (CCRT) for locally advanced squamous cell carcinoma of the head and neck (LASCCHN) because severe oral mucositis and dysphagia induced by CCRT lead to difficulty with oral intake. However, it is controversial whether all patients require prophylactic PEG for adjuvant CCRT. This study evaluated predictive factors for the feasibility of oral intake in adjuvant CCRT for patients with LASCCHN. This study retrospectively analyzed 117 LASCCHN patients who underwent surgery followed by adjuvant CCRT with cisplatin at Shizuoka Cancer Center between April 2008 and December 2018. To investigate predictive factors for the feasibility of oral intake, tumor factors, treatment factors and social factors were included in multivariate analyses. Of the 117 patients, 25 received total laryngectomy and 92 received other surgery. In multivariate analysis, total laryngectomy [HR (hazard ratio) 0.09, P = 0.001] and oral cavity of primary tumor location (HR 0.21, P = 0.031) were significantly associated with the feasibility of oral intake. Difficulty obtaining adequate nutrition via oral intake from initiation of CCRT until 1year after its completion was significantly rarer in the total laryngectomy group than in the other surgery group (16% vs. 57%, P < 0.001). Our study suggests that majority of patients who underwent total laryngectomy are able to maintain oral intake during adjuvant chemoradiotherapy.

Is prophylactic percutaneous endoscopic gastrostomy necessary for chemoradiotherapy after total laryngectomy?

Abstract Background Post-operative concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) for locally advanced squamous cell carcinoma of head and neck (LASCCHN) frequently induces severe oral mucositis and dysphagia, which lead to insufficient oral intake and negative impact on treatment outcomes. Therefore, prophylactic percutaneous endoscopic gastrostomy (PEG) has been widely performed. However, PEG placement often causes some complications such as bleeding or abscess. The aim of this study is to evaluate necessity of prophylactic PEG in adjuvant CCRT for high-risk patients with LASCCHN who underwent total laryngectomy. Methods This study retrospectively analyzed 117 LASCCHN patients who underwent either total laryngectomy or other surgery followed by adjuvant CCRT with CDDP at Shizuoka Cancer Center between April 2008 and December 2018. We evaluated the rate of patients unable to obtain sufficient nutrition via oral intake from initiation of CCRT until one year after completion of CCRT, and nutrition-support-free survival. The risk factors for inability of oral intake were determined by using the Cox proportional hazards model. Results Of 117 patients, 25 patients received total laryngectomy and 92 patients received other surgery. The rate of patients unable to obtain sufficient nutrition via oral intake was significantly lower in the total laryngectomy group (16% vs 57%, P Conclusion Prophylactic PEG for adjuvant CCRT may not be necessarily required for the LASCCHN patients who underwent total laryngectomy because of high feasibility of oral intake.

Comparison of Swallowing Act Videofluoroscopy after Open and Laser Partial Supraglottic Laryngectomy.

The aim of this study was to compare the functional outcomes of swallowing act detected by videofluoroscopy of two different techniques in the treatment of laryngeal carcinoma. This study was conducted on 41 patients undergoing two supraglottic laryngectomy techniques. The research population was assigned into two groups of open and laser supraglottic laryngectomy, including 21 and 20 patients, respectively. Food residue was present in most of the patients in the open laryngectomy group. Aspiration of the liquid and solid contrasts was observed in 16 and 4 patients, respectively. In the laser laryngectomy group undergoing a partial supraglottic laryngectomy via carbon dioxide (CO2) laser, aspiration was recorded in only six patients. There was a statistically significant difference between these two groups regarding the presence of aspiration as a marker of a bad functional outcome. Techniques that include the endoscopic removal of the tumor via CO2 laser result in good oncologic and functional outcomes, along with reduced postoperative morbidity and mortality.

Post-Laryngectomy stricture and pharyngocutaneous fistula: Review of techniques in primary pharyngeal reconstruction in laryngectomy.

