Underwent Supracricoid Partial Laryngectomy Research Articles

Oncological and Functional Outcomes of Supracricoid Partial Laryngectomy

Objective: The aim of this study is to review the oncological outcomes of T1-T4 glottic or supraglottic tumor patients who underwent supracricoid partial laryngectomy in our clinic. Material and Methods: A total of 43 patients with laryngeal squamous cell carcinoma who underwent supracricoid partial laryngectomy between January 2014 and December 2016 in the Otorhinolaryngology Department of Istinye University Hospital were retrospectively analyzed. Postoperative data of these patients regarding surgical margin, nasogastric feeding tube removal time, decannulation time, postoperative radiotherapy, local regional recurrence, and distant metastases were recorded. Results: Cricohyoidoepiglotopexy was applied to 16 patients by preserving both arytenoids and applied to 7 patients with a single arytenoid; Cricohyoidopexy was applied to 14 patients with both arytenoids preserved, and 6 patients were treated with a single arytenoid. The five-year survival was compared for Cricohyoidopexy/Cricohyoidoepiglotopexy with single arytenoid to double arytenoid preservation and found to be 80%-76% (p=0.56). The mean 5-year survival was 88% in the post-operative radiotherapy group, and 86% in the non- radiotherapy group. The study compared patients with Cricohyoidopexy/Cricohyoidoepiglotopexy with a single arytenoid to those with double arytenoid preservation; the mean decannulation time was 54.23±34.12 to 35.62±27.08 (p=0.05). Postoperative radiotherapy prolonged the decannulation time (51.16±38.5 versus 32.68±20.1; p=0.043). The duration of nasogastric tube placement in the Cricohyoidopexy/Cricohyoidoepiglotopexy with a single arytenoid group was 50.3±14.3 and double arytenoid preservation was 35.17±32.9 (p=0.088). Nasogastric tube removal time was 53.29±50.2 in the post-operative radiotherapy group and was 30.24±16.8 in patients who did not receive post-operative radiotherapy (p=0.040). Conclusion: Supracricoid partial laryngectomy with Cricohyoidoepiglotopexy and Cricohyoidopexy had satisfactory oncological outcomes, and laryngeal function was preserved by rebuilding the neolarynx.

Role of Neck Dissection in Organ-Preservation for Glottic Squamous Cell Carcinoma.

The surgical approach to the neck in laryngeal cancer depends on the tumor site and stage. Clinical practice guidelines recommend elective neck dissection in ≥ T2 N0 and all supraglottic cancers; however, there is no evidence supporting these recommendations. The objective is to evaluate the results of bilateral elective neck dissection in patients with glottic cancer who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Thirty-five patients diagnosed with ≥ T2 N0 laryngeal squamous cell carcinoma (LSCC) in a single-center retrospective study. Right-sided neck dissections yielded 900 lymph nodes, none of which were positive for metastatic disease. Left-sided neck dissections yielded 949 lymph nodes, one of which was positive for malignancy. Prelaryngeal (Delphian) neck dissection was performed in all patients. Out of 50lymph nodes removed; one was positive for malignancy. Median overall survival was 172months, and the 60-month overall survival was 87.3%. The 60-month disease-specific survival was 97.1%. Bilateral neck dissection and Delphian node dissection showed a low rate of metastasis (2.8%). Radical neck dissection may thus represent overtreatment; however, this surgical procedure could be justified to prevent regional recurrences.

Quality of life after Supracricoid Partial Laryngectomy

BackgroundSupracricoid partial laryngectomy has good oncologic results in the treatment of advanced laryngeal cancer with the advantage of preserving larynx phonatory function when compared with total laryngectomy. However the rehabilitation could be a challenge, especially regarding swallowing function. Is supracricoid partial laryngectomy associated with better quality of life than total laryngectomy?MethodsSurvey study that included 33 patients (16 total laryngectomy and 17 supracricoid partial laryngectomy) with advanced larynx cancer surgically treated and fully rehabilitated. The quality of life were evaluated with EORTC QLQ C30 and H&N 35 instrument.ResultsPatients who underwent supracricoid partial laryngectomy obtained better scores in global health status-quality of life and general activities and had lower levels of sensory and speech-related symptoms.ConclusionSPL was associated with better quality of life when compared with TL.Graphical abstract

