Supracricoid Laryngectomy Research Articles

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.

Voice, swallowing, and quality of life after management of laryngeal cancer with different treatment modalities

Abstract Laryngeal cancer is the most common malignant tumor of the upper aerodigestive tract. Surgical treatment of advanced laryngeal cancer often requires a total laryngectomy (TL), resulting in a permanent tracheostomy and potential difficulties with a patient’s speech and communication. The aim of this study was to assess post-treatment voice changes, swallowing, and quality of life (QoL) of patients with carcinoma of the larynx treated with different treatment modalities. A total of 100 patients with laryngeal cancer treated with different treatment modalities were included in the present study. The primary treatment modality included TL (n = 46), partial laryngectomy (PL) (n = 7), transoral cordectomy (n = 9), radiotherapy (Rx) (n = 29), or combined treatment during the last 10 years with radiation after TL (TL and Rx, n = 9). Patients were subjected to full history taking, complete ENT examination, and assessment of: global QoL, voice, and acoustic parameters using the computerized speech lab at the outpatient clinic of Tanta University Hospitals (TUH). Evaluation of swallowing was carried out using a modified Arabic version of the QoL questionnaire called the Sydney Swallow Questionnaire. Patients having problems with swallowing were further evaluated using fiberoptic endoscopic evaluation of swallowing, at the outpatient clinic of TUH. Respiratory function of the larynx was evaluated by applying a modification of St George’s Respiratory Questionnaire. Results of voice analysis showed that the best voice was evident in patients who had undergone cordectomy, followed by those who had received radiotherapy. There was no significant difference in voice characteristics between patients using voice prosthesis, esophageal voice, or electrolarynx after TL and those using these aids after PL. Worst voice as well as swallowing was seen in patients who had undergone combined TL and postoperative radiotherapy. The best results of swallowing were seen in patients who had undergone cordectomy. Patients who had undergone TL or radiotherapy alone showed similar swallowing results, but better than those who had undergone PL, especially those who had undergone supracricoid laryngectomy. Assessment of respiratory function showed best results in patients who had undergone cordectomy, followed by those who had undergone TL and radiotherapy. Poorest results were seen in patients with combined surgery and Rx, and those who had been treated with PL. Our study revealed that the best significant performance results were seen in patients who had undergone transoral cordectomy, followed by patients who had received radiotherapy only. This was followed by patients who had undergone TL and PL, with no significant difference between the two groups. The worst results were seen in patients who had undergone combined surgery and radiotherapy as the primary treatment modality.

Cirugía conservadora de laringe en pacientes candidatos a tratamiento combinado con quimio-radiación por cáncer laríngeo

BackgroundThe 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 methodsRetrospective 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. ResultsThere 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. ConclusionConservative 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.

Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know?

Supracricoid laryngectomies (SCLs) are conservative organ-sparing surgical techniques for the treatment of selected T2-T4 laryngeal carcinomas. Although these procedures allow preserving the larynx and its functions, in several countries SCLs are not adopted in oncological protocols. One of the possible reasons to account for this choice is the complexity of post-surgical in-hospital management and the variability in functional results. The aim of this review is to analyse the literature on functional results after SCLs as knowledge on functional results will help in focusing on what is needed in the future to reach more standardized post-surgical procedures and homogeneous outcomes. The analysis of the length of hospital stay, feeding-tube removal time and time to eventual tracheotomy decannulation showed a marked variability across authors and centres. Several factors may come into play, including health-system organizations in different countries. In most studies in-depth description of the criteria applied for discharge, tracheotomy tube removal and commencement of oral feeding were not reported. Moreover, the review on swallowing functional outcomes showed marked variability, as well as a lack of consensus on how to assess swallowing after SCLs. The analysis of voice functional outcomes also revealed a marked variability; surprisingly, the tools applied in the assessments were very often not adequate for substitution voice. Literature review showed that voice- and swallowing-related quality of life are often satisfactory but the variability among centres is still too large. Therefore, there is a need for clearer clinical recommendations on early post-surgical management, tracheal-cannula and feeding-tube removal criteria, voice- and swallowing-assessment protocol, rehabilitation need and timing.

