Supracricoid Laryngectomy Research Articles

Investigation of the Surgical Limitation by Extended Supracricoid Laryngectomy

Investigation of the Surgical Limitation by Extended Supracricoid Laryngectomy

輪状軟骨弓進展声門癌に対する拡大喉頭亜全摘出術 (ESCL-TCHEP) の治療経験

57歳女性の輪状軟骨弓進展声門部扁平上皮癌T4aN0M0症例に対して，輪状軟骨弓を合併切除する拡大喉頭亜全摘出術 (extended supracricoid laryngectomy : ESCL) とtracheocricohyoidoepiglottopexy (TCHEP) を施行後に術後照射をおこなった。現在術後7年5カ月が経過しているが明らかな再発はなく，嚥下障害や呼吸困難も認められない。輪状軟骨弓を切除してもTCHEPでは舌骨が第1気管輪に接するようにpexyされるため，舌骨体部が輪状軟骨弓の代わりに喉頭内腔確保のための支持組織としての役割を果たし，呼吸困難や嚥下障害は生じなかった。声門下進展喉頭癌に対する喉頭機能温存手術として，ESCL-TCHEPは有効な手段の一つと思われる。

Avaliação de voz e qualidade de vida após laringectomia supracricóide

OBJETIVO: Avaliar sujeitos submetidos a laringectomia supracricóide quanto à autoavaliação da voz, análises perceptivo-auditiva e acústica e impacto da alteração vocal na qualidade de vida. MÉTODOS: Estudo prospectivo, observacional, que envolveu 12 sujeitos do gênero masculino, com disfonia orgânica, média de idade de 59,3 anos, que realizaram laringectomia supracricóide para exérese de neoplasia maligna de laringe. Foi realizada análise perceptivo-auditiva, por meio da escala GRBASI em duplo-cego. A análise acústica realizada através do software VOXMETRIA® considerou parâmetros de frequência fundamental, jitter e shimmer, proporção harmônico-ruído e diagrama de desvio fonatório. A autoavaliação vocal e o estudo do impacto da disfonia na qualidade de vida dos sujeitos ocorreram por meio de aplicação dos protocolos: Qualidade de Vida em Voz (QVV) e o Índice de Desvantagem Vocal (IDV). RESULTADOS: A frequência das vozes variou entre 91,59 Hz e 260,05 Hz e as medidas de shimmer e jitter mostraram-se alteradas, comprovando as análises perceptivo-auditivas, que revelaram vozes com grau de desvio de moderado a intenso. A maioria dos sujeitos qualificou suas vozes como razoável ou boa. O QVV demonstrou escores brutos em níveis compatíveis com vozes disfônicas em 50,0%. O IDV mostrou predomínio do domínio orgânico. CONCLUSÃO: O grau de desvio vocal dos sujeitos mostrou-se entre moderado e intenso, confirmando parâmetros acústicos, enquanto que os sujeitos qualificaram suas vozes como razoáveis ou boas. Os escores do QVV e IDV revelaram predomínio de domínios físico e orgânico, respectivamente, com parte dos sujeitos com escores compatíveis a vozes disfônicas. Sugerem-se estudos que busquem aprofundar o conhecimento entre autopercepção da voz e impacto na qualidade de vida de sujeitos com disfonia decorrente de carcinoma de laringe.

Clinical Outcomes of 849 Laryngeal Cancers Treated in the Past 40 Years: Are We Succeeding?

We analyzed the clinical outcomes of 849 laryngeal cancers treated in the past 40 years, which overlapped with the era of the global treatment shift. To compare the chronological outcomes, patients were divided into four groups according to their registration year as 1972-82, 1983-92, 1993-2002 and 2003-12; treatment trends, larynx preservation rate and overall survival rate were compared. There were 104, 173, 253 and 319 patients registered in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. Five-year overall survival rates were 74, 76.5, 75.6 and 82.2% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. The five-year larynx preservation rates were 65.5, 75.7, 75.4 and 80.9% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. The number of patients treated at our institute increased, and the overall survival and larynx preservation rates exhibited favorable improvements over the past four decades. In the analysis of nonsurgical options, S1 combined radiotherapy showed superiority over concurrent chemoradiotherapy and radiotherapy in larynx preservation, and S1 combined radiotherapy, concurrent chemoradiotherapy and Tegafur Uracil combined radiotherapy showed superiority over radiotherapy in overall survival. In nonsurgical approaches, proper case selection is the key to success and may be much more important than pursuing radiotherapy dose escalation. In the analysis of surgical options, laser and supracricoid laryngectomy with cricohyoidoepiglottopexy contributed to larynx preservation in early- and intermediate-stage cancers, respectively. Supracricoid laryngectomy with cricohyoidoepiglottopexy demonstrated overall survival not worse than total laryngectomy, which is the prerequisite treatment basis for larynx preservation options. We must make extra efforts in pursuing an ideal balance between nonsurgical and surgical larynx preservation options.

