Vertical Partial Laryngectomy Research Articles

Carcinosarcoma of the larynx consisting of squamous cell carcinoma and inflammatory myofibroblastic tumor components

Carcinosarcoma is a rare malignant tumor with both carcinomatous and sarcomatous components. Carcinosarcoma can appear in various organs, but its occurrence in the head and neck, particularly larynx, is extremely rare. Furthermore, its response to treatment has not been well established. We report the case of a 79-year-old man with a 6-month history of hoarseness who presented with a mass having a polypoid appearance at the anterior commissure of the larynx. Further analyses revealed carcinosarcoma in the larynx that consisted of squamous cell carcinoma and an inflammatory myofibroblastic tumor (IMT). The tumor was excised at the first hospital visited. Because pathological examination revealed an IMT and positive margin, the patient was referred to our hospital. A front lateral vertical partial laryngectomy was performed for further treatment. Histological examination demonstrated a biphasic component, consisting of squamous cell carcinoma (SCC) and IMT. IMT rarely occurs in the head and neck region. Moreover, to best of our knowledge, no carcinosarcoma cases consisting of SCC and IMT in the larynx have been reported in the literature. The prognosis of carcinosarcoma is considered to be dependent on the type of malignant mesenchyme, and surgical excision with wide margins is generally used to treat IMT. Therefore, the treatment of laryngeal carcinosarcoma consisting of IMT can be best accomplished with complete excision of the tumor.

Laryngeal function reconstruction with hyoid osteomuscular flap in partial laryngectomy for laryngeal cancer.

The present study aimed to evaluate the clinical outcome of using a hyoid osteomuscular flap to repair the laryngeal defect after extended vertical partial laryngectomy. A total of 26 glottic cancer patients underwent reconstruction with osteomuscular hyoid flaps following tumor resections. Ipsilateral arytenoid cartilage was resected in all cases, and the upper region of the cricoid cartilage was resected in 11 cases. Selective ipsilateral level II, III and IV neck dissections were performed in node (N)-positive patients and ipsilateral level II, and III neck dissections in N0 patients. The bone grafts were then fixed to the cricoid and contralateral thyroid cartilages. Invasion of the thyroid cartilage endochorium was present in 12 cases and lymph nodes metastases was present in 11 cases. The extubation rate of the tracheostomy tube was 100%. The glottides of all patients were almost symmetrical. Patients were followed up for 2-7 years. One patient developed local recurrence, ipsilateral regional recurrence, contralateral regional recurrence and lung metastasis, respectively. The disease-free survival rates at 3 and 5 years were 100% (20/20) and 79% (11/14), respectively. Overall, laryngeal function recovered well upon hyoid osteomuscular flap reconstruction following extended vertical partial laryngectomy, with a high extubation rate and good sound quality.

A Novel Functional Reconstruction Method for Recurrent Laryngeal Cancer after Vertical Partial Laryngectomy

Background: To evaluate our novel approach to composite reconstruction through combining the myocutaneous flap and free cartilage grafts following resection of recurrent laryngeal cancer. Methods: A vertical incision was made from the thyroid notch to the cricoid cartilage. The myocutaneous flaps below the strap muscle were elevated. The thyroid cartilage was removed sufficiently to secure the required surgical margin. After tumor resection, the composite reconstruction was carried out by combining the myocutaneous flap and free cartilage grafts. At first, small pieces of cartilage were grafted into the paraglottic space and covered with omohyoid muscle. Following this, cartilage approximately 15 mm in length and 3mm in width was inserted along the level of the vocal cord. This cartilage altered the vocal cord plastic protrusion and demonstrated good postoperative vocal function. The flap was fixed to the edge of the laryngeal mucosa. Results: There was neither local infection nor partial wound dehiscence associated with this new procedure. Patients could receive nutrition orally the day after the procedure was performed. In this series, no aspiration was observed. The mean postoperative maximum phonation time (MPT) was 19.5 seconds with good phonation. Conclusion: This novel approach to reconstruction was effective in terms of healing and functional outcomes.

Treatment outcomes of the patients with early glottic cancer treated with initial radiotherapy and salvaged by conservative surgery.

