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PubMed1987

The treatment of T3 glottic carcinoma with vertical partial laryngectomy.

Total laryngectomy has traditionally been considered the optimal treatment for patients with advanced glottic carcinoma who present with a fixed true vocal cord. However, using whole-organ sectioning techniques, it has been demonstrated that vertical partial laryngectomy is a sound oncologic procedure for selected fixed vocal cord lesions. During the period 1969 to 1984, 27 patients who presented at UCLA with T3 glottic carcinoma were treated using vertical partial laryngectomy. Follow-up for these patients averaged 4.0 years. The absolute two-year disease-free survival rate for this group was 85% (23 of 27 patients), and the local cancer recurrence rate during a two-year postoperative interval was 11% (three of 27 patients). These encouraging results support the continued use of partial laryngeal surgery for a subgroup of patients with T3 glottic cancer. Successful patient selection requires a careful analysis of disease extent based on data obtained from physical examination, magnetic resonance imaging or computed tomographic scanning, and direct laryngoscopy.

Adolescent↗
PubMed1997

Partial laryngectomy in the treatment of radiation-failure of early glottic carcinoma.

BACKGROUND: This study was undertaken to analyze the functional results, complications, local control rates, and survival in patients undergoing conservation surgery for squamous cell carcinoma (SCC) of the larynx as a salvage procedure for recurrent tumors after previous radiotherapy. METHODS: Twenty-one patients underwent frontolateral laryngectomy for radiation failure, T1 and T2 glottic SCC, at the Cancer Institute Hospital, Tokyo, from 1976 to 1991. All patients were men between the ages of 42 and 83 years. The disease-free interval ranged from 1 to 87 months (median, 26 months). The stage at initial treatment was T1 in 17 patients and T2 in four patients. Local recurrence developed in three patients. RESULTS: The rate of local control was influenced by a surgical margin of less than 1 mm (p < 0.05). Overall voice preservation was achieved in 86% of the patients. The 5-year and 10-year survival rates following frontolateral laryngectomy were 86% and 70%, respectively. Maximum phonation time after surgery ranged from 4 to 18 seconds (median, 8.1 seconds). CONCLUSIONS: These results indicate that in carefully selected cases, frontolateral laryngectomy may be used for treating radiation failure stage I or II vocal cord carcinomas with good success. Careful follow-up may be necessary in patients with a close surgical margin.

Adult↗
PubMed1998

Pharyngocutaneous fistula following laryngectomy.

BACKGROUND: Pharyngocutaneous fistula (PCF) following laryngectomy is a serious complication, and its incidence varies from 7.6% to 50%. Despite the relative frequency of this complication, there is still uncertainty about the predisposing factors. METHODS: A retrospective study was performed in 295 patients who underwent total laryngectomy. RESULTS: Of the 295 patients, 37 (12.5%) developed PCF. The contributing factors,--such as early oral feeding postoperatively, prior radiotherapy or tracheostomy, accompanying neck dissection,--and the surgical technique failed to show a statistically significant effect. There was statistically significant association between tumor size and PCF formation. Also, when the suture materials used for the closure of the pharynx were compared, catgut showed a higher rate of PCF formation than vicryl (p < .05). CONCLUSIONS: The vicryl, when used as a suture material for the closure of the pharynx, seemed to decrease the fistula rate significantly, compared with catgut. Also, tumor stage was found to have a significant role in PCF formation, but no statistical significant difference could be demonstrated for other investigated parameters. We believe that after total laryngectomy, oral feeding can be started at the third postoperative day without increasing morbidity, which makes the patients feel more comfortable and confident without nasogastric tube.

Adult↗
PubMed1999

Quality of life after laryngectomy: are functional disabilities important?

