Transglottic Cancer Research Articles

Supracricoid Laryngectomy: Siriraj’s Experience

Objective: To evaluate the initial functional outcomes of laryngeal cancer patients who underwent supracricoid laryngectomy (SCL) in Siriraj Hospital. Materials and Methods: A retrospective review of patients who underwent SCL with cricohyoidoepiglottopexy or cricohyoidopexy for glottic and supraglottic squamous cell carcinoma in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital between 2000 and 2020. Results: Twenty-two patients underwent SCL. Twenty patients who met the criteria were recruited for the present study. The initial functional results from the T1 and T2 glottic or transglottic cancers in terms of time to decannulation, at 11 days, and time to nasogastric tube removal, at 16 days were achieved. Conclusion: SCL is one of surgical options to treat early laryngeal cancer in cases that were not suitable for conventional conservation laryngeal surgery, translaryngeal laser microsurgery, and cases that failed radiotherapy. This surgical technique could also be an alternative choice for certain advanced laryngeal cancers to avoid total laryngectomy. Keywords: Supracricoid laryngectomy; Functional and oncologic outcomes; Supraglottic and glottic cancer

PSAT192 Hypercalcemia of Immobility in a Patient with Post-Surgical Hypoparathyroidism

Abstract Background Hypercalcemia of immobility is a rare diagnosis in the general population, and thus requires careful evaluation to rule out other causes of non-PTH mediated calcium excess. The pathogenesis is not clearly established, however, likely involves a reduction in mechanical loading stimulus from osteocytes with resultant decreased bone formation and increased bone resorption. Management requires careful assessment to maintain normal calcium. We present a case of hypercalcemia of immobility in a patient with a known history of surgical hypoparathyroidism. Clinical Case A 64-year-old man with a history of transglottic cancer s/p total laryngectomy and tracheostomy with resulting post-surgical hypoparathyroidism and hypothyroidism presented for a tracheostomy change and was found to be hypercalcemic. Since his laryngectomy four years ago, the patient had a low PTH of 2.9 pg/mL (10.0 - 65.0 pg/mL) with resulting prolonged hypocalcemia from 5.9 to 7.9 mg/dL (8.5-10.5 mg/mL) requiring calcium and daily calcitriol treatment. Four months prior to current hospitalization, he developed avascular necrosis of the hip and became essentially bedbound from severe hip pain. Since immobilization, his calcium was noted to increase, with the highest corrected calcium of 10.9 mg/dL (8.5-10.5 mg/mL), necessitating tapering and eventual discontinuation of calcium supplements and calcitriol. During this admission, corrected calcium was 12 mg/dL (8.5-10.5 mg/mL). PTH-rP was 16 pg/mL (14 - 27 pg/mL), PTH was 11.2 pg/mL (15-65 pg/mL), vitamin D 25-hydroxy total was 14.7 ng/mL (30-60 ng/mL), 1,25 dihydroxy vitamin D was 18.2 pg/mL (19.9 to 79.3 pg/mL), SPEP did not detect monoclonal protein, thyroid function was normal and bone scan showed no evidence of metastasis, thus excluding other causes of hypercalcemia. Bone specific alkaline phosphatase was 11.7 (7.6-14.9 mcg/L). C-telopeptide, a marker of bone resorption, was markedly elevated at 2079 (87-345 pg/mL), suggesting hypercalcemia of immobility. The patient was started on vitamin D supplementation, intravenous fluid hydration and physical therapy was initiated to encourage mobilization. The patient was carefully monitored with regular labs to avoid the risk of hypocalcemia once mobilization improved. His calcium began to decline to 10.5 (8.5-10.5 mg/mL) at time of discharge, eventually requiring calcium and calcitriol supplementation to maintain normocalcemia. Conclusion Hypercalcemia of immobility should be suspected in patients witha history of post-surgical hypoparathyroidism who present with new onset hypercalcemia that persists despite titrating or discontinuing calcium and calcitriol therapy. It is a diagnosis of exclusion and thorough laboratory assessment is needed to rule out other causes of hypercalcemia. These patients are at risk of hypocalcemia once the underlying etiology is corrected i.e restoration of mobility. Therefore, bisphosphonates should be avoided for acute treatment of hypercalcemia unless refractory to intravenous hydration. Once mobilization improves, calcium levels should be carefully monitored, and calcitriol and calcium supplementation should be resumed to maintain normocalcemia. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Reconstruction of Tracheal Defect by Sternocleidomastoid Muscle Flap Covered with Skin Graft: A Case Report

