Supracricoid Laryngectomy Research Articles

The Surgical Indications and Limitations of Supracricoid Laryngectomy from the Perspective of the Resection Line

The Surgical Indications and Limitations of Supracricoid Laryngectomy from the Perspective of the Resection Line

Function evaluation of laryngeal reconstruction using infrahyoid muscle after partial laryngectomy in 37 patients

Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. ObjectiveTo analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. Materials and methodsBreathing, swallowing and phonation were analyzed in 37patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. ResultsThe rate of primary surgery without tracheotomy was 64.9% (13patients), with rapid resumption of oral feeding (mean intubation time, 13days). Mean VHI score was 28.3 and mean DHI 30score 2.7. Mean peak inspiratory flow was 203.3mL/min. ConclusionSupracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.

MON-PO522: Sarcopenia in Patients with Supracricoid Laryngectomy

MON-PO522: Sarcopenia in Patients with Supracricoid Laryngectomy

Supratracheal laryngectomy: a multi-institutional study

IntroductionSupratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. ObjectiveTo determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. MethodsThis is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. ResultsOf the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. ConclusionSelected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.

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.

Long-term Swallowing Function, Pulmonary Complications, and Quality of Life after Supracricoid Laryngectomy.

Long-term effects of supracricoid laryngectomies are nowadays under discussion. The purpose of this study was to detect the prevalence of chronic aspiration and incidence of pulmonary complications, to investigate possible influencing factors, and to analyze dysphagia-related quality of life in a cohort of patients who recovered swallowing function after undergoing supracricoid laryngectomies. Retrospective observational study. San Raffaele Hospital, Vita-Salute University, Milan, Italy. A cohort of 39 patients who recovered swallowing function free of disease after a minimum 3-year follow-up period was retrospectively investigated between October and December 2017-clinically with the Pearson's Scale and M. D. Anderson Dysphagia Inventory and instrumentally with fiberoptic endoscopic evaluation of swallowing. Chronic aspiration was demonstrated in a significant portion of patients (clinically in 33.3% and instrumentally in 35.9%). Aspiration was influenced by advanced age at surgery (P = .020). Type of surgical procedure, resection of 1 arytenoid cartilage, postoperative rehabilitation with a speech-language therapist, radiotherapy, age at consultation, and length of follow-up did not influence the prevalence of aspiration. Pulmonary complications affected 5 patients; incidence of pulmonary complications was related to aspiration and was favored by poor laryngeal sensation/cough reflex. Aspiration significantly affected quality of life. Chronic aspiration is frequent and affects patients' quality of life. However, incidence of pulmonary complications is low; therefore, oral feeding should not be contraindicated for aspirating patients. Preservation of laryngeal sensation and cough reflex is mandatory to prevent pulmonary complications.

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.

Functional outcomes in supracricoid laryngectomy

Supracricoid laryngectomies (SCLs) are conservative surgical techniques for the treatment of selected laryngeal carcinomas and are considered an organ-sparing alternative to total laryngectomy and chemo-radiotherapy. The main characteristics of SCLs are the preservation of the main laryngeal functions as respiration, phonation and swallowing, without a permanent tracheostomy. Supracricoid laryngectomies have been questioned for many years as regarding functional and oncological outcomes and are currently accepted, although patient selection criteria and functional results are still debated. The mainstream of this surgery is the maintenance of one functioning cricoarytenoid unit to allow restoring of swallowing and phonation. Thus, post-operative rehabilitation protocol is required to archive functional outcomes and avoid functional failure of this surgery; an early rehabilitation protocol improves functional results, in particular regarding swallowing. Swallowing and voice functional outcomes differ among several centres and are often related to the post-operative management, although SCLs provide commonly good swallowing and respiratory outcomes. To date, SCLs are proven surgical procedures for the treatment of laryngeal cancer and should be a valuable option to total laryngectomy and chemo-radiotherapy for selected advanced laryngeal squamous cell carcinoma. In this clinical review, we discuss the clinical outcomes in patients treated with SCLs with particular attention to rehabilitation protocol and functional outcomes for swallowing and voice rehabilitation.

