Vertical Partial Laryngectomy Research Articles

Vertical Partial Laryngectomy With Temporoparietal Free-Flap Reconstruction for Recurrent Laryngeal Cancer: Long-Term Study.

Treatment options for recurrent early glottic carcinoma's include conservative and radical surgical options. These options offer similar survival benefits with different impacts of patient's quality of life. We previously present our experience with vertical partial laryngectomy (VPL) and showed high locoregional control rates with high-quality voice results and normal swallowing. A long-term retrospective review. Tertiary Care Center. We analyzed all patients underwent VPL between the years 1995 to 2018. Long-term oncologic and functional outcomes were collected. A total of 40 patients were included. The majority of whom were male (n = 38, 95%) with a mean age of 64.9 years (SD ± 9.5). With a median follow up time of 12 years (range 0-24), 9 patients (22.5%) had disease recurrence; the majority of whom (8 patients), had local recurrence and all were salvaged with total laryngectomy. Eight patients (20%) developed second primaries in the head and neck region with a median time to diagnosis of 77 months (range 8-227 months). Ten-years overall survival, disease specific survival, and local disease-free survival were 80%, 90%, and 80%, respectively. Five patients had postoperative laryngeal dysfunction with a total 10-years laryngectomy free survival of 70%. VPL has a sustainable oncologic outcome with a high long-term laryngectomy free survival rate. This entity is an acceptable conservative salvage option for selected postradiated recurrent laryngeal squamous cell carcinoma patients.

Surgery for locally advanced laryngeal cancer

Surgical options for locally advanced laryngeal cancer range from organ-preservation surgeries, such as transoral laser microsurgery and partial laryngectomy, to total or near-total laryngectomy with partial or total pharyngectomy. Herein, we describe preoperative workup, surgical technique for total laryngectomy, including stomal incision and design, laryngeal framework isolation and thyroid management, entry into the larynx and pharynx, tracheoesophageal puncture, and closure options. Early and late postoperative complications are considered. Lastly, conservation laryngeal surgical options, including vertical versus horizontal partial laryngectomy and transoral laser microsurgery are discussed.

Oncological outcomes of surgical management for T2N0M0 glottic laryngeal squamous cell carcinoma

AbstractObjectivesThe research aimed to evaluate the clinical treatment outcomes of T2N0M0 glottic laryngeal squamous cell carcinoma (LSCC) patients who underwent laryngectomy.MethodsRetrospective review of 533 T2N0M0 glottic LSCC patients.ResultsFive‐year cancer‐specific survival (CSS) rate was 90.0%, and the overall survival (OS) rate was 89.1%. No statistically difference was found between the patients who have undergone total laryngectomy (5‐year disease‐free survival[DFS] = 80.7%, and the CSS = 86.7%) and those who have had partial laryngectomy (the 5‐year DFS = 85.3%, and CSS = 91.1%). There was no difference in the CSS and DFS rates between patients with negative margins and those with positive margins following postoperative radiotherapy (PORT) ± chemotherapy (the CSS: 90.8% vs. 81.8%, p = 0.458 and 5‐year DFS: 84.6% vs. 79.5%, p = 0.371). Patients who underwent vertical partial laryngectomy (VPL) had better survival (5‐year OS was 91.9%, and the CSS was 92.8%) than those who underwent cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) (the 5‐year OS = 83.8%, p = 0.022 and CSS = 84.9%, p = 0.038).ConclusionsSurgery remains the gold standard for treating T2N0M0 glottic LSCC patients because it can achieve satisfactory oncological outcomes. Regarding the systemic conditions, the effect of partial laryngectomy is similar to that of total laryngectomy. Moreover, partial laryngectomy preserves the function of the larynx. VPL may be superior to CHP/CHEP, depending upon the invasiveness of the tumor.

Application of Platysma Myocutaneous Flap in Surgical Repair after T2-3 Glottic Carcinoma Resection.