BACKGROUND: The purpose of this study was to determine the functional disabilities and overall quality of life (QOL) of patients successfully treated (ie, without evidence of disease at two years) for laryngeal or hypopharyngeal cancer by a total laryngectomy. METHODS: The University of Washington QOL questionnaire was administered to 10 patients prior to laryngectomy, at one year postlaryngectomy, and at two years postlaryngectomy. RESULTS: Postlaryngectomy QOL scores were not significantly different from prelaryngectomy scores. In all QOL domains the severity of functional disability was not significantly correlated with its importance. Ninety percent of patients (9/10) reported that compared with one year prior to the diagnosis of cancer their general health was the same or better at two years postlaryngectomy. Seventy percent of patients (7/10) reported having a good to excellent overall QOL. CONCLUSIONS: Though the loss of voice is disabling, the functional limitations caused by a laryngectomy do not necessarily translate into a worse overall QOL. Future research is needed to determine whether the importance of individual QOL domains changes as patients adjust to the experience of having and surviving cancer.

Carcinoma, Squamous Cell↗
PubMed2000

Survival and functional results of Pearson's near-total laryngectomy for larynx and pyriform sinus carcinoma.

BACKGROUND: Current treatment for most T3 and T4 transglottic and pyriform sinus carcinomas is total laryngectomy or total laryngectomy with partial pharyngectomy. Voice rehabilitation usually requires the use of a tracheoesophageal puncture (TEP). Pearson's near-total laryngectomy (NTL) is an option for voice preservation in selected cases with no invasion of the interarythenoid space and limited invasion of the subglottis. The purpose of this study is to report the functional and survival results of 42 consecutive patients who underwent NTL from 1988 to 1995. Patients and Methods The patients were 40 men and two women, with a median age of 58 years. All patients had squamous cell carcinoma. There were 37 larynx and five pyriform sinus tumors. T3 stage tumor represented 85.7% of the cases. RESULTS: There were complications in 13 patients (28.9%). Vocal quality was considered good in 83.3% of the cases. To date, eight patients presented tumor recurrences: two local, two in the neck, and four distant. The 5-year actuarial overall survival rates were of 81.7% in larynx carcinoma and 66.6% in pyriform sinus carcinoma. CONCLUSIONS: In selected transglottic and pyriform sinus carcinomas, NTL can be carried out with acceptable morbidity and a high potential of voice preservation and tumor control.

Adult↗
PubMed2003

Videofiberoptic examination of the pharyngoesophageal segment and esophagus in patients after total laryngectomy.

BACKGROUND: Posttreatment follow-up in patients with squamous cell carcinoma of the head and neck is critical because of the high risk of recurrence or a new primary tumor. However, in patients who have undergone total laryngectomy, evaluation of the pharyngoesophageal segment (PES) and esophagus is difficult. METHODS: Sixty patients who had undergone total laryngectomy received a videofiberoptic examination of the PES and esophagus at the OPD office during follow-up. RESULTS: Satisfactory examination was achieved in 56 (93%) of the patients. Each procedure was completed within 15 minutes. Although only 11 (18%) of the patients were symptomatic at follow-up, 19 patients (34%) had significant findings, including one local recurrence and two secondary esophageal cancers. Patients were asymptomatic in all three cases. CONCLUSIONS: Videofiberoptic examination is a simple, effective, and relatively noninvasive method that can be performed in the OPD office to evaluate the PES and esophagus in patients after total laryngectomy.

Adult↗
PubMed2001

Improving the functional outcome of Tucker's reconstructive laryngectomy.

BACKGROUND: The goal of reconstructive laryngectomy addressing glottic carcinoma, as described by Tucker, is twofold: achieve local control and preserve as much as possible the physiological laryngeal function. METHODS: The study consisted of long-term assessment of oncological, deglutitory, and vocal outcome in 34 patients following Tucker's reconstructive laryngectomy. Postoperative follow-up included fiberscopic examination, videoradiography, and voice assessment after speech rehabilitation. RESULTS: The 5-year overall survival rate was 92% +/- 5%. Fiberscopic examination and videoradiography contributed to observing and understanding the rehabilitation process and impairment to its progress. Two main compensatory movements were identified: the anticipatory backward movement of the tongue base (50%) and the anticipatory upward laryngeal motion (15%). Both movements occurred simultaneously at the beginning of the pharyngeal stage of the swallow (35%). The median duration prior to tracheostomy tube removal was 14 days. Swallowing of solids resumed on day 9 (median), and liquid intake (water and soup) resumed on day 12 (median). The median duration of hospitalization was 16 days. Following speech rehabilitation, the latest follow-up visit measured as follows: the mean conversational voice intensity at 64 dB (range, 57-79 dB); the mean maximum intensity at 87 dB (range, 78-96 dB); the minimum intensity at 54 dB (range, 45-65 dB); the mean maximum phonation time at 16 seconds (range, 10-29 seconds); and the mean phonation quotient at 284 mL/second (range, 205-341 mL/second). According to our classification, voice spectral analysis revealed 19 class-III patients, 12 class-II patients, and three class-I patients. CONCLUSION: Tucker's reconstructive laryngectomy is reliable in terms of both the oncological and functional outcome. Fiberscopic examination and videoradiography are two complementary methods for assessing postoperative deglutition.