Impact of the anterior commissure involvement on the survival of early glottic cancer treated with cricohyoidoepiglottopexy: a retrospective study.

BackgroundLaryngeal early glottic tumors can benefit from different treatment modalities, including transoral laser microsurgery, open partial horizontal laryngectomy (OPHL), and radiotherapy. However, the treatment of early glottic tumors with the involvement of the anterior commissure remains controversial. The studies about the role of anterior commissure involvement in oncologic outcomes in patients with early glottic cancer treated with supracricoid laryngectomy (SCL) are very few. For this reason, we conducted a retrospective study to evaluate local recurrence-free survival and specific survival in patients with and without involvement of the anterior commissure who underwent SCL with cricohyoidoepiglottopexy.MethodsThis retrospective study has been carried out on patients with T1b–T2 glottic squamous cell carcinoma submitted to SCL with cricohyoidoepiglottopexy. The patients’ demographic and clinical data were collected, and the histological findings of the surgical specimens were reviewed to identify patients who had involvement of the anterior commissure.ResultsA total of 72 patients were included in the study; two of them were female and 70 were male. The mean age at diagnosis was 61.5±8.0 SD years. In 26 of the 72 (36.2%) patients, anterior commissure was not pathologically involved (group A), while in 46 (63.8%) patients, it was involved (group B). The 5-year local recurrence-free survival rate was 96.1% and 93.48% in groups A and B, respectively, P=0.09. The 5-year disease-specific survival rate was 92.31% and 95.65% in groups A and B, respectively, P=0.057.ConclusionSCL with cricohyoidoepiglottopexy seems to be an adequate treatment modality, even for T1b–T2 glottic tumors with anterior commissure involvement.

Role of supracricoid partial laryngectomy with cricohyoidoepiglottopexy in glottic carcinoma with anterior commissure involvement

ObjectivesTo analyze oncologic and functional outcomes after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in glottic carcinoma with anterior commissure (AC) involvement, to determine predictive factors, and to compare results with those reported for other therapeutic strategies. Material and methodsA retrospective analysis included all patients who underwent SCL-CHEP for glottic squamous cell carcinoma with anterior commissure involvement in our institution, between 2000 and 2014. Swallowing function was evaluated on the DOSS (Dysphagia Outcomes and Severity Scale). ResultsFifty-three patients were included. Three-year overall, cause-specific and recurrence-free survival rates were 86, 95 and 80%, respectively. There were 5 cases of local recurrence (9%), all treated by total laryngectomy. Smoking was the only predictive factor of recurrence-free survival (P=0.02). Mean DOSS score was 5.5±0.9. DOSS scores≥6 (normal oral feeding) were recovered by 59% of patients. T-stage≥2 was the only predictive factor for DOSS score (P=0.04). ConclusionIn glottic carcinoma with anterior commissure involvement, SCL with CHEP provided a local control rate of more than 90%, which is higher than reported with endoscopic surgery or external radiotherapy. However, contrary to LSC, salvage of local recurrence can often be obtained by conservative treatments after endoscopic surgery. Therefore, total-laryngectomy-free survival rates after SCL-CHEP and endoscopic surgery are finally comparable.

Supracricoid partial laryngectomy for radiorecurrent laryngeal cancer: a systematic review of the literature and meta-analysis.

The objective of the current systematic review with meta-analysis was to report the pooled survival outcomes of supracricoid partial laryngectomy in the setting of radiorecurrent laryngeal cancer to investigate if and when an organ-sparing surgical treatment is adequate. The search included all original papers from 1990 to December 2017. The search terms included the following: cricohyoepiglottopexy; cricohyoidopexy; cricohyopexy; horizontal laryngectomy; and partial, subtotal, supracricoid, and supraglottic laryngectomy. Inclusion criteria were as follows: (1) data clearly distinguish results of partial laryngeal procedures; (2) clear description of tumor stage and selection criteria; (3) clear description or derivability of local control and survival rates. Eleven out of 270 papers were analyzed, and a total of 251 cases were included. Two-year LC, 3-year DFS, and 5-year OS were 92, 80, and 79%, respectively. Heterogenicity evaluated with the I2 parameter was 14, 0, 0%, respectively. The larynx preservation rate was 85.2%, the decannulation rate was 92.1%, and swallowing recovery was 96.5% (PEG dependence and the aspiration pneumonia rate were 3.5 and 6.4%, respectively). SCPL is oncologically sound, guaranteeing a high percentage of success. The homogeneity of data should encourage the use of SCPL as salvage treatment for recurrent LSCC.