Functional Outcome of Supracricoid Laryngectomy: The Role of Anatomical Factors

Functional Outcome of Supracricoid Laryngectomy: The Role of Anatomical Factors

Evaluation of swallowing function after supracricoid laryngectomy as a primary or salvage procedure.

The primary functional issues following conservative therapy for advanced laryngeal cancer concern swallowing. Here, we evaluated the recovery of swallowing after supracricoid partial laryngectomy (SCL) in patients with primary or recurrent laryngeal cancer. We evaluated the swallowing recovery in 27 SCL patients through oropharyngoesophageal scintigraphy, and we evaluated their quality of life using EORTC questionnaires. Four patients underwent total laryngectomy during follow-up. Patients who retained their larynges were able to feed without nutritional support and without tracheostoma. The only significantly different parameter between the primary and salvage cases was the time elapsed to the removal of nasogastric/PEG tubes, which was longer in salvage cases. SCL has been demonstrated as a valuable option for primary and recurrent laryngeal cancer patients. The present data demonstrate good functional results, particularly in terms of swallowing after previous treatments and in primary settings. The combination of oropharyngoesophageal scintigraphy and questionnaires appears to be an adequate, standardizable approach to assessing swallowing function after SCL.

Supracricoid laryngectomy and dysphagia: A systematic literature review.

Perform a systematic literature search to provide an overview of today's literature regarding the different aspects that can cause dysphagia after supracricoid laryngectomy. A systematic literature review. The inclusion criteria were laryngeal cancer, supracricoid laryngectomy, and swallowing. Thirty-one qualifying articles were included and analyzed describing swallowing after supracricoid laryngectomy. Included studies examined the incidence of dysphagia and discussed various factors that will or will not contribute to dysphagia after supracricoid laryngectomy, type of reconstruction, swallow training, radiation, arytenoid cartilage resection, extended procedures, and age. A high incidence of dysphagia was reported after supracricoid laryngectomy. However, good recovery rates were observed with low incidence of severe complications. The included studies used different methods and standards to start oral intake, remove the nasogastric feeding tube, and observe swallow function. Homogenous study population and standardized guidelines on how to handle the pre- and postoperative course after supracricoid laryngectomy and how to measure swallow function could improve further research.

One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control?

Supracricoid laryngectomy with cricohyoidoepiglottopexy has been known to be able to cope with tumor excisions with minimal margins. Extended resection may result in a limited margin and may impair the prognosis. We conducted a clinicopathologic analysis of local recurrence in supracricoid laryngectomy with cricohyoidoepiglottopexy patients. Between 1997 and 2013, 100 patients with glottic cancers underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. The clinicopathologic findings were evaluated. We also analyzed: (i) cancer-specific and overall survival rates, (ii) the correlation between locoregional recurrence and overall survival, (iii) T staging and larynx preservation rates and (iv) previous radiation history and larynx preservation rates. Local recurrence was recognized in eight of the 100 patients (8%); all were initially staged as T3 or T4. Recurrence was identified in the submucosal regions of the ipsilateral arytenoid and/or infraglottis. Six patients were salvaged by completion total laryngectomy except two. Cancer-specific survival at 5 years was 93%; overall survival at 5 years was 89%. There was no significant difference between overall survival and locoregional recurrence. There was a significant difference between larynx preservation in T1-2 and T3-4 patients. There was no significant difference between larynx preservation and the previous radiation therapy status. Our experience convinced us of the clinical potential of supracricoid laryngectomy with cricohyoidoepiglottopexy as one of the effective options for functional larynx preservation. Supracricoid laryngectomy with cricohyoidoepiglottopexy is the most suitable for unfavorable T2 and T3a cases and is applicable for appropriately selected radiation-failed patients. Thorough pre-operative evaluation, proper surgical techniques and careful follow-up are prerequisites for the success of supracricoid laryngectomy with cricohyoidoepiglottopexy.