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft. Key Words: Tracheal defect, Reconstruction, SCM muscle flap

Comparison of thyroid gland involvement in contrast enhanced computed tomography of the neck and histopathology and the necessity of thyroidectomy in patients with laryngeal and hypo pharyngeal cancer

<p class="abstract"><strong>Background:</strong> The aim of this study is to assess the thyroid gland involvement in the preoperative contrast enhanced computed tomography (CECT) of neck with histopathology (HPE) in determining the indications for ipsilateral thyroidectomy in patients undergoing total laryngectomy in laryngeal and hypopharyngeal cancers.</p><p class="abstract"><strong>Methods:</strong> Forty patients diagnosed clinically with stage 3 laryngeal and hypopharyngeal cancer were subjected to CECT of neck. Patients with cartilage erosion and extra laryngeal spread on CECT (T3, T4a) were routinely taken for total laryngectomy, partial pharyngectomy and hemi thyroidectomy. Specimens were sent for histopathological analysis and which was compared with preoperative CECT scan. </p><p class="abstract"><strong>Results:</strong> Of the forty cases, only four patients had thyroid gland involvement in CECT scan and 2 of the 40 had thyroid gland involvement in histopathology. Of the four patients where the CT scan which showed infiltration of the thyroid gland, none had thyroid gland involvement in histopathology. In two patients where thyroid gland was involved in histopathology, CT scan failed to pick up the thyroid gland involvement. Those two patients with histologically proven thyroid gland involvement identify as transglottic malignancy with cartilage erosion and extra laryngeal spread.</p><p class="abstract"><strong>Conclusions:</strong> Our study concludes that an ipsilateral hemi-thyroidectomy is probably still indicated in transglottic cancer with cartilage invasion and/or extra laryngeal spread.</p>

Thyroid Gland Invasion in Laryngeal Carcinoma

Objective: To determine the prevalence of, and describe transglottic cancer with thyroid cartilage invasion as a possible risk for, thyroid gland invasion in a series of patients with laryngeal carcinoma who underwent total laryngectomy with thyroidectomy.
 Methods
 Study Design: Retrospective case series
 Setting: Tertiary government hospital
 Subjects: 61 laryngeal carcinoma patients who underwent total laryngectomy with hemi- or total thyroidectomy from January 2010 to August 2017.
 Results
 Out of 61 patients with laryngeal carcinoma, 11 patients had supraglottic, 11 glottic, 2 subglottic and 37 had transglottic involvement. Eleven had thyroid cartilage invasion, all of whom had transglottic tumors. Of these 11 patients, only 1 had thyroid gland invasion. This was a case of a 78 year-old male patient, with poorly differentiated SCC stage IVa transglottic tumor with thyroid cartilage invasion.
 Conclusion 
 Thyroid gland invasion was uncommon in our sample of laryngeal carcinoma patients who underwent laryngectomy and thyroidectomy. Although transglottic involvement with thyroid cartilage invasion may increase the risk of thyroid gland invasion, it could not be confirmed by our series. Perhaps thyroidectomy should not be routinely performed on all patients with laryngeal carcinoma who undergo total laryngectomy, but more rigorous studies are needed to establish this.
 
 Keywords: laryngeal carcinoma, transglottic, thyroid cartilage invasion, thyroid gland invasion, thyroidectomy 

Tobacco exposure and complications in conservative laryngeal surgery.