Supracricoid Laryngectomy: The Function of the Remaining Arytenoid in Voice and Swallowing.

Introduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoids were not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.

Surgical Treatment of Laryngeal Carcinoma

Theoretical basis: The treatment of laryngeal carcinoma is associated with various operative interventions depending on the distribution of the tumor process. The Aim of the study is to characterize the advantages and disadvantages of various surgical techniques used in the treatment of laryngeal carcinoma. Results: Any surgical procedure that preserves physiological speech and swallowing function without the need for a permanent tracheostomy is defined as organ preservative laryngeal surgery. Open techniques in early laryngeal carcinoma are divided into: vertical partial laryngectomy (frontal-lateral resection) – classically it includes a vertical incision of the thyroid cartilage. The aim is to resect the tumor at the glottic level with part of the thyroid cartilage; supraglottic laryngectomy – is best applied in T1 and T2 supraglottic lesions; supracricoid laryngectomy – is based on the concept that the main functional unit of the larynx is the cricoarytenoid complex, preservation of which is essential for the success of the operation; laser excision of early laryngeal carcinoma. Treatment of advanced carcinoma of the larynx is total laryngectomy with or without dissection cervical lymph nodes. Conclusion: The selection of the appropriate type of surgical intervention that correlates with the spread of the carcinoma is of extreme importance for the outcome of the treatment.

Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle

IntroductionLaryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. ObjectiveThe aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. MethodsIn total, 29 male patients (average years 58.20±9.00 years; range 41–79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. ResultsThe mean maximum phonation time was 8.68±4.21s in Group A and 15.24±6.16s in Group B (p>0.05). The S/Z (s/s) ratio was 1.23±0.35 in Group A and 1.08±0.26 in Group B (p>0.05); the voice handicap index averages were 9.86±4.77 in Group A and 12.42±12.54 in Group B (p>0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73±3.08 in Group A and 13.64±1.49 in Group B (p>0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21±4.11, 32.21±6.85, and 20.14±2.17 in the Group B, and 29.20±2.54, 32.4±4.79, and 19±1.92 in Group A, respectively. ConclusionAlthough there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

Combined Vocal Exercises for Rehabilitation After Supracricoid Laryngectomy: Evaluation of Different Execution Times

The supracricoid partial laryngectomy allows the preservation of laryngeal functions with good local cancer control. To assess laryngeal configuration and voice analysis data following the performance of a combination of two vocal exercises: the prolonged /b/vocal exercise combined with the vowel /e/ using chest and arm pushing with different durations among individuals who have undergone supracricoid laryngectomy. Eleven patients undergoing partial laryngectomy supracricoid with cricohyoidoepiglottopexy (CHEP) were evaluated using voice recording. Four judges performed separately a perceptive-vocal analysis of hearing voices, with random samples. For the analysis of intrajudge reliability, repetitions of 70% of the voices were done. Intraclass correlation coefficient was used to analyze the reliability of the judges. For an analysis of each judge to the comparison between zero time (time point 0), after the first series of exercises (time point 1), after the second series (time point 2), after the third series (time point 3), after the fourth series (time point 4), and after the fifth and final series (time point 5), the Friedman test was used with a significance level of 5%. The data relative to the configuration of the larynx were subjected to a descriptive analysis. In the evaluation, were considered the judge results 1 which have greater reliability. There was an improvement in the general level of vocal, roughness, and breathiness deviations from time point 4 [T4]. The prolonged /b/vocal exercise, combined with the vowel /e/ using chest- and arm-pushing exercises, was associated with an improvement in the overall grade of vocal deviation, roughness, and breathiness starting at minute 4 among patients who had undergone supracricoid laryngectomy with CHEP reconstruction.