Corniculate reconstruction after arytenoid resection in supracricoid laryngectomy

Corniculate reconstruction after arytenoid resection in supracricoid laryngectomy

Assessment of the paraglottic space in supracricoid laryngectomy

EnAbstractBackgroundSupracricoid laryngectomy (SCL) is largely affected by invasion of the tumor into the paraglottic space.Aim of the workThe aim of this study was to histopathologically examine whether SCL provides adequate safety margins in terms of the paraglottic space or not.Patients and methodsA prospective study was carried out on 20 patients with advanced cancer larynx staged as T2b, T3 and cases with failed radiotherapy where SCL was performed, followed by whole-organ transverse sections of the specimens to evaluate the relation of the tumor to the paraglottic space.ResultsThe local success rate in this study was 90%; one case showed infiltrated surgical margins and the other showed local recurrence 6 months after the operation.ConclusionSCL allows for a safe enbloc resection of a malignant tumor in the larynx with complete resection of the paraglottic space. A safety margin of at least 4 mm is needed to eradicate the tumor as revealed by the whole-organ section technique.

A novel method for culturing human glottic cells

The objective of this basic investigation was to describe a new method of preparing primary monolayer cultures of human glottic cells. To our knowledge, this is the first report of the culturing of healthy human glottic cells. This technique may be of use for other applications in the challenging field of laryngeal diseases. Individual prospective cohort study. Tissue samples were collected from 15 patients who underwent laryngeal surgery due to chronic laryngitis or larynx carcinoma. An inverted phase microscope was used to study the cultured cells, and immunocytochemistry using a mouse anti-human cytokeratin 19 monoclonal antibody was performed to identify epithelial cells. The relationship between the culture results and several patient variables was evaluated. Cultures were positive in 40% of samples. The total and supracricoid laryngectomy groups had the highest rate of culture positivity (P < .02). The current study provides methodological details that will allow other research groups to replicate this model of glottic cell culture.

Cost Analysis in Patients Treated with Partial Laryngectomy

Methods: The length of stay, complication rates, decannulation time, time to initiate oral nutrition, costs of examination, medication costs and total cost were assessed by investigating the records and bills of 26 patients with larynx squamous-cell carcinoma treated with frontolateral, supraglottic and supracricoid laryngectomy surgery in the Ear-Nose-Throat Clinic of the Sisli Etfal Research and Training Hospital between January 2007 and December 2011.

Predictive Factors for Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Cancers

Objectives: 1) Determine which factors of the pre-operative assessment, cancer location, and planned surgical resection are predictive of postoperative need for gastrostomy placement in patients undergoing resection of upper aerodigestive tract cancers. 2) Determine if a pre-operative assessment algorithm can accurately predict need for gastrostomy placement. Methods: Retrospective chart review of all adult patients diagnosed with head and neck cancers that subsequently underwent cancer resection at Wake Forest Baptist Medical Center from 2007-2012. Patient charts were screened for placement of postoperative gastrostomy tube, patient demographics (ie, gender, age), tumor characteristics including size, location, bilaterality, and surgical treatment type. Univariate analysis was run on all patient variables and compared against gastrostomy placement. Results: Gastrostomy tube placement was found to be strongly associated with the patient characteristics of pre-operative weight loss (&lt;.001), history of radiation (.001) and prior dysphagia (.001). Characteristics of the disease including clinical nodal disease (.04) and tongue base tumor location (.05) were also associated. Tracheostomy placement (&lt;.001), supracricoid laryngectomy (.01), floor of mouth resection (.02), total glossectomy (.025) and free flap reconstruction (&lt;.001) were the procedures most significantly associated with gastrostomy tube placement. Post-operative failed swallowing evaluation was most strongly associated with G tube placement (2.8 × 10-22). Conclusions: Preliminary data suggest that certain patient characteristics, tumor features, and types of surgical procedures can predict post-operative gastrostomy tube placement. A risk stratification algorithm can likely be developed given the strength of multiple positive and negative associations between patient and tumor variables.