Obstructive sleep apnea in patients with laryngeal cancer after supracricoid or vertical partial laryngectomy

ObjectiveTo investigate whether partial laryngectomy is a risk factor for obstructive sleep apnea (OSA) and the effect of different partial laryngectomy methods on OSA.MethodA prospective study was carried out involving 40 patients who underwent supracricoid partial laryngectomy (SCPL) (24) or vertical partial laryngectomy (VPL) (16) for carcinoma of the larynx. Apnea-hypopnea index (AHI) and oxygen saturation determined by polysomnography (PSG), Epworth sleepiness scale (ESS) score, and body mass index (BMI) were evaluated in patients before surgery, on the day of tracheal tube removal and three months later. In patients who developed apnea, laryngoscopy, Muller’s test, computer tomography (CT) and dynamic sleep magnetic resonance imaging (MRI) were performed to assess the location of airway stenosis and collapse.ResultsThe AHI (P<0.001) increased and the lowest oxygen saturation (P<0.001), ESS score (P<0.001) and BMI (P=0.017) decreased after extubation compared with before surgery. Three months after extubation, the same changes were found in AHI (P<0.001) and the lowest oxygen saturation (P<0.001), but the ESS score (P<0.001) increased compared with that preoperatively. The AHI in the SCPL group was significantly higher than that in the VPL group post-operatively (P=0.010), while the miniSpO2 in the SCPL group was lower than that of the VPL group (P=0.022). Laryngoscopy showed that the patients with partial excision of the larynx had a narrowed retropalatal and retrolingual space post-operatively. Muller's test showed the collapse of the retropalatal and retrolingual space, and the CT scan showed that the tongue root was positioned lower in the SCPL group. Compared with the retropalatal and retrolingual space in the expiratory phase according to dynamic sleep MRI, the space in the inspiratory phase was clearly decreased.ConclusionLaryngeal function preservation surgery for laryngeal cancer results in the occurrence of OSA by altering the anatomical structure of the larynx and pharynx. OSA was more severe in patients undergoing SCPL than in patients undergoing VPL. The effect of partial laryngectomy on OSA may be related to the surgical method used.

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.

Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma.

SUMMARYThe aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.

Post-Surgical and Oncologic Outcomes of Supracricoid Partial Laryngectomy: A Single-Institution Report of Ninety Cases

Objective: The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). Methods: 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Results: Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Conclusions: Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.

A preliminary study on the assessment of swallowing function after supracricoid partial laryngectomy

To investigate a reliable and easy assessment method for swallowing function by evaluating objectively the recovery process of swallowing function in patients six months after supracricoid partial laryngectomy. The swallowing function of patients who underwent supracricoid partial laryngectomy was evaluated six months after operation in Nanfang Hospital of Southern Medical University between January 2013 and February 2014 with two methods, the modified barium swallow (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES), combined with modified penetration aspiration scale (MPAS). Furthermore, the feasibility, reliability and accuracy of these two methods were compared. Eleven patients were enrolled. MPAS equals score 1 for solid food, semiliquid food, and liquid food was defined as a criteria of normal swallowing function. By MBS evaluation, the numbers of patients with normal swallowing function were two cases at day 16-30 postoperation, two cases at day 31-45 postoperation, five cases at day 46-90 postoperation, and six cases at day 91-180 postoperation, respectively. By FEES evaluation, the above numbers were three cases, four cases, six cases and eight cases, respectively. When the aspiration was minimal and ejected completely and MPAS was less than or equal to score 4 for solid food, semiliquid food, and liquid food, the gastric tube could be removed. According to this standard, the gastric tube was removed in all cases, and the mean time was (21.7 ± 9.8) days. A good correlation was obtained between these two methods when evaluating solid and semiliquid food, and the Kappa values were 0.802 and 0.844, respectively. However, a little agreement was obtained between these two methods when evaluating liquid food, and the Kappa value was 0.529. Patients who underwent supracricoid partial laryngectomy could restore good swallowing function in six months after the operation. Both the MBS and FEES are valuable procedures for evaluating objectively the swallowing function in patients after supracricoid partial laryngectomy. The FEES is much better than MBS, because FEES is a simple operation performed alone by otolaryngologists with no radiation.

The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer.