Numerous methods and materials are available for vertical partial laryngectomy. In this study, the reparative effects of the platysma myocutaneous flap (PMF) and ribbon myocutaneous flap (RMF) on the postoperative voice quality of patients were compared to provide a reference for selecting a method conducive to improving postoperative voice quality. A retrospective analysis was performed on patients with unilateral T2-3 glottic carcinoma. Following vertical partial laryngectomy, the defect was repaired with a PMF or simple RMF. Twelve months after surgery, voice quality was assessed according to voice acoustics, aerodynamics, and subjective perceptual evaluation, and glottic morphology was recorded using a laryngeal stroboscopy. A total of 70 patients were identified, including 54 in the PMF group and 16 in the RMF group. The PMF group was superior to the RMF group in terms of voice quality assessed by voice acoustics, aerodynamics, and subjective perceptual evaluation. In the PMF group, 72.2% of patients performed phonation with their vocal cords, and approximately 27.8% of patients were affected by supraglottic compression. In the RMF group, 81.3% of patients were affected by supraglottic compression. No significant difference was found in the 5-year survival rate between the two groups. For defect repair following vertical partial laryngectomy, a PMF can allow better postoperative voice quality to be achieved than an RMF because a PMF can provide more tissue (including strap muscle under the flap) for padding, which enables the glottic portion corresponding to the vocal cord to close well. 3 Laryngoscope, 134:3181-3186, 2024.

Voice Restoration Through Vertical Partial Laryngectomy in Laryngeal Amyloidosis Patient: A Case Report

Amyloidosis is a idiopathic clinical syndrome caused by deposition of non-soluble protein fibers in the extracellular matrix of organs and tissues. It causes chronic inflammation and destruction of the architecture and functionality of the involved tissue. Amyloidosis occurring in the upper airway tract is rare, accounting for 0.2% to 1.2% of benign tumors of the larynx. In general, the purpose of treatment is reduce the risk of dysphagia and dyspnea. Endoscopic surgery is the mainstream of the treatment because laryngeal preserving is the most important goal of treatment. However, the disadvantage of this treatment is that it can lose voice and may require multiple reoperation. In this article, we report a case in which vertical partial laryngectomy (VPL) in a patient with laryngeal amyloidosis, because the patient want her voice restoration. It was observed that voice restoration and airway patency were maintained for two years without additional surgical treatment after the surgery. Although additional studies are needed, VPL can be a good option for patients who want to preserve their voice.

Horizontal middle partial laryngectomy with cricothyroidopexy: an effective treatment for stage T1b glottic carcinoma

Background The current treatment options for T1b glottic carcinoma often lead to poor treatment outcomes or voice quality. Objectives This study evaluates the therapeutic efficacy of horizontal middle partial laryngectomy with cricothyroidopexy (HMPL-CTP) for stage T1b glottic carcinoma. Material and Methods A retrospective analysis was conducted on 73 patients with T1b glottic carcinoma. The patients were categorized into three groups: Group A (n = 22) underwent transoral laser microsurgery (TLMS), Group B (n = 21) received frontolateral vertical partial laryngectomy (FVPL), and Group C (n = 30) underwent HMPL-CTP. The study analyzed the 5-year overall survival rate (OS), recurrence rate, phonatory status, and incidence of laryngeal stenosis. Results Voice quality scores varied significantly in the three groups, while the 5-year OS were similar. The local recurrence rate is higher in Group A than in the other two groups. The laryngeal stenosis rate in Group B is higher than in Groups A and C. Adhesions in the anterior commissure were observed in 18 cases in Group A and nine cases in Group C. Conclusions and Significance HMPL-CTP demonstrates efficacy as a treatment for stage T1b glottic carcinoma, offering favorable preservation of laryngeal function and minimal complications.

Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy.

Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients. Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. 4 (retrospective case series review).