This retrospective study analyzed the oncological and treatment outcomes of the patients with T1-T2N0 glottic cancer, who were treated with radiotherapy as initial treatment and salvaged by conservative surgery for radiation failure. Between May 1999 and December 2010, 115 patients with glottic laryngeal cancer were treated at Kobe University Hospital. At presentation, 54 patients had stage T1a disease, 26 had stage T1b disease and 35 had stage T2 disease. Seventy-nine patients were treated with conventional radiotherapy and 36 patients were treated with hyperfractionated radiotherapy as initial treatment. Median duration of follow-up was 61 months. Five-year local control rates of radiotherapy were 92% in T1a, 83% in T1b and 86% in T2. Of 12 patients who developed local recurrence, larynx was successfully preserved in 3 patients by laryngomicrosurgery, 7 patients by vertical partial laryngectomy and one patient by subtotal laryngectomy. Ultimate 5-year laryngeal preservation rate and local control rate of all cases were 99 and 100%, respectively. Present results suggest that initial treatment with radiotherapy salvaged by organ preservation surgery is an effective strategy for laryngeal preservation in the treatment of T1-T2N0 glottic laryngeal cancer.

Hypopharynx and larynx defect repair after resection for pyriform fossa cancer with a platysma skin flap.

We used a platysma skin flap to repair larynx and hypopharynx defects to improve postoperative laryngeal function in patients with pyriform fossa cancer. Larynx-sparing surgery and postoperative radiotherapy were used in 10 patients with pyriform fossa cancer. The surgical approaches of lymph node dissection of the neck, vertical partial laryngectomy, and pyriform fossa resection were adopted, and a platysma skin flap was used to repair the resulting defects. In this group, the overall 3-year survival rate was 75% according to the Kaplan-Meier analysis, and the local control rate was 90%. Additionally, all patients were able to speak fluently with mild-to-moderate hoarseness. The tracheal tube was removed in all cases. Laryngeal fistulas were observed in 1 patient during radiotherapy. In conclusion, a platysma skin flap can be used to rebuild the larynx and hypopharynx in larynx-sparing resection for pyriform fossa cancer. These patients can obtain good postoperative function in swallowing, breathing, and pronunciation.

The history and current status of surgical treatment of laryngeal cancer

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

Case of partial vertical laryngectomy with vocal cord reconstruction using a thyroid gland flap

To preserve laryngeal function in early-stage laryngeal cancer, chemotherapy and radiotherapy are performed more often than surgery as initial treatment. However, in recurrent cases, complex salvage surgery is often required as patients who received aggressive chemoradiotherapy are susceptible to postoperative complications. We report here salvage therapy that preserved laryngeal function in a recurrent case. A 52-year-old man with recurrent laryngeal cancer (rT2N0M0) after chemoradiotherapy and followed by induction chemotherapy underwent partial vertical laryngectomy and right vocal cord reconstruction with a thyroid flap. Laryngeal functions were successfully preserved and the patient was discharged 2 months after surgery. The number of salvage surgeries performed after high-dose chemotherapy and radiation is expected to increase in the future. A thyroid gland flap promises to be an effective treatment option for vocal cord reconstruction especially for patients at high risk of postchemoradiotherapy complications.

Comparative videostroboscopic analysis after different external partial laryngectomies

After external partial laryngectomias, videostroborscopy is very usefull in evaluation of postoperative phonatory mehanisms showing the "slow motion" of the vibrations of the remaining laryngeal structures. The aim of this paper was to compare the videostroboscopic characteristics of the vibration and to establish the differences in the phonation mechanisms depending on the type of external partial laryngectomy performed. This prospective study was conducted during the period 2003-2009 at the Ear, Nose and Throat Clinic, Clinical Center of Vojvodina, Novi Sad, including 99 patients with laryngeal carcinoma, treated with open surgical approach using different types of vertical and horizontal partial laryngectomy. Videostroboscopy was used to analyse vibrations of the remaining laryngeal structures. The dominant vibration structure after partial horizontal laryngectomy, chordectomy, frontolateral laryngectomy and three quarter laryngectomy was the remaining vocal fold, after hemilaryngectomy it was the false vocal fold and after subtotal and near total laryngectomy it was the arythenoid. In patients with supracricoid hemilaryngopharyngectomy performed, many different structures were involved in the vibration. After most of the partial laryngectomies, vibrations can be found in the reconstructed part of the defect. In both horizontal and vertical partial laryngectomies movements of the larynx during phonation were mostly medial, while in cricohyoidoglottopexies they were anterior-posterior. Most of the operated patients (72.7%) had insufficient occlusion of the neoglottis during the phonation. Videostroboscopy is a useful method in examining the phonation mechanisms of reconstructed laryngeal structures after partial laryngectomy as well as in planning postoperative voice therapy.

