Laryngeal Resection Research Articles

シンポジウム １：高齢者の下咽頭，食道の生理と病態 Ｂ． 高齢者の下咽頭頚部食道癌の外科治療と再建術後の機能 とくに遊離空腸移植術

Forty-one cases of hypopharyngeal cancer and nine cases of cervical esophageal cancer were resected and reconstructed between 1984 and 1990. “Elderly”was defined as age 65 or above in this paper. There were 21 elderly hypopharyngeal patients and 5 elderly cervical esophageal cancer patients.Surgical procedure, pathological examination, prognosis and recurrence type were compared between elderly and under 65 groups. Reconstruction procedure and functional evaluation were studied via a questionnaire on meal intake and VTR of postoperative barium swallow.Pharyngolaryngoesophagectomy was performed in all hypopharyngeal cancer cases. Radical neck dissection on the tumor side and functional dissection on the opposite side were mainly performed, while bilateral functional dissection was done in nine patients, 6 of whom were under 65.Reconstruction in cases of hypopharyngeal cancer after resection of pharynx, larynx and cervical esophagus was by free jejunal transplantation in 38 cases, by gastric tube in two and by myocutaneous flap of latissimus dorsi in one. In the elderly, eighteen cases were reconstructed by free jejunal transplantation and in 3 patients over 80 years old.Functional evaluation via questionnaire of meal intake and VTR of postoperative barium swallow revealed slightly poor results in the elderly, but reconstruction by free jejunal transplantation should be the first choice after resection of hypopharyngeal carcinoma, without establishing an age limit.

Rehabilitation of patients who underwent laryngeal resection for cancer

The basic parameters of respiration and blood circulation in 45 patients (mean age 48+8 years) who underwent laryngeal resection for stage I, II, and III cancer from 6 months to 6 years after surgery were studied using the veloergometer method. Eight patients underwent chordectomy with resection of the scapular cartilage, 28 underwent anterolateral resection of the larynx, 6 underwent hemilaringectomy, and 3 underwent horizontal resection.

Glottic reconstruction with thyroid perichondrium and investing cervical fascia.

Various surgical procedures have been designed for glottic reconstruction following vertical partial laryngectomy. Many of these techniques require flaps or even a second stage to adequately compensate for the loss of lining or bulk that accompanies extended laryngeal resection. Thyroid perichondrium and investing cervical fascia were used in 20 cases of glottic reconstruction. Laryngeal reconstruction following vertical partial laryngectomy using readily available local tissue allows for the wide resection of tumor as well as for the preservation of laryngeal structure and function.

A study of whole organ cancerous larynges to determine resectability by conservation surgery.

Sixty-two extirpated whole larynges containing squamous cell carcinoma were examined by a transverse slicing method to determine whether a partial laryngeal resection would have been feasible. The epithelial origin and sites of invasion of each tumor were recorded. The observations suggested that in one third of the specimens conservation laryngeal surgery could have achieved complete removal of the cancer.

Pull-Through Esophagectomy Without Thoracotomy

Twenty patients with carcinoma of the hypopharynx, esophagus and thyroid underwent pull-through esophagectomy. Seventeen of them received combined resection of the larynx and trachea. Dissection of the lymph nodes at the upper mediastinum was performed in 11 patients by sternotomy. Seven patients received mediastinal tracheostomy after combined resection of the trachea and the larynx. Pull-through esophagectomy was followed by pharyngogastrostomy without thoracotomy via the posterior mediastinum. This technique is described in detail. Because there is no thoracotomy and ligation of the esophageal vessels is ensured, no pulmonary complications and no massive mediastinal hemorrhages occurred. There were no operative deaths. This operation offers excellent palliation and little morbidity. Moreover, the use of sternotomy and mediastinal tracheostomy for pull-through esophagectomy made it possible to dissect the upper mediastinal lymph nodes, and we could resect the affected trachea with certainty.

Laryngeal resection in patients of seventy years and over.

Laryngeal resection in patients of seventy years and over.

Simultanes Wachstum von Carcinom und Pr�cancerose im Kehlkopf ? eine stratigraphische histomorphologische Analyse

Chronic and diffuse contact between inhalation noxae and the mucosa plays an important role in the pathogenesis of cancer of the larynx and lead us to expect a multilocular development of carcinoma and precancerous changes. This supposition was examined in some 100 larynx resection preparations.

An evaluation of wound complications after neck dissection and composite resection utilizing transverse cervical incisions

The incidence of major wound complications (carotid rupture or persistent fistula) in a personal series of 72 consecutive patients who had neck dissection alone or in continuity with oral or laryngeal resections with the use of only tran,sverse cervical incisions is six percent. This incidence is lower than in most previously described series of patients in whom other types of incisions were used. Major wound complications did not occur in any of 25 patients who had not received preoperative irradiation therapy. Major wound complications occurred in nine percent of 47 patients who

One-stage radical resection of cervical esophagus, larynx, pharynx, and neck, with immediate reconstruction.

A ONE-STAGE operation for the treatment of patients with extensive cancer of the pharynx, hypopharynx, postcricoid areas, and cervical esophagus has been developed in the hope of mitigating the morbidity encountered in the treatment of these patients by the multiple-stage method of excision and delayed reconstruction of the pharynx and esophagus. This one-stage operation consists of radical resection of the cancerous growth in the pharynx, esophagus, and neck and immediate reestablishment of continuity between the fenestrae in the oral pharynx and cervical esophagus by the careful anastomosis of a free thick-split skin graft to these structures. The free tubed graft is covered inferiorly with the lobes of the thyroid and superiorly by the associated prevertebral fascia and the skin flaps of the neck. Postoperative contracture is mitigated by the implantation of an inert stent and bouginage. INDICATIONS Patients for whom this type of operation is indicated are divided into those

Speech rehabilitation after total removal of larynx.

The problems that confront the patient who has undergone a radical laryngeal resection are generally not too well known. To present a total picture of the person who has undergone radical laryngectomy and his problems is one of the aims of this paper. Further, it is our purpose to show that practically all patients, after a total laryngectomy, can acquire a natural form of speech 1 without the use of any artificial aid and that they can resume their former occupations and activities requiring the use of the voice. The number of patients with cancer of the larynx who have a total laryngectomy is increasing yearly. 2 They number in the thousands. Physicians in many communities in the United States and other countries now have to care for many more of these persons, whose medical needs are many, sometimes unique. The necessity for speech rehabilitation after the operation is now

Resection of Larynx and Pharynx

Resection of Larynx and Pharynx