Smoking is an important risk factor in the development of head and neck cancer. However, little is known about its effects on postoperative complications in head and neck cancer surgery. We performed a retrospective analysis on 535 consecutive laryngeal cancer patients submitted to open partial laryngectomy at the Otolaryngology-Head and Neck Surgery Department of Florence University to evaluate a possible correlation between smoking and surgical complications. Patients were grouped in non smokers and smokers and evaluated for airway, swallowing, local and fistula complications by multivariate analysis: 507 (95%) patients were smokers, 69% presented supraglottic, 30% glottic and 1% transglottic cancer. The most common operation was supraglottic horizontal laryngectomy in 58%, followed by supracricoid partial laryngectomy in 27% and frontolateral hemilaryngectomy in 15% of cases. The incidence of overall complications was 30%, airway complications representing the most frequent (14%), followed by swallowing (7%), local (6%) and fistula complications (3%). Smokers developed more local complications (p = 0.05, univariate, p = 0.04, multivariate analysis) and pharyngocutaneous fistula (p = 0.01, univariate, p = 0.03, multivariate analysis).

The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

Objectives: We aimed to assess the associations between localization, size, stage and histopathological differentiation of primary tumor in larynx and neck metastases and the impact of disease stage on survival. Materials and methods: We analyzed the medical records of 333 laryngeal cancer patients who underwent total or partial laryngectomy as primary treatment, combined with neck dissection and/or postoperative radiotheraphy if required, between 2000 and 2010 years at our clinic. Age and gender of patients, tumor localization, size, stage and histopathological differentiation of tumor; presence of preoperative positive lymph nodes, performed operations, operation findings and histopathological results were analysed retrospectively. Results: Tumor localizations were glottic in 172 (51.6%) cases, supraglottic in 108 (32.4%), and transglottic 53 (15.9%) of the the cases. In glottic cancers; cervical metastases were observed in 18.6% of the patients, whereas occult metastases in 11%. In supraglottic cancers; cervical metastasis rate was 45.3% and occult metastases rate was 24%. In transglottic cancers, cervical metastases rate was 49% and occult metastases was 22.6%. Postoperative recurrence was 41 (12.3%). Postoperative radiotherapy was recommended to 111 of 333 patients. The overall survival rate was 75.4% at 50th month and the cumulative survival rate was 68.9%. Conclusion: In conclusion, although there is controversy regarding the optimal treatment in the N0 larynx cancers, in case of a high risk for occult metastases, elective unilateral or bilateral neck dissection should be performed according to the anatomic localization of the tumor. In addition, survival rate decreased significantly with the increasing tumor stage.

Relation between PGS Invasion and LN Metastasis in SCPL

Objective: Transglottic cancer invading PGS is characteristically known to show a high incidence of laryngeal skeleton invasion and cervical metastasis. The objective was to determine the role of paraglottic space (PGS) invasion in lymph node metastasis in patients undergoing supracricoid partial laryngectomy (SCPL). Method: We retrospectively reviewed the clinical and pathological data of 98 patients who were diagnosed with glottis laryngeal carcinoma and underwent SCPL. We examined the relationship between PGS invasion and clinicopathological factors such as age, gender, tumor stage, vocal cord mobility, anterior commissure invasion, thyroid cartilage invasion, and subglottic extension. Results: The PGS invasion rate was 60.2% (59/98). Significant correlations were found between PGS invasion and cervical lymph node metastasis ( P = .022). Fifteen of the 59 patients (25.4 %) with the PGS invasion had cervical lymph node metastasis, whereas only 3 of the 39 patients (7.7%) without any evidence of PGS invasion had lymph node metastasis. There was also a significant correlation of PGS invasion with T stage ( P = .008), vocal cord mobility ( P = .001), and subglottic extension ( P = .014). Patients with no evidence of PGS invasion may have a survival benefit even without statistical significance ( P = .118). Conclusion: PGS invasion was found to be significantly related to the presence of cervical lymph node metastasis, which suggests that could be used to predict the presence of lymph node metastasis and to determine operative extent and prognosis in patients undergoing SCPL.