Adult↗
PubMed2005

25-year experience of using a linear stapler in laryngectomy.

BACKGROUND: Stapler application for pharyngeal closure after total laryngectomy allows for rapid watertight closure without field contamination and for potentially reduced fistula rate. METHODS: One thousand four hundred fifteen patients underwent laryngectomy with linear stapler closure. In 98.6%, laryngectomy was performed after radiation failure. RESULTS: A relatively high incidence of pharyngeal fistulae (12%) was seen, although these rates were reduced to 5.5% during the recent decade. Simultaneous creation of tracheoesophageal fistula and myotomy by a novel technique was introduced. Swallowing problems were observed in 11 patients and local recurrences in nine patients (0.6%). CONCLUSION: The advantages of mechanical sutures with the closed stapling technique are simple and rapid application, watertight closure with good hemostasis, prevention of field contamination, good speech and deglutition, no increase in fistula rate, and low local recurrence rates. Operating room expenses may also be significantly reduced, rendering this method cost-effective as well.

Adult↗
PubMed2006

Cancer recurrence after total laryngectomy: treatment options, survival, and complications.

BACKGROUND: A follow-up schedule to detect asymptomatic cancer recurrence is offered to all patients with laryngeal cancer. In this study, the therapeutic options, prognosis, and morbidity of patients with total laryngectomy, who were found to have cancer recurrence during this follow-up schedule were determined. METHODS: Patients who had undergone a total laryngectomy between January 1, 1990, and January 1, 2000, and had cancer recurrence were included. Data from this group were analyzed retrospectively. RESULTS: The prognosis was poor after the development of cancer recurrence. Curative therapy could only be offered to 27.5% of these patients. Only 5% of the patients were disease free at the end of the study period. Many patients with cancer recurrence needed interventions. A large proportion of them had complications. CONCLUSIONS: The follow-up schedule offered to patients after total laryngectomy should put greater emphasis on care than on early detection of cancer recurrence.

Adult↗
PubMed2006

Partial horizontal laryngectomy and epiglottiplasty.

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat some patients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriform fossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4% in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7% after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.

Carcinoma, Squamous Cell↗
PubMed2006

[Prosthetic voice rehabilitation after laryngectomy. Failures and complications after previous radiation therapy].

BACKGROUND: Indwelling voice prostheses are state of the art for post-laryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications. PATIENTS AND METHODS: We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provox) and Provox2). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy. RESULTS: Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt. CONCLUSION: Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when post-laryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.

Adult↗
PubMed2005

[Surgical voice restoration following total laryngectomy].

In spite of the progress made in organ-preserving therapy modalities, including endoscopic or external partial laryngectomies, radiotherapy or chemoradiation in many patients with advanced laryngeal and hypopharyngeal carcinomas, total laryngectomy remains the only safe possibility for long lasting local tumour control. The existing strategies for a sufficient restoration of voice following total laryngectomy are still controversial. Besides the strictly conservative methods of esophageal voice and electronic devices, different surgical procedures are carried out worldwide. At present, the exclusively surgical voice shunt techniques are only offered in a few very specialized centres. In Germany, three surgical methods are in use: (1) microvascular laryngoplasty according to Hagen (> 300 cases), (2) the "jejunal speaking siphon" according to Ehrenberger modified by Remmert (> 60 cases), and (3) the modified Asai-technique according to Maier and Weidauer (> 80 cases).