In this study, the incidence of thyroid cartilage invasion in early-stage laryngeal tumors involving anterior commissure was assessed. Medical charts and pathology reports of 62 patients who underwent supracricoid partial laryngectomy as the primary treatment of early-staged laryngeal squamous cell carcinoma were retrospectively reviewed. Patients were divided into two groups according to the macroscopic examination of the surgical specimen: tumors limited to the glottis with the involvement of anterior commissure (TLG); tumors invading both supraglottis and glottis with the involvement of anterior commissure (TISG). Thirty-seven of the cases were classified as TLG group (59.7 %) and the remaining 25 of them were classified as TISG group (40.3 %). Thyroid cartilage invasion was observed totally in ten patients (16.1 %), as macroscopic invasion in two cases and microinvasion in eight patients. Only two were in the TLG group (cartilage invasion rate of 5.4 %), the remaining eight were in the TISG group (cartilage invasion rate of 32 %). Thyroid cartilage invasion rate of TISG group was significantly higher than that of TLG group (p = 0.011, p < 0.05). Tumors limited to the glottis with AC involvement may be more suitable for endoscopic resection; on the contrary, tumors with vertical extension invading both AC and supraglottis should be evaluated more suspiciously due to high rate of thyroid cartilage invasion, which may still necessitate external laryngectomy techniques.

Clinical observation of supracricoid partial laryngectomy

To evaluate clinical outcomes and pronouncing and swallowing functions after supracricoid partial laryngectomy (SCPL). Eight-five cases underwent supracricoid partial laryngectomy from 1990 to 2008 were reviewed. The 3- and 5-year accumulative survival rates were 90.4% and 81.6%, respectively. 97.6% (83/85) patients were decannulated. 89.4% (76/85) were able to eat normally within 6 weeks after surgery and the swallowing functions in the rest patients were recovered by training in different time after surgery. Fiber laryngoscope showed the reconstructed throats could close well with good swallowing functions six months after the operation. SCPL is a good choice in selected cases with laryngeal cancer, with satisfactory pronouncing and swallowing functions after surgery.

Awake Glidescope® intubation in patients with severe arytenoid swelling after laryngeal surgery with radiation therapy

General anesthesia in patients who have previously undergone supracricoid partial laryngectomy (SCPL) and radiation therapy for laryngeal cancer is not common but a challenging task for anesthesiologists because of the distortion of the airway anatomy with stiff neck. A 42-year-old (171 cm, 73 kg) man was scheduled for inser tion of a percutaneous endoscopic gastrostomy (PEG) feeding tube under general anesthesia. One month before the referral, the patient had undergone SCPL and a bilateral neck dissection with tracheostomy and then adjuvant radiation therapy for laryngeal cancer. There was no problem with facial mask ventilation and intubation at that time. He was fed through a nasogastric tube. PEG insertion is generally performed under local anesthesia with sedative agents such as midazolam. However, he had a history of airway obstruction after intravenous administration of midazolam. Therefore, the gastroenterologists consulted us because his preoperative airway evaluation was expected to indicate difficult intubation (Fig. 1). We discussed a “can't intubate, can't ventilate (CICV)” state including mortality risks, and an awake intubation with the patient in details. However, as for a fiberoptic bronchoscopy (FOB), the patient refused. In case of critical situation, various kinds of laryngeal mask airway (LMA) and Glidescope Ⓡ (Verathon Inc., Bothell, WA, USA) were prepared, and there was no choice to leave an awake procedure as our last option. Sufficient preoxygenation (100% oxygen at 6 L/min over 5 minutes) was applied through a facial mask. Thiopental sodium 350 mg and succinylcholine 80 mg were administered for anesthetic induction. After the drugs, mask ventilation could not be effective. At that moment, immediate endotracheal intubation by direct laryngoscope was attempted with an armored tube (ID: 8.0 mm), and then a smaller tube (ID: 7.0 mm), however, these actions failed. The vocal cords could not be viewed because of swollen arytenoids with his stiff neck. We soon determined that he was in a CICV state. So we used supraglottic airway (LMA Igel Ⓡ , No 4) temporarily with little success. The patient regained consciousness and started breathing fortunately. His oxygen saturation (SpO2) by pulse oximetry remained above 97%. After