Oncologic effectiveness of open partial vertical laryngectomy in the treatment of early glottic cancer

Introduction. In the last decades, a discernable trend towards more frequent use of endoscopic laser surgery in operative treatment of cancer of the middle part of the larynx is observed. Smaller operative trauma, absence of tracheostomy, short hospitalization time, and better functional outcomes without compromising oncological outcomes are significant reasons for transition to endoscopic methods. However, local recurrence involving anterior commissure develops in every 4th patient. This can explain attempts to return to analysis of possibilities of a surgical alternative – open laryngectomies.Aim. To retrospectively analyze the oncologic effectiveness of open partial vertical laryngectomy in the treatment of early glottic cancer.Materials and methods. Results of treatment of 66 patients aged between 39 and 72 years (mean age 61.4 ± 8.7 years) with cT1–2N0m0 glottic cancer were analyzed. 33 patients had T1 tumors and 33 – T2. Anterior commissure was involved in 14 cases. Surgery was the only mode of treatment in 92.4 % of cases. Oncologic effectiveness was assessed with the following parameters: the rate of local, regional recurrence and kaplan–meyer overall survival.Results. mean follow up was 58.64 ± 28.33 months (range 8–120 months). The rate of local recurrence for the whole cohort, T1 and T2 cases was 4.5; 3.0 and 6.1 %. The difference in local recurrence rate between T1 and T2 cases was statistically insignificant. The anterior commissure involvement did not affect negatively the rate of local recurrence. Regional recurrence was detected in 3 (4.5 %) patients. Larynx was preserved in 63 patients (92.4 %). 5 year overall survival was 86.12 %.Conclusion. Open partial vertical laryngectomy is characterized by low rate of local recurrence and acceptable functional results. The method may be the optimal choice of treatment for certain subgroup of patients with more advanced and invasive tumors.

Use of an open partial laryngectomy technique for a massive laryngeal leiomyosarcoma in a 40-year-old man with functional preservation postoperatively

Abstract Laryngeal cancers are one of the most common head and neck malignancies and can lead to significant morbidity and mortality. Although they most commonly originate from squamous cell carcinoma, there are multiple different pathologies that can arise. We present a patient with an atypical presentation of a glottic mass for which final pathology revealed a leiomyosarcoma (LMS). We report the first case in the English literature of a large bulky LMS that was removed entirely through a partial vertical laryngectomy and pharyngectomy, with maintained swallow and speech function postoperatively.

Clinical Application of the Residual Thyroid Cartilage for Laryngeal Function Reconstruction in the Partial Laryngectomy-A Single Center Experience.

To investigate the outcomes of using the residual thyroid cartilage for laryngeal function reconstruction in early glottic laryngeal carcinoma. From March 2017 to June 2022, 21 patients with glottic carcinoma who underwent laryngeal function reconstruction were analyzed retrospectively. The operation was performed under general anesthesia. Reconstruction of ipsilateral hemilarynx defect by downward movement of ipsilateral residual thyroid cartilage plate. During the follow-up period, the laryngeal function and tumor recurrence were evaluated. otally 20 male patients and 1 female patient were enrolled in this study. Of the 20 initial primary tumors, there were 6 patients with T1N0M0 stage, 12 ones with T2N0M0 stage, 1 with T1N1M0 stage, 1 with T3N0M0 stage, and 1 with T2N1M0 stage. The patient with recurrent tumor was T3N1M0 stage. The follow-up time ranged from 9 to 63months. All patients were healed by first intention after surgery. All patients without laryngeal stenosis were removed from tracheotomy tube. So far, all patients have good laryngeal function. One patient relapsed at the last follow-up. It is safe to repair hemilarynx defect with residual thyroid cartilage plate on the affected side, and it is an important choice for laryngeal function reconstruction after vertical partial laryngectomy.

Treatment of Laryngeal Verrucous Carcinoma: 28-Year Retrospective Cohort Study and Literature Review.