第28回日本嚥下医学会]喉頭半切・亜全摘術施行例における嚥下動態の経時的変化

第28回日本嚥下医学会]喉頭半切・亜全摘術施行例における嚥下動態の経時的変化

Traditional transcutaneous approaches in head and neck surgery.

The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing.In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool.In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.

Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience

To evaluate the long-term oncologic results of supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) for laryngeal cancer. A 35-year retrospective study concerning 291 patients treated by supracricoid laryngectomy with CHEP for laryngeal cancer was performed. The following postoperative data were studied: recurrence rates (lymph node and laryngeal), distant metastases and second cancer. The mortality rate and overall survival were estimated by the Kaplan-Meier method. The postoperative mortality was 1.03 %. 23 patients were lost to follow-up. The 3-year survival rate was 84 % and the 5-year survival rate was 80 %. 12 patients developed distant metastasis. 31 patients developed a second cancer. The local (laryngeal) control rate was 93.94 % and the regional (cervical lymph node) control rate was 92.05 %. In multivariate analysis, the occurrence of a second non-ENT cancer and metastasis as well as margins involvement were reliable to mortality. Supracricoid laryngectomy with CHEP appears to be associated with very good long-term oncologic results and still has a place in the management of T1, T2 and selected T3 glottic cancers.

Oncologic and Functional Outcomes of Partial Laryngeal Surgery for Intermediate‐Stage Laryngeal Cancer

To evaluate the oncologic and functional outcomes of partial laryngeal surgery (PLS) using transoral laser microsurgery (TLM) and supracricoid laryngectomy (SCL) in patients with intermediate-stage laryngeal squamous cell carcinoma (LSCC). Historical cohort study. Single tertiary care center. Retrospective review of oncologic and functional outcomes in intermediate-stage (T2-3/N0-1, stage II and III) LSCC patients who underwent TLM or SCL from 1998 to 2010. Sixty patients were included, of whom 28 (47%) underwent TLM and 32 (53%) underwent SCL. For the entire cohort, 2- and 5-year probabilities were 86.2% (95% confidence interval [CI], 73.0%-93.2%) and 72.9% (95% CI, 52.4%-85.6%), respectively, for overall survival (OS) and 79.3% (95% CI, 65.6%-88.0%) and 62.4% (95% CI, 41.9%-77.4%), respectively, for recurrence-free survival (RFS). There was no difference between the TLM and SCL cohorts in OS (P = .542) or RFS (P = .483). More than 75% of patients avoided adjuvant therapy. Communication Scale and Functional Outcome Swallowing Scale scores at median follow-up of 33 months were 2 or better in 97% and 91% of patients, respectively, reflecting functional voice and swallowing postoperatively. Eighty-eight percent of patients retained a functional larynx. PLS provides excellent oncologic and functional outcomes for intermediate-stage LSCC and should be considered an alternative to chemoradiation or total laryngectomy in selected patients.

Buccal fat augmentation for insufficient neoglottal closure after supracricoid laryngectomy with cricohyoidoepiglottopexy

Supracricoid laryngectomy with Cricohyoidoepiglottopexy (SCL-CHEP) is a functional organ preservation surgery for laryngeal cancers. Post-operative laryngeal function is generally promising. Some patients, however, cannot attain satisfactory functional results because of an excessively wide neoglottis resulting in an insufficient neoglottal closure. Autologous buccal fat augmentation was conducted to correct the insufficiency. Two patients underwent intervention. Under general anesthesia, autologous fat was harvested from the buccal fat pad. Fat tissue was injected into the widest plane of the neoglottis under direct laryngoscopy; a navigation system was incorporated to identify the responsible site. Acoustic, aerodynamic, and perceptual analyses along with videofluoroscopic swallowing study and screening questionnaires were used for functional evaluation. A total of 0.8ml (Case 1) and 0.7ml (Case 2) of fat tissues were injected into the submucosal space of the responsible sites. Both patients experienced functional improvement subjectively after augmentation; psychological parameters for voice and swallowing also improved. Buccal fat augmentation to correct insufficient neoglottal closure after SCL-CHEP was technically feasible. A navigation system was helpful for confirmation. Fat absorption occurred and one third of the volume remained at 3 and 6 months. Although, vocal measurements remained unchanged, psychological parameters for voice and swallowing improved.