Wyniki leczenia operacyjnego raka krtani w różnych typach laryngektomii częściowej na podstawie materiału własnego

The aimof the study was to evaluate the oncological results of laryngeal cancer treatment performed in the Laryngology University Ward in Zabrze in the years 1990–2000, depending on the type of partial surgery applied. Materials and methodsRetrospective clinical material includes 209 patients in whom surgery was a primary treatment method. No distant metastases (M1) or another malignant cancer were found. In all 209 patients the squamous cell carcinoma of various degree of malignancy (G1–G3) was found. The most common operation in the analyzed group was a chordectomy – 83 surgeries (40%), next, vertical partial laryngectomies – 38 (18%), horizontal glottis surgeries – 28 (13%). In 79 patients (38%) partial laryngectomy was complemented with a nodal operation.The median of the observation period was 9 years. Local recurrence, nodal recurrence and distant metastasis are rated as treatment failure. Treatment effectiveness was evaluated with relation to overall survival, disease-free survival, cause specific survival and local control. All the above-mentioned parameters were analyzed with the updated percentages method. The level of statistical significance was assumed to be p≤0.05. ResultsThe best oncological results were observed after vertical operations. In the vertical operations group the most favourable oncological results were noted after chordectomy. 83% overall survivals, 82% disease-free survivals, 93% cause specific survivals and 96% local controls in the 5-year observation. On the other hand, the least favourable treatment results were observed after ¾ subtotal partial operation, after horizontal supraglottic operation and after reconstruction operation with CHP. Statistically significant differences in treatment results between the groups of patients after various types of partial operations were found in relation to local controls and disease-free survivals.

Functional recovery of laryngeal reconstruction with the anterior cervical turnover myocutaneous flap after partial laryngectomy

Objective To evaluate the laryngeal function recovery following laryngeal defect reconstruction with anterior cervical turnover myocutaneous flap after partial laryngectomies.MethodsThe swallowing,respiration and phonation functions of 43 patients,who received vertical partial laryngectomy,extended vertical partial laryngectomy,expanded frontovertical partial laryngectomy or subtotal laryngectomy,and laryngeal reconstruction with turnover myocutaneous flap between 2008 and 2010,were retrospectively analyzed.Thirty-two patients had glottic carcinoma(15 phase Ⅱ,16 phase Ⅲ,1 phase Ⅳ) and 11 had transglottic carcinoma(5 phase Ⅱ,6 phase Ⅲ).The aspiration rate and decannulation rate were recorded.The swallowing function score,respiration function score,and voice parameters were analyzed and compared before and after operation.ResultsSix months after operation all the cases had normal swallowing and respiration functions,with no aspiration and with a decannulation rate of 100%.The swallowing function scores were similar before and after operation(U =903.1,P =0.559),and the respiratory function was significantly improved after operation(U =713.5,P =0.012).All the cases had normal voice.Six months after operation,the voice quality(such as Jitter,Shimmer and normalized noise energy \) were significantly better than that before the operation(P 0.05).The fundamental frequency(F0) of voice was significantly decreased after operation(P 0.05),and the NNE at 12 months after operation was significantly better than that at 6 months after operation(P 0.05).ConclusionAnterior cervical turnover myocutaneous flap for reconstruction of laryngeal defects following partial laryngectomies can achieve high decannulation rate and better phonation recovery,showing a satisfactory restoration of laryngeal function.

Obstructive sleep apnea: is there a difference between vertical and horizontal laryngectomy?

Partial laryngectomy is used in the treatment of laryngeal cancer. Structural alterations of the upper airway arising from partial laryngectomy can cause obstructive sleep apnea (OSA). ObjectiveTo compare the prevalence and severity of OSA in patients submitted to horizontal and vertical partial laryngectomy and assess the role of spirometry for these patients. MethodCross-sectional clinical study with individuals offered partial laryngectomy. The included patients were assessed through interview, upper airway endoscopy, polysomnography, and spirometry. ResultsFourteen patients were evaluated and 92.3% were found to have OSA. The apnea-hypopnea index was significantly higher among patients submitted to vertical laryngectomy (mean = 36.9) when compared to subjects offered horizontal laryngectomy (mean = 11.2). The mean minimum oxyhemoglobin saturation was 85.9 in the horizontal laryngectomy group and 84.3 in the vertical laryngectomy group. Spirometry identified extrathoracic upper airway obstruction in all patients with OSA. ConclusionThe studied population had a high incidence of obstructive sleep apnea. OSA was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy. Spirometry seems to be useful in the detection of cases of suspected OSA, as it suggests the presence of extrathoracic upper airway obstruction.