Laryngeal verrucous carcinoma (LVC) comprises 1% to 4% of all laryngeal tumors. Although controversial, surgery has been the mainstay of treatment, due to concern about anaplastic transformation with radiotherapy. We aimed to study LVC patients to identify treatment patterns for primary and recurrent diseases. Retrospective cohort study. Tertiary referral center. Patients with a pathological diagnosis of LVC treated over a 28-year period were included. Baseline demographics, and treatment outcome measures including 5-year laryngeal preservation rates (LPR), overall survival (OS), and recurrence-free survival (RFS) were included. A literature review of published studies within the same study period was also completed. Thirty-two patients were included in the analysis (median age 61.5 years, 93.8% [30/32] male). Twenty-three patients had T1 disease, and 9 had T2 disease with no evidence of regional or metastatic disease. The most common presenting symptom was hoarseness (93.8%) and the majority within the glottis 81.3% (26/32). Twenty-nine patients underwent primary surgery only (28 local excisions, 1 vertical partial laryngectomy) meanwhile 3 underwent local excision with postoperative radiotherapy. LPR, OS, and RFS at 5 years were 95.8%, 90.1%, and 80.6%, respectively. Our literature review identified 23 previous studies, mostly single-institution retrospective case series. Our study was the largest Canadian study in the literature to date. All LVC patients were treated with primary surgery, consistent with the current literature with excellent 5-year OS and LPR. There was no consensus on the treatment of recurrent disease. Future prospective multicenter studies are warranted to further study this rare disease population.

Clinical analysis of 12 cases of laryngeal neuroendocrine carcinoma

Objective: To investigate the clinical and pathological features, treatments and prognosis of laryngeal neuroendocrine carcinoma (LNEC). Methods: We conducted the retrospective analysis of the clinical data of 12 patients with LNEC admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Second Hospital of Shanxi Medical University from May 2014 to December 2021, including 9 males and 3 females, aged 50-77 years. There were 4 cases of typical carcinoid tumour (highly differentiated), 5 cases of atypical carcinoid tumour (moderately differentiated) and 3 cases of neuroendocrine small cell carcinoma (hypofractionated). The clinical features, diagnosis, treatment and prognosis of LNEC were analysed. Results: The clinical manifestations of LNEC varied according to the tumour type but did not correlate with the pathological types. The supraglottic type was characterized by sore throat, foreign body sensation in the pharynx, coughing, obstructive sensation when eating and choking on water. The treatments were determined according to the pathological types, lesion location and invasion scope. Of 12 patients 4 underwent horizontal partial laryngectomy plus elective lymphatic dissection plus postoperative radiotherapy/chemotherapy, 4 underwent vertical partial laryngectomy (3 of them with cervical lymphatic dissection), 3 underwent supported laryngoscopic plasma laryngectomy for laryngeal cancer, and 1 abandoned for treatment. With the follow-up of 8 -78 months, 5 patients were alive, 1 died from chemotherapy reactions, 3 died from other diseases, 1 died from lung metastasis, 1 died from lung infection and 1 was lost to follow-up. Conclusion: LNEC is clinically rare, the clinical manifestations are less specificity, diagnosis relies on pathological and immunohistochemical examinations, and treatment modalities and prognoses are closely related to the pathological subtypes of LNEC.

Open Partial Laryngectomies: History of Laryngeal Cancer Surgery.

Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved in recent decades and was influenced by many historic events and the development of new technologies. Partial laryngectomies may be performed by open, endoscopic or transoral robotic approaches. In this historic paper, we describe the evolution of open partial laryngectomy techniques, indications and surgical outcomes. Since the first partial laryngectomy in 1788, many U.S., U.K. and European surgeons, including Henry Sands, Jacob da Silva Solis-Cohen and Theodor Billroth, performed this surgical procedure under local anesthesia for tuberculosis, cancer or syphilis. Partial laryngectomy gained reputation in the medical community in 1888 due to the laryngeal cancer and death of the prince of Prussia, Frederick III. Frederick III’s death represented the turning point in the history of partial laryngectomies, calling attention to the importance of semiotics, biopsy and early diagnosis in laryngeal cancers. Hemi-laryngectomy was indicated/proposed for lateral laryngeal tumors, while thyrotomy was indicated for cancers of the middle part of the vocal fold. The second landmark in the history of partial laryngectomies was the discovery of cocaine, novocaine and adrenaline and the related development of local anesthetic techniques, which, together with the epidemiological and hygienic advances of the 19th century, allowed for better perioperative outcomes. General anesthesia was introduced in the second part of the 20th century and further improved the surgical outcomes. The diagnosis of laryngeal cancer was improved with the development of X-rays and direct laryngoscopies. The 20th century was characterized by the development and improvement of vertical partial laryngectomy procedures and the development of horizontal partial laryngectomies for both supraglottic and glottic regions. The history and the evolution of these techniques are discussed in the present historical paper.

Oncologic outcomes of transoral laser microsurgery versus open partial laryngectomies in the management of early stage glottic carcinoma

BackgroundThe oncologic outcomes between transoral laser microsurgery (TLM) and open partial laryngectomy (OPL) using comprehensive analysis in one clinical center is rare. The purpose of this study was to evaluate the oncologic outcomes of TLM in patients with early stage glottic carcinoma, and to compare the results with OPL. Subjects and methodsRecords of 425 glottic carcinoma patients with T1 - T2 stage treated with TLM, vertical partial laryngectomy (VPL), and cricohyoidoepiglottopexy (CHEP) from 2005 to 2010 were retrospectively analyzed. The overall survival (OS), disease-specific survival (DSS), and laryngeal function preservation (LFP) of these three treatments were assessed. ResultsOne hundred and twenty-two patients were treated with TLM. Regarding OPL, 167 patients underwent VPL, and 136 patients underwent CHEP. The mean age was 59.7 years, with men accounting for 97.2 % of all cases. The OS, DSS, and LFP rates of patients with anterior commissure (AC) involvement undergoing TLM were worse than those of patients without AC involvement, but these differences were not statistically significant. The 5-year OS, DSS, and LFP of patients undergoing TLM were 88.4 %, 89.9 %, and 83.5 %, respectively, and the oncologic outcomes of patients undergoing TLM, VPL, and CHEP were not statistically different. ConclusionGlottic carcinoma patients with early stage treated with TLM experience satisfactory oncologic outcomes. No compelling difference in oncologic outcomes among three treatments of TLM, VPL and CHEP, as well as VPL and CHEP can be alternatives to patients who are not suitable for receiving TLM.

Laryngeal function-preserving of frontolateral vertical partial laryngectomy (FLVPL) for selected T4a glottic cancer with thyroid cartilage invasion adherence to the anterior commissure: an innovative attempt

ObjectiveTo evaluate the feasibility and efficacy in selected T4a glottic cancer (thyroid cartilage invasion adherence to the anterior commissure) treated with frontolateral vertical partial laryngectomy (FLVPL) and laryngeal framework reconstruction using titanium mesh.MethodsSix patients with the limited T4a glottic cancer with thyroid cartilage destruction adherence to the anterior commissure, underwent FLVPL from 2009 to 2016 in Sun Yat-Sen University Cancer Center. All patients were followed up postoperatively.ResultsAll patients comprised radical tumor resection and favorable functional outcomes, and no aspiration and laryngeal stenosis were observed. According to postoperative pathology, four patients should go through postsurgical radiotherapy with a mean dose of 66 Gy. But one of them refused to undergo postoperative radiotherapy, who observed local recurrence in postcricoid area underwent total laryngectomy (TL) and ipsilateral selected neck dissection in post-surgery two year. During follow-up period, all patients were still alive, and five patients without local recurrence and distant metastases.ConclusionFLVPL and laryngeal framework reconstruction using titanium mesh is one viable surgical procedure to obtain adequate oncologic and functional outcomes.