A Clinical Study of 109 Cases of Glottic Squamous Cell Carcinoma

A total of 109 patients with glottic squamous cell carcinoma were retrospectively evaluated at Hyogo College of Medicine Hospital between 2003 and 2010; 106 patients were male and 3 patients were female, with a median age of 69 years (range, 51-90 years). According to the 7th edition of the Union for International Cancer Control TNM classification, the clinical TN stages were T1aN0 in 47 cases, T1aN1 in 1 case, T1aN2a in 1 case, T1bN0 in 19 cases, T3N0 in 11 cases, T4aN in 5 cases, and T4aN2b in 1 case. No distant metastasis was observed in any cases at initial treatment. Treatments were radiotherapy alone in 75 cases, concurrent chemo-radiotherapy in 20 cases, supra-cricoid laryngectomy in 1 case, and total laryngectomy in 13 cases. Salvage surgery was performed for 14 patients who had undergone radiotherapy or concurrent chemo-radiotherapy. Salvage surgeries included frontolateral partial laryngectomy in 8 cases, supra-cricoid laryngectomy in 2 cases, and total laryngectomy in 4 cases. The 5-year overall survival rate was 77.6%, and the 5-year disease-specific survival rate was 92.5%. The 5-year laryngeal preservation rate was 82.9%. With regard to T-stages, the laryngeal preservation rates were 100% for T1a, 89.5% for T1b, 91.5% for T2, 18.2% for T3, and 16.7% for T4a.

Phonatory Activity after Supracricoid Partial Laryngectomy

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

Les résultats cliniques de 849 cancers laryngés traités dans les 40 dernières années : quel bilan ?

But de la presentation We analyzed the clinical outcomes of 849 laryngeal cancer patients treated in the past 40 years (1971–2012), a time period that saw global treatment shift from surgery to chemoradiotherapy, at a single Japanese tertiary referral center and university teaching hospital. Materiel et methodes To compare the chronological treatment trends, patients were divided into four decades (1972–1982, 1983–1992, 1993–2002, and 2003–2012), and larynx preservation and overall survival rates were compared. The total dose of radiotherapy (RT)-based treatments was fixed at 60 Gy, and has not been increased over the past 40 years. In 1997, we conducted the first supracricoid laryngectomy (SCL) in Japan, and since then, we have become the primary institute for promoting SCL. Resultats There were 104, 173, 253, and 319 patients registered in 1972–1982, 1983–1992, 1993–2002, and 2003–2012, respectively. Five-year overall survival rates (all stages) were 74, 76,5, 75,6, and 82,2 % in 1972–1982, 1983–1992, 1993–2002, and 2003–2012, respectively. Five-year larynx preservation rates (all stages) were 65,5, 75,7, 75,4, and 80,9 % in 1972–1982, 1983–1992, 1993–2002, and 2003–2012, respectively. In non-surgical options, S1 (an oral fluoropyrimidine derivative) + RT showed superiority over RT alone in larynx preservation and overall survival. Among surgical options, SCL significantly contributed to larynx preservation in intermediate and advanced stages and radiation-failed cancers. SCL was associated with overall survival not poorer than total laryngectomy. Conclusion The number of laryngeal cancer patients treated at our institute has increased and overall survival and larynx preservation rates have exhibited favorable improvements over the past four decades. In non-surgical approaches, proper case selection is the key to success and may be much more important than pursuing RT dose escalation. Treatment selection should not merely be decided based on guidelines; each patient's individual status must be taken into consideration. Moreover, the patient's benefit should be considered before clinical interests. We must make extra efforts in pursuing an ideal balance between non-surgical and surgical larynx preservation options in treating laryngeal cancers.