Partial laryngectomy as salvage surgery after radiotherapy: Oncological and functional outcomes and impact on quality of life. A retrospective study of 20 cases

The gold standard for the management of laryngeal squamous cell carcinoma in a previously irradiated patient is "salvage" total laryngectomy, but surgical management by partial laryngectomy can sometimes be proposed in selected patients. This study was designed to review the functional and oncological outcomes of patients treated by open partial laryngectomy for recurrent squamous cell carcinoma after failure of radiotherapy or involving previously irradiated tissues and to define prognostic criteria for the selection of patients eligible for this treatment strategy. In this retrospective study, 20 patients underwent partial laryngectomy between 2000 and 2011 for recurrence or second primary stage I or II laryngeal squamous cell carcinoma in an irradiated territory (11 vertical partial laryngectomies; 9 horizontal partial laryngectomies). The 3-year overall survival rate in patients with negative resection margins was 66%, with higher survival rates for tumours confined to the glottis, and the 2-year local control rate was 67%. Positive resection margins requiring total laryngectomy were observed in 20% of cases. The 3-year overall survival rate was 56% in these patients. Exclusive oral feeding was restored in 75% of patients after an average of 32 days. The tracheotomy tube was removed after an average of 18 days in 90% of patients. The disease-free functional larynx preservation rate was 45%. Salvage partial laryngectomy in irradiated tissues is an alternative treatment option to total laryngectomy in selected patients.

A Modified Frontolateral Partial Laryngectomy with Laryngeal Framework Reconstruction

Objectives: Endoscopic resection and radiotherapy are organ-preservation strategies for glottic cancer because of the high local control and quality of voice after the therapy. However, frontolateral partial laryngectomy is still needed in some cases. This procedure has the complication of hoarseness. Therefore, we applied the theories of laryngeal framework surgery to partial laryngectomy with reconstruction using strap muscles and skin flap in order to improve postoperative voice qualities. Methods: We performed a modified frontolateral partial laryngectomy in three selected cases (rT1a, T3 cases). The retrospective analysis of voice qualities (PPQ, APQ, NHR, MPT) was performed in 10 frontolateral partial laryngectomy cases (7 conventional and 3 modified methods). Surgical procedure: Frontolateral vertical partial laryngectomy with tumor-free margin was performed via laryngofissure approach. After tumor resection, approximation laryngoplasty was performed using sternothyroid muscle flap that was inserted into posterior dead space to gain better contact of the posterior vocal fold on the reconstructed vocal ridge. After these procedures, a reverted sternohyoid muscle was placed inside the preserved outer perichondrium to reduce dead space and externally medialize cervical skin flap, which shaped new vocal fold. Results: No recurrence was observed in any case. No aspiration and laryngeal stenosis were observed in any case. The postoperative voice qualities were improved over pretreatment qualities in modified cases. PPQ after modifying this method was better than conventional methods. Conclusions: It is better for voice quality to treat selected glottic cancers with this modified frontolateral partial laryngectomy.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction.

ObjectiveLaryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection.MethodsFour patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated.ResultsThe four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months.ConclusionThe combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy.

Middle Frontal Horizontal Partial Laryngectomy (MFHPL): A Treatment for Stage T1b Squamous Cell Carcinoma of the Glottic Larynx Involving Anterior Vocal Commissure