Paratracheal lymph node dissection in cancer of the larynx, hypopharynx, and cervical esophagus: The need for guidelines

In laryngeal, hypopharyngeal, and cervical esophageal carcinomas, the paratracheal lymph nodes (PTLN) may be at risk for lymph node metastasis. The presence of PTLN metastasis is an important prognostic factor for the development of mediastinal and distant metastases, stomal recurrence, and disease-free and overall survival. Studies on PTLN metastasis are scarce. In most studies, PTLN dissection has not been routinely performed, and selection criteria for PTLN dissection are usually not well defined. Therefore, in most reported studies, selection bias is present and results are difficult to compare. The reported prevalence of PTLN metastases varies according to the site and stage of the primary tumor: subglottic cancer, transglottic cancer, and glottic cancer with subglottic extension have a higher risk of PTLN metastases. Diagnostic imaging is not sufficiently reliable to detect occult PTLN metastases and avoid unnecessary PTLN dissections. PTLN dissection is associated with limited morbidity, but damage to major vessels may occur, and because of exposure of these vessels PTLN may increase the morbidity of fistulae that can occur after total laryngectomy. The dissection may produce hypocalcemia, if performed bilaterally. Nevertheless, the limited morbidity and high rate of metastasis in specific laryngeal, hypopharyngeal, and cervical esophageal carcinomas argue in favor of routine elective PTLN treatment for these tumors. Large prospective studies are needed to identify the patients at risk with primary tumors in more detail. Moreover, improved diagnostic imaging is needed to detect (occult) PTLN metastases more reliably. Based on future studies, clinical guidelines have to be developed to avoid undertreatment and overtreatment.

Analysis of curative effects on laryngeal carcinoma patients in the northeast region of China

Conclusions. In the past 20 years, the level of laryngeal carcinoma treatment in our country has been significantly improved. Early diagnosis is the key for increasing the ratio of larynx preservation surgeries and improving survival rates. The main causes of death within 5 years are local recurrence and metastasis. Objective. To describe the main treatment methods for laryngeal carcinoma in China in the 1980s and 1990s and their prospective effects and investigate the prognostic factors. Patients and methods. A retrospective investigation was performed on the 1115 laryngeal carcinoma patients receiving treatment in the department of ENT of the First Affiliated Hospital of China Medical University during 1983–1996 and the survival rates and causes of death were analyzed statistically. Results. There were 780 patients surviving for more than 5 years, 260 dead patients, and 75 patients lost to follow-up. According to the cumulative survival rate curve, the 5-year survival rate was 77% (94% for stage I, 89% for stage II, 82% for stage III, and 66% for stage IV). Glottic cancer has the highest 5-year survival rate, followed by supraglottic cancer, subglottic cancer, and transglottic cancer. The 5-year survival rate of patients receiving partial laryngectomy was 85%, while the 5-year survival rate of those receiving total laryngectomy was 68%. The leading causes of death within 5 years were local recurrence and metastasis (70%), and the causes of death were unknown in 14% of cases.

T3 Supraglottic Cancer: Treatment Results and Prognostic Factors

Objective—A retrospective study was performed in order to analyze the treatment results and prognostic factors in patients with T3 supraglottic carcinoma and to differentiate between the treatment results obtained for T3 transglottic carcinoma and T3 pure supraglottic carcinoma.Material and Methods—Thirty-two patients who underwent surgery with or without postoperative radiation therapy between 1990 and 2000 were studied. Neck dissection was performed in 27 patients and 24 received postoperative radiation therapy.Results—The 3-year overall survival rate was 81.7%. The 3-year overall survival rates for T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). Univariate analysis revealed a prognostic significance for vocal cord fixation. T3 transglottic carcinoma was significantly correlated with vocal cord fixation.Conclusions—We suggest that surgery, either alone or in combination with postoperative radiation therapy, provides acceptable cancer control and survival rates for patients with T3 supraglottic carcinoma. Vocal cord fixation detected during preoperative fiberoptic laryngoscopy is a significant prognostic factor. T3 transglottic cancer needs more aggressive management.