Lateral cervical approach for supracricoid partial laryngectomy

IntroductionThe supracricoid partial laryngectomy has been described for the treatment of T3 laryngeal glottic and supraglottic tumors as well as upfront and salvage surgery. Good oncological and functional outcomes are expected, while the post-operative rehabilitation can be quite difficult for the patient. Early and late complications can occur especially in salvage surgery. Neck dissection according to the T stage is often associated with the resection of the primary tumor. ObjectiveTo verify the feasibility of a minimally invasive procedure for supracricoid partial laryngectomy by adopting the lateral cervical approach. Methods/resultsA 61-year old man affected by a cT3N0 glottic cancer already treated 10years prior with radiotherapy for oropharyngeal cancer underwent supracricoid laryngectomy using the lateral approach. The key point of the procedure was a subfascial dissection with the harvesting of anterior cervical flap including skin, fat, platysma, fascia superficialis, anterior jugular veins, homo- and sterno-hyoid muscles. ConclusionSupracricoid laryngectomy by a lateral approach is feasible and safe; it allows to perform a simultaneous neck dissection and the removal of the entire laryngeal specimen preserving ample healthy tissue compared to the classic anterior approach.

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.

Transoral laser microsurgery for managing laryngeal stenosis after reconstructive partial laryngectomies.

To retrospectively analyze our experience of transoral laser microsurgery (TLM) for treating postoperative laryngeal obstruction (POLO) after supracricoid and supratracheal laryngectomy (open partial horizontal laryngectomy [OPHL]) types 2 and 3, and to investigate potential relationships between patients' clinical features and their functional outcomes. A retrospective cohort study. The prognostic influence of clinical and surgical parameters on functional outcomes was investigated in a univariate statistical setting in terms of decannulation rate (DR), time to tracheostomy closure (TTC), and number of laser procedures required (NLP). OPHL type 2 was associated with a better functional outcome than OPHL type 3 in terms of DR, TTC, and NLP (P = .03, P = .02, and P = .02, respectively). Annular and semicircumferential stenoses developed more frequently after OPHL type 3, and were particularly difficult to manage with TLM. Fixation of the residual arytenoid was a negative prognostic factor in terms of functional outcome in terms of DR, TTC, and NLP (P = .0002, P = .08, and P = .08, respectively). There is no standardized laser treatment for POLO; it must be tailored to individual patients. Identifying prognostic factors influencing functional outcome could help surgeons to earmark patients less likely to benefit from TLM for the treatment of POLO, and enable an adequate preoperative counseling, given the high probability of repeat postoperative TLM procedures. 4 Laryngoscope, 2016 127:359-365, 2017.

Laryngeal conservative surgery in patients candidates for combined treatment with chemo-radiotherapy

Abstract Background The standard of care for advanced-stage laryngeal cancer is combined treatment (chemo-radiotherapy). However, the complications with this treatment are not few, mainly in swallowing. Conservative laryngeal surgery remains an effective alternative for cancer control without the complications of chemo-radiotherapy. Material and methods Retrospective study was conducted on patients with laryngeal cancer cT3, cN0 with paraglottic infiltration, fixation of the vocal cord, minimal invasion of the hyo-thyroepiglottic space, but with normal arytenoid mobility and no sub-glottic extension, were treated with subtotal supracricoid laryngectomy. Complications, sequels of treatment, and local recurrence were evaluated. Bronchial aspiration was studied with radioactive swallow. Results There were 25 patients, 22 with negative surgical margins, one had tumour contact with the surgical margins, and 2 were positive. Two patients received postoperative radiotherapy. The mean decannulation was 15 days and removal of nasogastric tube 25 days. During the mean follow-up of 26 months, none of the patients had tumour recurrence or required conversion to total laryngectomy. In all patients swallowing has been normal and none required permanent or temporary tracheotomy or definitive gastrostomy. The voice is considered intelligible in all patients. Radioactive swallow showed aspiration in 15/25 patients, with none being clinically relevant. There were postoperative complications in 5 patients, and 4 patients required re-intervention but no conversion to total laryngectomy. Conclusion Conservative surgery is an effective surgical-alternative to chemo-radiotherapy in patients with locally advanced laryngeal cancer, providing oncological control, acceptable complications and minimal sequels. Although most patients have aspiration, this does not affect functional status.