Factors associated with supracricoid laryngectomy functional outcomes

Supracricoid partial laryngectomy (SCPL) is an option for laryngeal cancer resection that preserves laryngeal function; however, little information exists regarding factors that are associated with functional outcomes. A medical chart review was performed on patients that underwent SCPL at our institution between 2006 and 2011. Data were collected on surgical, voice, and swallowing outcomes. Eighteen patients were identified. Thirteen underwent cricohyoidoepiglottopexy (CHEP) and 5 had a cricohyoidopexy (CHP). Mean follow-up was 737 days. On average, decannulation occurred at 27.4 days and feeding tube removal at 87.9 days postoperatively. Sixty-seven percent of patients tolerated an unrestricted diet at follow-up. Increased age and a CHP procedure were associated with negative outcomes. Age may be a proxy for more extensive disease and prior treatments. Patients who undergo an SCPL require extensive rehabilitation after surgery. Those who have undergone multiple cancer interventions and have more extensive surgery may be at risk for poorer outcomes.

Quality of life in patients treated by organ preservation surgery for early laryngeal carcinoma

Quality of life in patients treated by organ preservation surgery for early laryngeal carcinoma Eugenia Allegra, Teresa Franco, Serena Trapasso, Teodoro Aragona, Rossana Domanico, Aldo GarozzoDepartment of Otolaryngology, Head and Neck Surgery, University of Catanzaro, Catanzaro, ItalyBackground and objective: Supracricoid partial laryngectomy (SCL) was introduced as an organ preservation procedure for treating selected early laryngeal cancer. However, the recovery of the voice after SCL may result in different degrees of dysphonia. To improve the functional recovery and quality of the voice, we realized a modified supracricoid laryngectomy (MSCL) using sternohyoid muscles for neoglottic reconstruction in selected patients affected by T1b&ndash;T2 laryngeal cancer. In this study, we evaluate the quality of life (QoL) in patients treated by SCL and MSCL.Methods: The quality of life (QoL) evaluation was undertaken using the Italian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.Results: The overall QoL, assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, was better in patients treated with MSCL than in those treated with SCL. The better QoL correlates with the highest response scores to the questions on the relative global functioning scales in patients treated with MSCL.Conclusion: The new surgical technique has improved the QoL of patients with early laryngeal cancer, with improved communication ability achieved. Reconstruction of neocords in MSCL improves speech function in comparison to SCL, and patients experience less discomfort and achieve an almost normal communication performance.Keywords: supracricoid laryngectomy, quality of life, laryngeal carcinoma, EORTC QLQ

Supracricoid Partial Laryngectomy

The aim of this study was to analyze the functional and oncologic results of supracricoid partial laryngectomy. Case series with chart review. Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. The medical records of 56 patients, who underwent supracricoid partial laryngectomy between March 2002 and December 2010, were reviewed in this study. Forty-three patients underwent supracricoid partial laryngectomy with cricohyoidopexy, and 13 patients underwent cricohyoidoepiglottopexy. The overall and disease-specific survival, local control rates, and the mean time of decannulation and nasogastric tube removal were evaluated. Association of type of surgery with the functional and oncologic outcomes was evaluated and statistically compared. The median follow-up period was 58 months. The 1-, 3-, and 5-year overall survival rates were 100%, 96.4%, and 82.1%, respectively. The 1-, 3-, and 5-year local control rates were 100%, 96.1%, and 92.5%, respectively. Type of surgery did not show any significant difference in survival and local control rates (P = .546, P = .455). The mean (SD) decannulation and nasogastric feeding tube removal time was 11.43 (2.03) and 16.79 (3.51) days, respectively. The mean time of decannulation and nasogastric tube removal was significantly longer in patients who underwent cricohyoidopexy when compared with those who underwent cricohyoidoepiglottopexy (P = .002, P = .000). Although delaying deglutition functions could be termed a disadvantage of supracricoid laryngectomy, especially with cricohyoidopexy, supracricoid laryngectomy has reliable oncologic and functional results for locally advanced laryngeal cancers while maintaining laryngeal functions.