Paraglottic space in supracricoid laryngectomy.

Paraglottic space (PGS) is a connective tissue compartment of the larynx and is important in the extension of laryngeal cancer. It communicates with the preepiglottic space superiorly and with the extralaryngeal region inferiorly through the gap within the cricothyroid membrane. Transglottic cancer of the larynx, which spreads within PGS, is characterized by a high incidence of laryngeal skeleton invasion and of cervical metastasis. Determining the correct stage of transglottic cancer of the larynx is difficult, leading to therapeutic failure of partial laryngectomy in some cases. To clinically confirm a pathologically complete resection of PGS from the piriform sinus mucosa by supracricoid partial laryngectomy in laryngeal cancers involving PGS. Eight patients with transglottic cancer whose cancer was confirmed clinically and pathologically at stages T2b or higher underwent supracricoid partial laryngectomy. During supracricoid partial laryngectomy, we performed a sharp dissection of PGS from the piriform sinus mucosa to obtain a complete resection margin while preserving the piriform sinus mucosa. Microscopic evaluation of the specimens was made for the invasion of PGS and the safe margin distance from the piriform sinus mucosa. Pathological cancer invasion of PGS was confirmed in 7 of 8 patients and a sufficient pathological margin from tumor invasion to the piriform sinus mucosa was obtained. The average safety margin was 10.3 mm. Supracricoid partial laryngectomy could be considered a safe surgical modality for cancers not extending to PGS.

Systematic analysis of cervical lymph node metastasis of larynx and hypopharynx carcinomas--a clinical computerized tomography study with special reference to extension of the primary tumor

To assess the incidence and patterns of cervical lymph node metastases in laryngeal and hypopharyngeal carcinomas according to the location, extension, and relation of the primary tumor to the parapharyngeal compartments and tissues arising from different embryological structures as branchial arches and somites. The findings of clinical and CT examinations of 230 patients with histological evidence of laryngeal and hypopharyngeal carcinoma (44 T1-, 33 T2-, 41 T3-, 112 T4-carcinomas with lymph node involvement in 116 cases) were evaluated retrospectively. Local tumor spread and relation of the primary to the parapharyngeal compartments and to tissues arising from different embryological structures such as branchial arches and somites were analysed and related to cervical lymph node involvement. The pattern of cervical lymph node involvement depends upon location and extension of the primary tumor in the adjacent tissues of the larynx and hypopharynx. The density of the lymphatic vessels in these areas determines the likelihood of lymph node involvement. The frequency of NO cases in carcinomas strictly located in the vocal cord (n = 31) was 100%; in the glottic-supraglottic, supraglottic, and transglottic cancer (n = 106) 85%; in larynx-hypopharynx carcinomas (n = 54) 26%; in hypopharynx carcinomas (n = 12) 17%; and in larynx-hypo-oropharynx carcinomas (n = 46) 9%. Tumors in tissues arising from branchial arches 4, 5, and 6 are glottic-supraglottic, transglottic laryngeal, and laryngeal-hypopharyngeal carcinomas. Metastases of these tumors were frequently found in the jugular lymph node chains, particularly if the developed tissue of the "primitive glottis" was invaded by the primary. Upper jugular nodes ipsilateral to a supraglottic or hypopharyngeal primary were usually involved. The frequency of metastases in the jugular lymph node chains decreased in craniocaudal direction. If the tumor invaded the posterior wall of the hypopharynx or tissues.

The paraglottic space and transglottic cancer: anatomical considerations.