Adult↗
PubMed2002

Hypothyroidism in patients treated with total laryngectomy. A multivariate study.

One of the complications of the treatment of head and neck carcinoma patients is hypothyroidism. The objective of our study was to quantify the prevalence of hypothyroidism in patients with laryngeal or hypopharyngeal cancer treated with a total laryngectomy and to evaluate the importance of different variables in the appearance of hypothyroidism in this group of patients. A transversal study in 182 patients treated with total laryngectomy between 1986 and 1998 was carried out. TSH and FT4 were determined in all patients. Hypothyroidism was classified as subclinical (increased TSH and normal T4 levels) and clinical (increased TSH and decreased T4 levels). Univariate and multivariate analysis was carried out to examine the relationship between hypothyroidism and different variables. Our results showed that the prevalence of hypothyroidism in our group of patients was 52% (27% subclinical and 25% clinical). Sex, initial extension of the tumour, hemithyroidectomy, use of chemotherapy and radiotherapy were variables associated with the appearance of hypothyroidism in the univariate analysis (P < 0.05). When all these variables were included in a multivariate study, only hemithyroidectomy (RR 3,6; CI 95% 1,7-7,2) and combined treatment with radiotherapy (RR 3,4; CI 95% 1,2-9,6) appeared as prognostic factors. In conclusion, hypothyroidism is a frequent complication in patients treated with a total laryngectomy (52%), especially when this treatment includes hemithyroidectomy and/or radiotherapy. We consider that it is important to check the thyroid function periodically in these patients to obtain early diagnosis and appropriate treatment.

Aged↗
PubMed2002

Relation between mood, social support and the quality of life in patients with laryngectomies.

Two hundred laryngectomized members of the Norwegian Society of Laryngectomies (NSL), a subsidiary of the Norwegian Cancer Society, were invited to answer the EORTC QLQ-C30 (version 3.0) and QLQ-H&N35 QOL questionnaires to assess their quality of life (QOL). The Beck Depression Inventory (BDI) scores, their levels of social support and their marital and educational statuses were also determined. In addition, the activity levels of each patient within the NSL were assessed. The questionnaires were returned anonymously by 104 patients. The results of this sample were compared with the responses to the EORTC QLQ C30/H&N35 by all of the survivors of treatment for head and neck squamous cell carcinoma (HNSCC) in western Norway between 1992 and 1997. This sample included 96 of 106 eligible patients. The QLQ-C30 symptom scores include, e.g., dyspnea, smell and taste. However, neither the QLQ-C30 functional scores nor the disease-specific scores of the people with laryngectomies differed from the general HNSCC-treated population. The level of social support by family, friends and neighbors was not associated with the QOL, whereas high BDI scores were associated with reduced QOL by most measured indexes. Furthermore, a positive association was determined between the level of activity within the NSL and QOL. This relation was to some extent secondary to differential BDI scores. In conclusion, the QOL of people with laryngectomies is relatively similar to a general population of patients treated because of HNSCC, is related to the activity level within a patient interest organization and is associated with a lower mood level.

Activities of Daily Living↗
PubMed2006

Pharyngocutaneous fistula following total laryngectomy: a single institution's 10-year experience.

The etiology of postoperative pharyngocutaneous fistula (PCF) formation following major head and neck surgery is multifactorial and the incidence varies greatly. We reviewed retrospectively the records of 108 consecutive patients who underwent a total laryngectomy during the period from December 1992 to December 2002 at the Helsinki University Central Hospital, Helsinki, Finland. PCF occurred postoperatively in 19 (18%) patients. Two additional patients (2%) developed a PCF later than 30 days after laryngectomy. Nineteen percent of these patients with fistula formation had received previous radiation therapy and laryngectomy was performed for local recurrence. Eighteen (86%) of the all fistulae closed spontaneously and surgical closure of the fistula was performed in three (14%) cases. We conclude that the PCFs in our patient population occurred both in radiated and nonirradiated patients. Although most fistulae close spontaneously without surgical intervention this complication leads to prolonged hospitalization and increased patient morbidity.