Analysis of multicentricity in supraglottic laryngeal carcinoma treated with partial laryngeal surgery

A clinicopathological analysis of multicentricity in patients treated with either supraglottic horizontal laryngectomy or supracricoid partial laryngectomy for supraglottic squamous cell carcinoma of the larynx was conducted. This study included 63 patients who underwent supracricoid partial laryngectomy or supraglottic horizontal laryngectomy for T2 or T3 supraglottic laryngeal squamous cell carcinoma. The patients were divided into two groups: Group 1 included patients with one focus of the tumor (monocentric), and Group 2 included patients who had more than one focus of the tumor (multicentric) diagnosed after pathology examination. Forty-eight (76.2 %) of the patients had one focus of the tumor (Group 1) and 15 (23.8 %) of the patients had more than one focus of the tumor (Group 2). The rates of lymph node metastasis in Group 1 and Group 2 were 12.5 and 60 %, respectively. The second focus was invasive in seven (46.6 %) of the patients, carcinoma in situ in six (40 %) of the patients, and both invasive and carcinoma in situ in two (13.3 %) patients. The overall 3- and 5-year survival rates of Groups 1 and 2 were 77.1-66.7 % and 56.2-46.7 %, respectively. With regard to survival rates, no statistically significant difference was observed between Group 1 and Group 2 (p = 0.576). The lack of statistical significance might have been associated with the low sample size. Although multicentric tumors of the supraglottic larynx have high incidence of nodal metastasis, no significant increase in the rate of recurrence was determined.

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.

Transoral robotic supracricoid partial laryngectomy with cartilaginous framework preservation.

To report the technical feasibility of performing transoral robotic supracricoid partial laryngectomy with preservation of the thyroid cartilage. This is a case report from a tertiary-care academic institution. A patient with recurrent T2 glottic squamous cell carcinoma of the larynx underwent supracricoid partial laryngectomy with negative margins and preservation of the laryngeal framework using transoral robotic surgery, where an adequate exposure to the endolarynx was obtained by using a Feyh-Kastenbauer retractor. The patient was successfully decannulated in postoperative week 4, and his gastrostomy tube was removed in postoperative week 6. Transoral robotic surgery may be feasible in select glottic/subglottic laryngeal lesions, if adequate exposure is obtained.

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.

Laryngeal function preservation following supracricoid partial laryngectomy

Supracricoid partial laryngectomy is a surgical technique that preserves laryngeal function. A retrospective review of clinical records identified 41 patients that underwent supracricoid partial laryngectomy at our institution since 1998. In all, 26 patients with a minimum follow-up of 3 months were alive with a functioning larynx. All of them accepted participation in a functional evaluation. Ninety-seven percent of the patients were decannulated, and every patient achieved oral intake. The 5-year actuarial laryngoesophageal dysfunction-free survival was 66.5%. Median Voice Handicap Index (VHI) score was 26, with 75% of patients scoring <40. The Median MD Anderson Dysphagia Inventory (MDADI) score was 92, with 75% of patients scoring ≥80. Median maximum phonation time (MPT) was 12 seconds. Median maximum intensity (Imax) was 99 dB. Supracricoid partial laryngectomy allows laryngeal function preservation at a rate similar to that of chemoradiation protocols. When a careful preoperative patient selection is performed, long-term functional results are outstanding. © 2011 Wiley Periodicals, Inc. Head Neck, 2012.

Oncologic Outcomes after Supracricoid Partial Laryngectomy

To review the oncologic outcomes of a series of supracricoid partial laryngectomy. Case series with chart review. La Paz University Hospital, Madrid, Spain. Forty-one patients with glottic or supraglottic squamous cell carcinoma who underwent supracricoid partial laryngectomy between 1998 and 2008 at the authors' institution. Local control rate, specific-disease survival rate, and overall survival rate. All patients were male, with a mean age of 56 years (range, 38-71 years). Forty-one percent of tumors were classified as locally advanced carcinomas (T3-T4). Thirty-three patients (80%) underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Epiglottis was resected in the remaining 8 patients. One patient died in the immediate postoperative period because of cardiac tamponade, 6 developed pneumonia, 2 had a postoperative bleeding that required reintervention, and 2 developed pharyngocutaneous fistula. The median follow-up period was 43 months. More than 85% of the patients completed more than 2 years of follow-up. Five-year actuarial local control rate was 80%, being 92% for T1-T2 tumors and 67% for locally advanced tumors. Thirty-five patients (85%) preserved their larynx. The 6 patients who underwent total laryngectomy had a local recurrence or a regional recurrence that infiltrated the larynx. No laryngectomy was performed for functional reasons. Supracricoid partial laryngectomy is an oncologically safe procedure to preserve laryngeal functions in selected patients with glottic and supraglottic carcinomas.