Transglottic cancer of the larynx crosses the laryngeal ventricle and involves both the vestibular and vocal folds. It has been described to spread within the paraglottic space (PGS). This region of adipose tissue, containing blood vessels and nerves, immediately adjacent to the thyroid laminae, was originally defined by Tucker and Smith (1962). However, the precise topographic relationships of this clinically important space are still controversely discussed. Therefore, a reinvestigation was done in serial sections of 19 plastinated adult human larynges. Laterally, the PGS is bordered by the thyroid cartilage. Superomedially, the PGS is continuous with the preepiglottic space (PES) in most specimens. In some cases, the PGS and the PES are completely separated from each other by a conspicuous collagenous fiber septum. Small projections of the paraglottic adipose tissue extend between the fibers of the thyroarytenoid muscle. Inferomedially, the PGS is bordered by the conus elasticus. Anteroinferior extensions of the PGS escape the larynx beneath the inferior rim of the thyroid cartilage. Posteroinferiorly, the paraglottic adipose tissue extends between the intrinsic laryngeal muscles and towards the cricoarytenoid joint. Dorsally, the PGS is bordered by the mucosal lining of the piriform sinus. A precise knowledge of the topography of the PGS can explain typical symptoms and routes of spread of tumorous growth: extension toward the hypopharynx, extension into the anterior extralaryngeal tissues, invasion of the thyroid cartilage, impairment of vocal cord movements due to infiltration of laryngeal muscles or immobilization of the cricoarytenoid joint.

후두암의 임상적 고찰

Background and Objectives:Laryngeal cancer is the most common malignancy in head and neck region. The aim of this study was to evaluate the clinical features and treatment outcomes of laryngeal cancer. Materials and Methods:We revie- wed medical records of 169 patients from 1984 to 1997 retrospectively. We investigated age, sex distribution, TNM staging in 169 patients and treatment modalities, survival rate in 141 patients who were treated. Results:In all patients, there were 64 glottic, 57 supraglottic, 46 transglottic and 2 subglottic cancers. Among 141 patients, we performed 92 surgical procedur- es and 49 radiotherapies. Total and near total laryngectomy were performed in 45 cases and conservation laryngectomy in 47 cases. Five year survival rate (YSR was 88.4% totally. In early cancer cases, 5 YSR was excellent in both surgery and radiotherapy group. Glottic and supraglottic cancer showed much better prognosis than transglottic cancer. There was no sta- tistical differences in the view of 5 YSR between surgery and radiotherapy group. Treatment failures were mainly found at primary sites. Functional preservation of larynx was successful in 79 cases after 3 year-follow up. Conclusions:Compared with previous studies, our study presented higher proportion of conservation laryngectomy and functional preservation pro- cedues. Early diagnosis and treatment are important and required to improve patient's outcome. (Korean J Otolaryngol 1999;42:1015-20

Clinical Underestimation of Laryngeal Cancer: Predictive Indicators

To evaluate the accuracy of clinical staging of advanced laryngeal cancer and to morphologically analyze the underestimated cases. We conducted a retrospective histopathologic study of larynges from patients who had had total laryngectomy and were seen over a 21-year period. Academic tertiary referral medical center. Forty-one patients had clinically staged T3 laryngeal cancer and 16 patients had T4 cancer. Patients all underwent wide-field total laryngectomy. All larynges were processed as whole-organ serial sections in the coronal plane. The incidence of clinically underestimated laryngeal cancer. During this investigation, it became obvious that predictive indicators of thyroid cartilage involvement could be established. Clinical underestimation had been made in approximately 50% of all T3 laryngeal cancer cases. The extent of the cartilage involvement in the underestimated group was characterized by microinvasion without penetration; approximately 90% of the cartilage involvement affected the thyroid notch and adjacent area. We established five objective indicators of thyroid cartilage involvement: (1) extensive cartilage ossification (risk for cartilage involvement, 73%); (2) glottic fixation (54%); (3) transglottic cancer (74%); (4) tumor length longer than the entire vocal fold length or longer than 2 cm (66%); and (5) extensive involvement of the anterior commissure (67%). Clinical underestimation of T4 laryngeal cancer was high because thyroid cartilage involvement was not accurately diagnosed. We believe our indicators of thyroid cartilage involvement will provide objective guidelines for laryngeal cancer staging and will contribute to more reliable clinical cancer-staging decisions.