Long-term prognosis of vertical partial laryngectomy in elderly patients

Long-term prognosis of vertical partial laryngectomy in elderly patients

Characteristics of obstructive sleep apnea syndrome in patients with partial laryngectomy.

ObjectivesThe impacts of partial laryngectomy on sleep‐disordered breathing were rarely investigated and reported in a limited number of patients. The aim of this study was to assess the prevalence of obstructive sleep apnea‐hypopnea syndrome (OSAHS) in patients with partial laryngectomy.Study designCase series.MethodsAll patients undergoing partial laryngectomy by open approach (frontolateral vertical partial laryngectomy and supracricoid horizontal partial laryngectomy) for squamous cell carcinoma of the larynx between January 2006 and December 2019 were enrolled. Listed patients were contacted via telephone to propose participating in the study and plan a sleep study: self‐assessments of sleep quality using the Pittsburgh Sleep Quality Index (PSQI) following a home sleep recording using respiratory polygraphy. Daytime sleepiness was also self‐assessed by using the Epworth sleepiness scale.ResultsTwenty patients with sleep record were included to the analyses. There were 11/20 patients (55%) diagnosed with moderate to severe OSASH. No relationship between OSAHS severity and age as well as body mass index (BMI) was observed. The Epworth sleepiness score was not necessarily high in patients with moderate/severe OSASH. Type of partial laryngectomy did not influence apnea‐hypopnea index (AHI) results. There was no difference in terms of age, BMI, gender, type of partial laryngectomy, and the presence of adjuvant radiotherapy between two groups AHI < 15/h and AHI ≥ 15/h.ConclusionA sleep study screening for OSAHS should be considered in patients with partial laryngectomy in order to improve their sleep quality and quality of life even though they did not exhibit daily sleepiness and obesity.

Pignat's vertical partial laryngectomy with crico-hyoido-epiglotto-plasty.

Pignat's partial laryngectomy with crico-hyoido-epiglotto-plasty (CHEPL) is a vertical laryngectomy with resection of the anterior portion of the thyroid cartilage and reconstruction with a wires net and the subhyoid muscles. The aim of this retrospective study was to evaluate and analyze oncologic and functional outcomes in patients affected by laryngeal squamous cell carcinoma and treated with Pignat's partial laryngectomy. Seventy patients with cT1-cT3 glottic cancer were surgically treated with Pignat's technique. invasion of posterior cricoid arch, more than 3 mm under glottis, of more than one arytenoid, of posterior portion of thyroid cartilage, of the suprahyoid epiglottis. Overall survival, disease free survival, rates of decannulation and enteral feeding were analyzed. 23 (32.9%) pT1, 37 (52.9%) pT2, 5 (7.1%) pT3, 5 (7.1%) pT4a, 64 (91.5%) pN0, 5 (7.1%) pN1, 1 (1.4%) pN2. Adjuvant treatment was administered to 13 patients (18.6%). All patients had tracheotomy. Five year OS and DFS were 81.66 and 77.95%, respectively. A statistically significant DFS difference was observed between early and late stages. Five year local control was 81.16%. Five year larynx preservation rate was 89.16%. Median decannulation time was 12 days. Median duration of enteral nutrition was 16 days. All patients achieved efficient phonation. Pignat's partial laryngectomy with CHEPL can represent an alternative to horizontal supracricoid laryngectomy to achieve laryngeal preservation. Good oncologic and functional outcomes are possible as long as indications are followed.

Horizontal versus vertical partial laryngectomy: anatomic and functional differences

Horizontal versus vertical partial laryngectomy: anatomic and functional differences

A Study on Vertical Partial Laryngectomy for Glottic Cancer

A Study on Vertical Partial Laryngectomy for Glottic Cancer