Aged↗
PubMed2000

Initial treatment of the early stages (I, II) of supraglottic squamous cell carcinoma: partial laryngectomy versus radiotherapy.

The purpose of this study was to define the treatment of choice (partial laryngectomy vs radiotherapy) in the early stage of supraglottic squamous cell cancer (ESSC). One hundred and fifteen patients with ESSC were treated with either partial laryngectomy (25 patients) or with radiotherapy(90 patients) between January 1984 and December 1996. All patients had a follow-up of over 29 months. Radiotherapy (RT) had a local control rate of 79%, which increased to 90% with salvage surgery, and a high larynx preservation rate (83%). Partial laryngectomy (PL) offered a better initial local control rate of 84%, which increased to 88% with salvage surgery, and functional results were also good (80%). No statistically significant differences were found between RT and PL. RT was less costly, showed better suitability for treatment, produced moderate morbidity and sequelae, and local recurrence was easier to rescue. However, it is a once-only application technique. PL showed higher immediate postoperative morbidity, higher cost and lower suitability for treatment but had fewer sequelae, offered the best initial local control and is multi-applicable. No clear oncological arguments were found in our series to define whether PL or RT is the treatment of choice for ESSC. Both are effective therapies. Secondary factors such as suitability for treatment, morbidity, cost and applicability should be individually evaluated when choosing the type of treatment. As the laser endoscopic approach decreases morbidity and costs and makes the condition more suitable for treatment, it could be the treatment of choice for ESSC, in cases where local tumoral extent and larynx exposure allow radical excision.

Aged↗
PubMed1999

Extended fronto-lateral laryngectomy with simultaneous reconstruction by means of a mucochondral nasal septum flap.

As treatment for laryngeal cancers the extended fronto-lateral laryngectomy allows tumor to be removed that involves the glottis with the vestibule of the larynx. Since 1979 we have performed 417 extended fronto-lateral laryngectomies with simultaneous reconstruction of the anterior part of the larynx using a mucoperichondral flap from the anterior septum. This operation was indicated for stage T1b cancer (175 cases), stage T2 tumor (231 tumors) and T3 extended operations with epiglottectomy (11 cases). For the total number of 417 patients operated on, 19 cases during the 5-year period of following had local recurrences that required total laryngectomy. In 11 cases, metastases to the cervical lymph nodes required surgical neck dissection. In the remaining 387 cases, a normal air passage and a large laryngeal lumen were found. In 15 cases graft rotation into the larynx made respiration and phonation difficult but without dyspnea occurring. Follow-up to a maximum of 18 years showed that the oncological and functional results after this surgical procedures are encouraging.

Aged↗
PubMed2001

Near total laryngectomy with epiglottic reconstruction. our experience of 65 cases.

From 1980 to 1998, 65 patients whose glottic lesions were classified T1 or T2 were operated with a reconstructive anterior frontal laryngectomy with epiglottoplasty such as described by Tucker (Arch Otolaryngol Head Neck Surg 115:1341-1344). This procedure consists of resection of the two vocal cords, in some cases one arytenoid, the anterior commissure with a part of the thyroid cartilage, the anterior part of both false vocal cords, and of 1 cm of the subglottis. The epiglottis is grasped downward to close the larynx. There were no per or postoperative deaths. Our functional results confirm those reported in the previous publications. The mean time of removal of the nasogastric tube was about 12 days and the patients were generally satisfied about their residual voice. Decannulation was performed after satisfactory peroral feeding, generally about 2 weeks postoperatively. Three patients only required subsequent procedures which can be considered due to functional failures. There were four recurrences, which means a 5-year actuarial local control rate of 94%. This operation takes place as part of our surgical treatment policy of laryngeal carcinomas, considering that this surgery is like an extensive frontolateral laryngectomy. In case of an infiltrating tumor or in case of invasion to the arytenoid cartilage, we perform a supracricoid partial laryngectomy with crico-hyoido-epiglottopexy (the Majer-Piquet's procedure).

Adult↗