The preepiglottic space revisited: Is it significant?

One hundred fifty-four laryngeal specimens were examined by a serial sectioning method to determine the importance of the preepiglottic space (PES) in the spread of cancer. Controversy surrounds the status of the PES in the two major TNM classifications regarding laryngeal anatomy. However, both the UICC (International Union Against Cancer) and the AJCCS (American Joint Commission on Cancer Staging) imply a T3 grading for tumors invading the PES. Several variables relating to laryngeal cancer spread were entered into a computer program designed to calculate statistical relationships. Of all laryngeal cancers, PES invasion usually occurred in association with primary supraglottic tumors. Preepiglottic space invasion was also found in association with more than half of the cases involving base of tongue and strap muscle invasion. It was also noted in more than half of the cases with transglottic cancer spread. Statistically, these relationships were all highly significant. These findings suggest that PES invasion should be considered equivalent to the spread of cancer outside the larynx, and should therefore be assigned a T4 grading. These statistics also dispel the myth that supraglottic tumors tend to remain localized even when advanced, casting doubt on supraglottic partial laryngectomy as a curative procedure in all but the earliest supraglottic tumors.

Clinicopathological Studies of Transglottic Cancer

Clinicopathological studies were performed in twenty transglottic cancers. Each specimen obtained by total laryngectomy was processed for study by whole-organ serial section. Paraglottic space involvement was found in all 20 patients, while preepiglottic space involvement, submucosal infiltration, and thyroid cartilage invasion in about half of the patients. So there was a strong tendency to infiltrate deeply in transglottic cancer. In half of the T2 and T3 patients, the invasion of thyroid cartilage was found. Therefore the laryngologist should look for the cartilage invasion described above if the patients with transglottic cancer are treated by radiotherapy or partial laryngectomy. This tumor tends to infiltrate more deeply than supraglottic cancer and the pattern of cartilage invasion in transglottic cancer differs from supraglottic cancer. The invasion of arytenoid cartilage occurred in all the patients with vocal cord fixation, and the invasion of cricoarytenoid joint in 75%. The in cidence of cervical lymph node metastasis was 30%. There was a tendency to infiltrate deeply in the patients with lymph node metastasis. All 20 patients in this study were smokers. Carcinogenesis in transglottic cancer seems to have a close relationship with tobacco consumption.

T3 glottic cancer: options and consequences of the options.

This report is a review of 106 Stage III glottic cancers treated surgically from January 1971 through December 1980. For analysis of recurrence and cause of death, the patients were assigned to four subgroups as well as considered as a single group. The subgroups were T3,N0, transglottic, all T3 glottic cancers regardless of prior treatment, and all T3 glottic cancers without prior treatment. Of the entire group, 8% either were not dead or had died of something other than cancer; 91% of patients with T3,N0 cancers without prior treatment either were alive or had died of another cancer. In the other subgroups the survivorship was between 80% and 91% with the exception of those with transglottic cancers. The findings in this study are discussed in light of the current controversies related to the stage of disease, particularly the issue of radical radiation with surgery for salvage for T3 glottic cancer.

Partial laryngectomy for transglottic cancers.

A reconstructive procedure was utilized after three-quarter laryngectomy in five patients with transglottic cancers. The physiologic reconstruction was successful in four of the five, and tumor control was 100% in all of the patients. It is concluded that with proper selection patients with transglottic cancers may survive after partial laryngeal surgery.