Clinical outcome of supracricoid laryngectomy with cricohyoidoepiglottopexy: Radiation failure versus previously untreated patients

A history of radiation therapy is known to be a major risk factor promoting post-surgical complications. By comparing the clinical outcomes of supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in irradiated and non-irradiated patients, we investigated the usefulness of salvage SCL-CHEP. 73 patients who received SCL-CHEP between 1997 and 2010 (30 had received radiation therapy preoperatively and 43 had not). Staging error, wound infection, accuracy of surgical margin determination, acquired laryngeal function, and prognosis were compared between the two groups. Staging error occurred in 6/30 (20%) irradiated and 14/43 (33%) non-irradiated patients. An intraoperative margin study demonstrated a dysplastic or positive margin in 15/30 (50%) irradiated and 13/43 (30%) non-irradiated patients. Wound infection developed in 12/30 (40%) irradiated and 7/43 (16%) non-irradiated patients (P<0.05). Delayed wound infection was identified in four patients with a radiation dose over 65Gy. Swallowing function (ability to eat in public) was acquired in 28/30 (93%) irradiated and 39/43 (91%) non-irradiated patients. Five-year larynx preservation rates were 94% in irradiated and 91% in non-irradiated patients. Five-year overall survival rates were 81% in irradiated and 87% in non-irradiated patients. Risk of infection was significantly higher in irradiated patients; delayed infection should be appropriately managed. Functional and oncological results were stable regardless of radiation history. We encourage head and neck surgeons to take reasonable risks in performing salvage SCL-CHEP.

Prognostic value of hypoxia-inducible factors (angiogenin and endoglin) in open partial laryngectomies: uni- and multivariate analyses

PurposeAdvances in transoral laser microsurgery, radiotherapy, and chemotherapy (and their combinations) have reduced the indications for open partial laryngectomies, although they have replaced total laryngectomies in selected advanced or recurrent laryngeal squamous cell carcinomas (LSCCs). Tissue hypoxia in malignancies appears to be strongly associated with tumor cell invasiveness and metastases. Whether hypoxia-inducible factors can contribute to a rational recommendation of open partial laryngectomy should be investigated. Materials and methodsFifty consecutive patients who had undergone primary open partial laryngectomy (supraglottic and supracricoid laryngectomies) were investigated, measuring the immunohistochemical expression of the hypoxia-inducible proteins angiogenin and endoglin in their primary LSCCs also with image analysis. ResultsUnivariate analysis showed a significantly higher recurrence rate (P = .007) and shorter disease-free survival (P = .0047) in patients with LSCC with endoglin expression more than 9.0%. Multivariate analysis found endoglin expression independently prognostic in terms of disease-free survival (P = .012). Angiogenin expression (in carcinoma or endothelial cells) was not associated with prognosis. ConclusionsEndoglin should be further studied as a biomarker of patients with LSCC at higher risk for recurrence after open partial laryngectomy who may benefit from more aggressive treatments. Endoglin expression in positive laryngeal biopsies may prove useful as a parameter for choosing between different surgical and multimodality approaches to controversial LSCC cases.

Multidimensional Evaluation of Vocal Function after Supracricoid Laryngectomy with Cricohyoidopexy

The aim of this study was to assess the vocal outcome and the impact of arytenoid resection on vocal function following supracricoid laryngectomy with cricohyoidopexy. Twenty-eight male patients who had undergone supracricoid laryngectomy with cricohyoidopexy were included in the study. In 7 patients, one arytenoid cartilage had been totally resected; in 11, both arytenoid cartilages had been preserved; and in 10, one arytenoid cartilage had been partially resected. The maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were assessed and analyzed. Perceptual analysis was performed with the grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Abduction-adduction and anteroposterior squeezing actions were analyzed from videoendoscopic records. The Voice Handicap Index-10 (VHI-10) was used for self-assessment. The acoustic and aerodynamic parameters and GRBAS score showed severe impairment. The self-assessment revealed that patients were relatively satisfied with their voice quality. There were no statistically significant differences in the acoustic and aerodynamic parameters, the GRBAS score, or the VHI-10 score according to the level of arytenoid resection. Supracricoid laryngectomy with cricohyoidopexy caused deterioration of acoustic and aerodynamic voice parameters and the GRBAS score. Statistically, the level of arytenoid resection had no apparent effect on the objective, perceptual, or subjective voice parameters.