The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. Retrospective ChartReview. We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

Acellular dermal graft pharyngeal repair augmentation after laryngectomy

PurposePharyngocutaneous fistula (PCF) after laryngectomy continues to be a serious complication, especially after radiation. Recruitment of non-radiated tissue into the surgical defect may decrease the risk of fistula. These techniques however have significant morbidity and increases operative time. We hypothesized that using acellular dermal graft to reinforce the pharyngeal closure could decrease the risk of fistula, without the added morbidity of a vascularized flap. MethodsWe performed a retrospective chart review of all patients that underwent a laryngectomy between 2005 and 2015 at an acedemic tertiary referral center. Patients who underwent primary pharyngeal closure with Alloderm® reinforcement without any other flap reconstruction were identified. Basic demographics, previous treatment, operative technique and fistula were extracted from the medical records. The primary outcome was PCF rate. The time to closure, margin status and disease recurrence was also evaluated. ResultsAmong 16 patients with AlloDerm® augmentation, eight had primary laryngectomy and eight had salvage laryngectomy. A total of three in the salvage laryngectomy with prior history of radiation developed PCF. The fistula closed in all three cases with conservative treatment. There was no PCF in the primary laryngectomy group without prior history of radiation. ConclusionThe rate of PCF among the salvage laryngectomy group with previous radiation did not differ from historical data. AlloDerm® can however, provide a simple alternative for repair in radiation patients where flap cannot be performed for pharyngeal reconstruction. In non-radiated patients, AlloDerm® augmentation may have a protective effect on fistula formation.

Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma.

SUMMARYThe aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.

Relationship among airway infection, lung function damage and the tumor recurrence in patients with laryngeal cancer

Objective:To investigate the relationship among airway infection, lung function damage and the tumor recurrence in patients with laryngeal cancer.Method:Eighty-six patients with laryngeal cancer were retrospectively analyzed.Infection rate were compared between different surgical airway and operation time, the lung function damage and the tumor recurrence were analysed.Result:Total laryngectomy group joint cervix lymph node dissection showed higher airway infection rate than laryngectomy［32.5%（13/40）vs 4.3%（2/46）,P <0.05］. Significant differences were observed among operation time＜4 h, 4-6 h,＞6 h airway infection rate is statistically ［2.5%(1/40),19.4%(6/31),53.3%(8/15), P <0.05］; Infection rate was positively correlated with the trachea and the operation time(r=0.41P <0.01). Significant rise in FEV1% and reduce in V25 were observed after operation(P <0.05). No statistical difference were observed in patients with airway infected or uninfected with tumor recurrence and uninfected group is ［13.3% (2/15)vs 9.9%(7/71)，P > 0.05］.Conclusion:Throat cut method may lead to airway infection and impairment of the lung function, but airway infection has no obvious effect in tumor recurrence.

Pharyngocutaneous fistula: the incidence and the risk factors.

A pharyngocutaneous fistula is the most common complication following laryngectomy. A wide range of potential risk factors has been suggested. The purpose of this study was to determine the incidence and risk factors for the fistula at the Department of Otorhinolaryngology and Head and Neck Surgery in Ljubljana, Slovenia between 2007 and 2012. Charts from patients treated for head and neck cancer by laryngectomy were retrospectively reviewed. Comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgery and postoperative period. The patients were categorised into the group with the fistula (a study group) and without it (a control group). The incidence of the fistula was calculated and the groups were statistically compared according to potential risk factors using the Chi square test, Fisher exact test, T test, Mann-Whitney U test and binary logistic regression analysis. Hundred fifty-eight patients were included. The incidence of the fistula was 30.4%. In the primary laryngectomy group the incidence was 22.6%, whereas in the salvage laryngectomy group 44.6% (p=0.006). The independent predictors for the fistula were history of head and neck cancer (p=0.001), invasion of piriform sinus (p=0.020) and surgical wound infection (p<0.001). The timing of surgical wound infection could be of some importance. In the PCF group, it started on the 5th postoperative day, whereas in the control group on the 7th postoperative day (p=0.063). Decreasing the rate of surgical wound infection could diminish the fistula rate.