Laryngocoele as an unusual complication of supracricoid partial laryngectomy: evaluation of 62 cases

This study sought to evaluate the incidence, aetiology, clinical features and treatment modalities for laryngocoele formation after supracricoid partial laryngectomy. The medical charts of 62 patients who had undergone supracricoid partial laryngectomy were reviewed. Three patients developed laryngocoele, giving an incidence of 4.8 per cent. Two of these patients presented with a cervical mass, dyspnoea and fever. The mobility of the arytenoids was disturbed on the involved side. The third patient was admitted complaining only of a compressible cervical mass. In all patients, diagnosis was made by computed tomography scan. The transcervical surgical approach was preferred for resection. Laryngocoele can occur as a late complication of supracricoid partial laryngectomy. Remnants of the laryngeal ventricle may be the cause of laryngocoele formation. The integrity of the laryngeal ventricle in the resected specimen should be routinely checked in order to avoid this rare complication. Clinicians should be aware that, following supracricoid partial laryngectomy, a cervical mass presenting with dyspnoea and disturbance of arytenoid mobility does not always indicate tumour recurrence.

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy in patients with radiation therapy failure

BackgroundTo assess functional results, complications, and success of larynx preservation in patients with recurrent squamous cell carcinoma after radiotherapy.MethodsFrom a database of 40 patients who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) from June 2001 to April 2006, eight patients were treated previously with radiotherapy due to squamous cell carcinoma of the glottic region and were treated for recurrence at the site of the primary cancer.ResultsSCPL with CHEP was performed in six men and two women with a mean age of 67 years due to recurrence and/or persistence at a mean time of 30 months postradiotherapy (in case #8 after concomitant chemoradiotherapy). Bilateral neck dissection at levels II-V was performed in six patients. Only case #8 presented metastasis in one node. In case #5, Delphian node was positive. It was possible to preserve both arytenoids in five cases. Definitive surgical margins were negative. Complications were encountered in seven patients. Follow-up was on average 44 months (range: 20-67 months). Organ preservation in this series was 75%, and local control was 87%. Overall 5-year survival was 50%.ConclusionsIn selected patient with persistence and/or recurrence after radiotherapy due to cancer of the larynx, SCPL with CHEP seems to be feasible with acceptable local control and toxicity. Complications may occur as in previously non-irradiated patients. These complications must be treated conservatively to avoid altering laryngeal function.

Factors That Predict Postoperative Pulmonary Complications After Supracricoid Partial Laryngectomy

To determine the risk factors related to postoperative pulmonary complications in patients who undergo supracricoid partial laryngectomy. Retrospective analysis of medical records. Tertiary care referral center. One hundred eleven patients who underwent supracricoid partial laryngectomy from January 1, 1993, through December 31, 2008. Relationship between postoperative pulmonary complications and perioperative risk factors, such as age, sex, chronic lung disease, smoking status, tumor site, tumor stage, preoperative irradiation, extent of surgery, reconstruction method, and pulmonary function tests. Thirty-six patients (32.4%) developed postoperative pulmonary complications. Significant correlations were found among age (P = .002), chronic lung disease (P = .005), smoking status (P = .02), and postoperative pulmonary complications. Cricohyoidopexy (P = .008) and ipsilateral arytenoidectomy (P = .03) were associated with postoperative pulmonary complications. The multivariate analysis showed a significant association of the postoperative pulmonary complications with age (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.2-11.7 in patients 60 to 69 years old; and OR, 7.1; 95% CI, 1.3-37.6 in patients 70 to 79 years old) and cricohyoidopexy (OR, 4.4; 95% CI, 1.1-18.1). Patients 60 years or older and patients with cricohyoidopexy are at high risk of having postoperative pulmonary complications after supracricoid partial laryngectomy.