ObjectiveThe therapeutic effect of middle frontal horizontal partial laryngectomy (MFHPL) in treating stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure (AVC) was compared with that of the anterior frontolateral vertical partial laryngectomy (AFVPL). The feasibility and practical significance of MFHPL in clinical application was discussed in the present study.MethodsFrom January 1996 to January 2010, a total of 65 patients diagnosed with stage T1bN0M0 glottic laryngeal cancer were treated with MFHPL or AFVPL. The postoperative complications, glottic reconstruction, recurrence rate, voice quality and survival rates were evaluated and compared between two treatments.ResultsAFVPL and MFHPL were performed in 34 and 31 patients, respectively. Flexible fiberoptic laryngoscopy revealed that in the MFHPL-treated patients the reconstructed glottis was spacious and symmetric. In contrast, AFVPL treatment resulted in irregular glottic area with poor symmetry and tubular glottis. The incidence of postoperative laryngeal stenosis significantly differed between the MFHPL- and AFVPL-treated groups (P = 0.025). No significant difference was detected in the 3- and 5-year overall- or tumor-free survival rates between two treatments. The Voice Handicap Index (VHI) and maximum phonation time (MPT) after surgery were 51.0±12.99 and 12.42±3.44 sec in the AFVPL-treated group; while in the MFHPL-treated patients they were 31.81±7.48 and 7.65±1.98 sec, respectively. Both differences in VHI (P = 0.012) and MPT (P = 0.024) were significant between two treatments.ConclusionsMFHPL was comparable to AFVPL with respect to postoperative complications, recurrence rate and survival rates, but possessed advantages over AFVPL in terms of the incidence of laryngeal stenosis and voice quality. Our study indicated that MFHPL has a potential value in clinical practice of treating stage T1b squamous cell carcinoma of the glottic larynx involving AVC.

当科における喉頭垂直部分切除術の臨床的検討

目的：喉頭機能温存治療である喉頭垂直部分切除術（以下：部切術）に関して，病変制御，喉頭温存と共に術後の喉頭機能を評価することで部切術の有用性を検討すること。対象と方法：慈恵医大第三病院耳鼻咽喉科において部切術を施行した5症例。術後病変の再発，転移の観察と共に最長発声持続時間の測定とGRBASスコア等を用いて術後の喉頭機能評価を行った。結果：TNM分類では，声門型T2N0 1例，放射線治療後rT2N0 1例，T3N0 2例であり，声門上型ではT2N0 1例であり，全例M0であった。垂直部分切除が5例に施行された。術中，内視鏡を用いて内腔から明視下に切除を行うことと，舌骨付き胸骨舌骨筋弁を用いて輪状軟骨再建を行う工夫を行った。術後局所感染のために1例に喉頭全摘術を施行したため喉頭温存率は4/5例（80%）であったが，観察期間中（34～87か月，平均64.6か月）全例局所再発なく非担癌生存中である。術後の喉頭機能ではGRBAS評価において気息性の成分が強かったが，最長発声持続時間は全例14秒以上であり日常生活上の会話に支障はみられなかった。嚥下機能では，すべての症例で誤嚥性肺炎をきたしたものはなく気管切開孔は閉鎖され唾液のクリアランスも良好であり普通食の摂食が可能であった。結語：喉頭部分切除術は局所制御率が高く，術後の音声，嚥下機能に関しても化学放射線療法に比較して著しく劣るものではなかった。喉頭部分切除術は放射線治療後の救済手術としてばかりでなく，放射線治療に対する抵抗性が危惧されるようなT2および一部のT3症例に対して初回治療として用いることは有用であると思われる。

Supracricoid partial laryngectomy cricohyoidoepiglottopexy (SCPL-CHEP) versus vertical partial laryngectomy for the treatment of glottic carcinoma

The study aimed to compare the survival rate and functional outcome of supracricoid partial laryngectomy cricohyoidoepiglottopexy (SCPL-CHEP) and vertical partial laryngectomy (VPL) in the treatment of glottic carcinoma. Thirty-nine patients underwent SCPL-CHEP and 45 patients underwent VPL between 2002 and 2007. Post-operative clinical staging were performed according to the UICC staging criteria (2002). The primary endpoints were survival time and recurrence rate. The secondary endpoints were the laryngeal functions including pronunciation, swallowing, and respiration. Overall, the estimated mean survival time was 75.6 months. There was no significant difference in survival times between the two groups (P = 0.496). The SCPL-CHEP group had a significantly lower post-operative local recurrence rate than VPL group (2.6 vs. 17.8 %, P = 0.033). Significantly longer nasogastric tube removal (22 vs. 14 days, P < 0.001) and tracheostomy decannulation (38.5 vs. 15 days, P < 0.001) times in SCPL-CHEP group was observed with the VPL group, respectively. Significantly higher aspiration rates were observed at 3, 6, and 12 months in the SCPL-CHEP group compared with the VPL group (P < 0.001, P < 0.001, P < 0.05, respectively). Although the survival rate was not significantly different between the two groups, the local regional control rate and organ preservation in the supracricoid partial laryngectomy cricohyoidoepiglottopexy group was better than those observed in the vertical partial laryngectomy group.