Respiratory functions after partial laryngectomy surgery

AimLarynx cancers are among the smoking-related cancers frequently encountered at the head and neck area. Partial surgeries have been preferred in the early-stage larynx cancers during the recent years. Even though partial surgeries are advantageous in terms of protection of the breathing, swallowing, and voice functions, studies regarding the change in the postoperative respiratory functions are not sufficient. Our objective in this study is the scrutiny of the change in the respiratory functions subsequent to various partial surgeries. Materials and methodsPatients who had 34 (10 cordectomy, 7 frontolateral, 9 supraglottic, 8 supracricoid laryngectomy) partial laryngectomy operations and 30 healthy control patients were included in our study. The patients were subject to respiratory function test in the postoperative period and their FEV1, FVC, FEV1/FVC and FEF25–75 values were examined. Data were compared with the healthy control group. ResultsLower FEF25–75 value (p < 0,05) was observed in the supracricoid laryngectomy patients compared to the control group. In three patients of the supracricoid laryngectomy group, various degrees of restrictive and obstructive findings were observed in the respiratory function test. The least respiratory function change was observed in patients with cordectomy. ConclusionsIn our study, various degrees of restrictive and/or obstructive findings were observed in the respiratory functions after partial surgeries. It was determined that such findings increased as long as the amount of the removed larynx tissue increased. We recommend that patients undergo a respiratory function test after partial laryngectomy and treated according to the findings as restrictive and obstructive findings affect patients' survival.

Challenges in the Management of Laryngeal Cancer in Ile-Ife: Any Emerging Pattern?

Background : We undertook this study to detect emerging pattern in the challenges in managing patients with laryngeal cancer in our setting. Methodology : We review the 16 patients with histologically confirmed laryngeal carcinoma managed at the Otorhinolaryngology Head and Neck surgery Department of Obafemi Awolowo University Teaching Hospitals complex between 1 st January 2008 and 31 st December 2013. Result : There were 11 males and 5 females with mean age of 58.0 years. Three (18.8%) patients who were all males had history of smoking. History of significant alcohol intake was found in 4 (25.0 %) males and 1 (6.3%) female. Fifteen (93.8%) patients presented as an emergency with airway obstruction necessitating emergency tracheostomy. Eight (50.0%)patients had total laryngectomy as primary treatment modality and 1 (6.25%) patient had radical radiotherapy as her primary treatment modality. Six (37.5%) patients refused further treatments after their initial emergency Tracheostomy, Laryngoscopy and Biopsy and were subsequently lost to follow up. One (6.35%) patient died before commencement of definitive treatment. Among the laryngectomy group, 2 (12.5%) died on admission, 2 (12.5%) was lost to follow up and1 (6.25%) had stoma recurrence; Three (18.75%) patients are alive. All the patients with loco-regional failure had it within 18 months with only 1 (6.25%) survival at 2 years. Conclusion : Late presentation and treatment refusal remain the major challenges in this study. There is thus an urgent need for health education to promote early presentation.

Evaluation of health-related quality of life with EORTC QLQ-C30 and QLQ-H&N35 in Romanian laryngeal cancer patients.

The aims of this study were to evaluate the health-related quality of life (HRQL) according to: type of surgery, adjuvant oncological treatment and postoperative complications. We performed a retrospective case-control study between October 2013 and November 2014 at the Ear Nose and Throat Clinic of Cluj-Napoca. We included patients diagnosed with laryngeal or hypopharyngeal cancer treated with total or partial laryngectomy, and a sample of healthy volunteers recruited from the hospital stuff. We used the European Organisation for Research and Treatment of Cancer (EOTRC) core questionnaires (the QLQ-C30 version 3) and the head and neck cancer module (the QLQ-H&N35). We included in the study 80 patients diagnosed and surgically treated for laryngeal/hypopharyngeal squamous cell carcinoma and 20 healthy volunteers. Median age of the patients was 59.90years. The most common location was the larynx, in 72 (90%) of cases and the hypopharynx in 8 (10%) cases. Sixty-six (82, 50%) underwent total laryngectomy and 14 (17, 50%) a partial laryngectomy. Forty-eight patients had received external radiation therapy, with adjuvant chemotherapy in 25 patients. Postoperative complication rates were 14 (17, 50%) cases. We found a low score in total laryngectomy group regarding functional scales: role (28.03), emotional (37.75) and social (37.88) and a high score on insomnia (35.86) and financial difficulties (45.45). Partial laryngectomy group had a high score on functional scales: role (47.62), emotional (51.19) and social (52.38). These two QOL instruments were effective for Romanian patients. The QLQ-H&N35 questionnaire discriminating better the problems between groups compared with QLQ-C30.