Laryngeal Reconstruction with a Sternohyoid Muscle Flap after Supracricoid Laryngectomy: Postoperative Respiratory and Swallowing Evaluation

To compare postoperative respiratory and swallowing functions between patients who underwent classic supracricoid laryngectomy (SCL) and those who underwent SCL with laryngeal reconstruction using the sternohyoid muscle. Prospective study. National cancer center. Forty-four patients who consecutively underwent SCL for laryngeal squamous cell carcinoma from December 2009 to March 2011 were included. Postoperative parameters including the mean tracheostomy decannulation time, tracheostomy decannulation rate at 6 months, mean nasogastric tube (NGT) removal time, degree of dysphagia at 3 months, and survival time after surgery were evaluated. Twenty-one patients underwent classic SCL (group A), and 23 underwent SCL with laryngeal reconstruction (group B). After a median follow-up period of 37 months (range, 3-44 months), group A had a significantly longer mean decannulation time (120.05 ± 109.38 days vs 33.43 ± 22.60 days, respectively; P < .01) and NGT removal time (37.30 ± 29.97 days vs 17.22 ± 10.95 days, respectively; P < .01) than group B. Swallowing function after 6 months was significantly better in group B than in group A (P = .004). The decannulation rate after 6 months was significantly higher in group B than in group A (95.7% vs 66.7%, respectively; P = .036). The 3-year disease-free survival rate was not significantly different between group A and group B (95.2% vs 95.7%, respectively; P = .961). Laryngeal reconstruction using a sternohyoid muscle flap seems to improve quality of life in the early postoperative period after SCL.

Subtotal supracricoid laryngectomy: changing in indications, surgical techniques and use of new surgical devices

PurposeThe aim of this study is to evaluate the evolution of supracricoid partial laryngectomy (SCPL) in indications, surgical techniques and outcomes through last decades. Materials and methodsA retrospective analysis of 146 patients affected by laryngeal cancer treated with SCPL was carried on. We defined: (1) group A, 100 patients treated by cold instruments between 1995 and 2004; (2) group B, 46 patients treated by harmonic scalpel between 2005 and 2010. Complications rate, and functional and oncological results were documented and a comparison between the two groups was made; histopathological analysis of surgical margins was evaluated and correlated with local incidence of recurrence. ResultsSignificant differences in age mean-value (p=0.02), T classification (p=0.007), and in indication for more advanced-staged patients were found in group B (p=0.001). Surgical procedure was shorter in group B (p<0.001), with shorter swallowing recovery (p=0.003). Oncological outcomes did not report any significant differences. Group B showed a higher incidence of post- operative arytenoid edema (p=0.03) associated with a lower rate of pneumonia (p=0.038). Despite a higher rate of close or positive-margins found in group B no higher incidence of local-recurrence was reported (p=0.02) compared to group A. ConclusionsWe documented changing in indications and surgical technique for SCPL because of the development of modern diagnostic techniques and the introduction of low-thermal injury device allowing a more challenging tumor excision as well as with a shorter swallowing recovery in our series.

A new extended supracricoid laryngectomy technique for tongue base and hyoid bone involvement: crico-glosso-mandibulopexy technique

In the conventional supracricoid laryngectomy technique, tumors extending beyond the lingual surface of the epiglottis with tongue base invasion are contraindicated due to the requirement of the hyoid bone resection. The loss of the hyoid bone causes intractable aspiration and renders the cricoidal pexy process impossible. Therefore, surgeons tend to treat such tumors with total or subtotal laryngectomies or organ preservation protocols. In this article, a new supracricoid partial laryngectomy technique for tumors requiring resection of the hyoid bone and the base of the tongue was described.

Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society

We present herein the proposal of the European Laryngological Society working committee on nomenclature for a systematic classification of open partial horizontal laryngectomies (OPHL). This is based on the cranio-caudal extent of laryngeal structures resected, instead of a number of different and heterogeneous variables present in existing nomenclatures, usually referring to eponyms, types of pexy, or inferior limit of resection. According to the proposed classification system, we have defined three types of OPHLs: Type I (formerly defined horizontal supraglottic laryngectomy), Type II (previously called supracricoid laryngectomy), and Type III (also named supratracheal laryngectomy). Use of suffixes "a" and "b" in Type II and III OPHLs reflects sparing or not of the suprahyoid epiglottis. Various extensions to one arytenoid, base of tongue, piriform sinus, and crico-arytenoid unit are indicated by abbreviations (ARY, BOT, PIR, and CAU, respectively). Our proposal is not intended to give a comprehensive algorithm of application of different OPHLs to specific clinical situations, but to serve as the basis for obtaining a common language among the head and neck surgical community. We therefore intend to present this classification system as a simple and intuitive teaching instrument, and a tool to be able to compare surgical series with each other and with non-surgical data.

Laryngeal cancer

Treatment of laryngeal carcinoma continues to evolve, and whereas there was a transition from total laryngectomy to chemoradiation in response to the Veterans Affairs study and Radiation Therapy Oncology Group (RTOG) 91-11, recent data suggest the role of partial laryngectomy must be revisited. Recent data have shown that laryngeal preservation does not equate with laryngeal function. Data are accumulating in support of operative management of advanced laryngeal carcinoma away from chemoradiation for select patients. In particular, supracricoid laryngectomy may be a viable option for intermediate and selected advanced laryngeal carcinoma while maintaining laryngeal function. The evolution of treatment for advanced laryngeal carcinoma is focusing treatment on maintaining locoregional control while also maintaining a functional larynx.

The history and current status of surgical treatment of laryngeal cancer

The purpose of this study is to review the development of modern surgery of laryngeal carcinoma. The main focus is pointed at the laryngeal saving surgical techniques, their indications, possibilities and limitations. The main principals of the the open operative procedures have been described – vertical partial laryngectomy, supraglottic and supracricoid laryngectomy, as also the transoral laser excision of early carcinomas.

Early and Severe Dyspnea After Supracricoid Partial Laryngectomy

We present the case of a not-yet-reported complication that occurred during the immediate postoperative period after supracricoid partial laryngectomy. We include a review of the literature on complications following this procedure, emphasizing technical considerations that are critical during this surgery. Clinical, diagnostic, and operative findings are presented, as is a differential diagnosis for early and severe postoperative dyspnea following supracricoid laryngectomy.

Partial Laryngectomy with Cricoid Reconstruction: Thyroid Carcinoma Invading the Larynx

Laryngotracheal invasion worsens the prognosis of thyroid cancer and the surgical approach for laryngotracheal invasion is controversial. In this paper, partial full-thickness excision of the cricoid cartilage with supracricoid laryngectomy and reconstruction of existing defect with thyroid cartilage are explained in a patient with papillary thyroid carcinoma invading the thyroid cartilage and cricoid cartilage without intraluminal invasion. Surgical indication should not be established by the site of involvement in thyroid carcinomas invading the larynx, as in primary cancers of the larynx. We think that partial laryngectomy according to the involvement site and the appropriate reconstruction techniques should be used for thyroid cancer invading the larynx.

Early Glottic Cancer: Role of MRI in the Preoperative Staging

Introduction. Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservation surgery to demolitive surgery. Materials and Methods. This prospective study was conducted on 26 male patients, with suspected laryngeal neoplasia of glottic region. The images of MRI and CT were analyzed to define the expansion of glottic lesion to anterior commissure, laryngeal cartilages, subglottic and/or supraglottic site, and paraglottic space. The results of MRI and CT were compared with each other and with the pathology report. Results. CT accuracy was 70% with low sensitivity but with high specific value. MRI showed a diagnostic accuracy in 80% of cases, with a sensitivity of 100% and high specificity. Statistical analysis showed that MRI has higher correlation than CT with the pathology report. Conclusion. Our study showed that MRI is more sensitive than CT in the preoperative staging of early glottic cancer, to select exactly the eligible patients in conservative surgery of the larynx, as supracricoid laryngectomy and cordectomy by CO2 laser.