True carcinosarcoma of the larynx

To explore the diagnosis and treatment of carcinosarcoma of the larynx. Clinical information, including presentation, pathology, treatment and outcome, was obtained from a review of patient charts. Seven male patients were confirmed pathologically to have had carcinosarcoma between 2003 and 2009 in our hospital. All patients underwent surgery: four total laryngectomies, two vertical partial laryngectomies, and one supracricoid partial laryngectomy-cricohyoidopexy. The mean follow up was 40.6 months. At the time of writing, six patients were alive and being followed; two of these suffered regional metastasis to the cervical lymphatic nodes and underwent radical neck dissection. One patient died of multiple distant metastases 60 months post-operatively. Carcinosarcoma of the larynx describes a biphasic tumour showing both carcinomatous and sarcomatous differentiation. It is extraordinarily rare and prone to metastasise to the cervical lymph nodes. Complete surgical resection of laryngeal primary lesions with wide margins and suitable neck dissection of cervical nodes is reasonable therapy.

Combined hyoid bone flap in laryngeal reconstruction after extensive partial laryngectomy for laryngeal cancer

Patients undergoing extensive partial laryngectomy require laryngeal reconstruction to restore function. Several techniques have been described, but they are associated with complications such as laryngeal stenosis. The aim of this study was to describe a new technique of combined hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction after tumor resection, and to evaluate outcome. Eight patients requiring an extensive vertical or frontal partial laryngectomy for cancer were enrolled. Following radical tumor resection, laryngeal reconstruction was performed using the hyoid bone with a thyrohyoid membrane flap. Postoperative recovery time, complications, vocal quality, and cancer outcome were evaluated. The procedure was successful in all patients. There were no deaths, and no reports of postoperative dyspnea or dysphagia. Decannulation was performed in all patients after a median duration of 3 days (range 2-5 days). Swallowing and respiratory function were satisfactory and laryngeal stenosis did not occur during the mean follow-up period of 30.5 months. One patient had a local recurrence and required a salvage operation. A combined hyoid bone and thyrohyoid membrane flap is a reliable and relatively safe procedure that can be successfully performed for laryngeal reconstruction after extensive vertical or frontal partial laryngectomy.

Preliminary report of laryngeal preservation in the surgical salvage of recurrent laryngeal cancer

To explore the plausibility of laryngeal preservation in salvage surgery of recurrent laryngeal carcinoma. Comprehensive clinical and radiological assessments on a specific group of patients with recurrent laryngeal cancer and their relapsed tumors were carried out to determine the methods and indications of salvage surgery for preservation of laryngeal functions. Salvage surgery with preservation of larynx was performed in a selective of 36 laryngeal cancer patients with relapsed tumors in their larynges after radiotherapy or partial laryngectomies. All patients were regularly followed up after discharge from the hospital. Postoperative survival was calculated by Kaplan-Meier's method. Among various laryngeal preservation regimens given, a second transoral laser surgery was carried out in 4 cases, horizontal hemilaryngectomy in 4 cases, vertical hemilaryngectomy in 13 cases and Majer-Piquet's operation in 15 cases, respectively. Simultaneous neck dissection was conducted in 18 cases. Postoperative complications were encountered in 6 cases, most common of which were local infection and laryngeal fistula with no hospital mortality and other major morbidities. Five cases with immediate postoperative complications were cured with proper management. The remained one case undergone vertical partial laryngectomy for recurrence after tumor resection via laryngeal fissure received postoperative radiation due to positive surgical margin, and complicated laryngeal atresia and obstruction with loss of his laryngeal functions. Local recurrence was observed in 5 cases and simultaneous locoregional recurrence was seen in 1 case, with the resulting local control rate of 83.3% (30/36). The 3-year postoperative survival rate was 80.6%. The cause of death was tumor recurrence in 3 cases, distant metastasis in 3 cases and non-tumor-associated disease (heart attack) in 1 case, respectively. Salvage surgery with laryngeal preservation can be carried out in the selected cases with early or locally-confined recurrent lesions within the larynx, on the condition that the recurrent tumors be assessed thoroughly and indications for associated surgical techniques be evaluated properly.