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PubMed2000

[Long-term follow-up result of partial laryngectomy].

OBJECTIVE: To study the long-term follow-up result of partial laryngectomy and reservation of laryngeal function. METHODS: Three hundred and seventy-nine patients who underwent partial laryngectomy from 1986 to 1995 were summarized (male 290 cases, female 89 cases). Among them, 184 cases were supraglottic carcinomas (T1 8 cases, T2 115, T3 48, T4 13, according to UICC in 1992), 192 cases were glottic carcinomas (T1 115, T2 63, T3 13, T4 1), 3 cases were transglottic carcinomas (T2 1, T3 2). In common 8 kinds of operations were performed: 26 cases underwent cordectomy, 138 vertical laryngectomy, 7 frontolateral laryngectomy, 12 horizontal glottic laryngectomy (middle part of the larynx), 58 supraglottic laryngectomy, 95 horizontovertical (3/4) laryngectomy, 24 subtotal laryngectomy with cricoglossoepiglottic anastomosis, 19 near-total laryngectomy with cricoglossal anastomosis (with reservation of unilateral arytenoid cartilage). 193 cases underwent concurrent neck dissection(121 unilateral, 72 bilateral). RESULTS: All cases restored their phonation and overcame aspiration with removing nasal feeding from 7 to 23 days after operations. 362 cases were decannulated from 9 days to 3 months after operations. Another 8 cases were decannulated after a secondary plastic operation. Decannulation rate was 97.6%. The three, five and ten year survival rates were 86.8% (329/379), 81.3% (266/327) and 69.4% (120/173) respectively. CONCLUSION: Partial laryngectomy is a kind of radical operation with reservation of laryngeal function. Mastering indications strictly, correct operation choices, excellent surgical skills and perfect repairing technique are bases of improving life qualities and curative effect.

Adult↗
PubMed2005

Factors influencing tumour relapse after total laryngectomy.

OBJECTIVES: To determine the prognostic factors predictive of tumour recurrence after surgical treatment for laryngeal carcinoma with total laryngectomy. STUDY DESIGN/METHODS: Retrospective review of 308 patients with laryngeal carcinoma who underwent total laryngectomy in the ENT Department of AHEPA University Hospital between 01/01/1992 and 31/12/1999. In 238 patients, total laryngectomy was performed as primary treatment of laryngeal carcinoma, and in 70 others as treatment of tumour recurrence following radiotherapy or partial surgery. Follow-up was standardized, following a strict protocol, the mean follow-up time was 68 months. RESULTS: During post-operative follow-up, recurrences were observed in 96 of 308 patients (31%). The relapse rates were 27% (65 of 238) for patients treated with primary total laryngectomy, and 44% (31 of 70) for those treated for recurrence following previous treatment. The difference in relapse rates was statistically significant. In 39 of 238 (16%) cases treated with primary total laryngectomy cervical lymph node infiltration was present at diagnosis and radical or modified neck dissection was performed. The tumour recurrence rate in this group was 46% (18 of 39), while in metastatic node-free patients the relapse rate was 24% (47 of 199) [p < 0.05]. Primary laryngectomy was effective in 82% of glottic, 70% of supraglottic, and only 59% of transglottic carcinoma. Concerning primary tumour extension at the time of surgery, total laryngectomy proved effective in 85% of T2 tumours, 81% of T3, and only 55% for T4. The higher recurrence rates for supraglottic and transglottic tumours seem related mainly to the higher rates of cervical lymph node metastasis at diagnosis. The majority of tumour recurrences were observed during the first two years of post-operative follow-up. Thus, 76% of the 308 patients remained disease-free after the first year of post-operative follow-up, 68% after the second year, and 67% after the fifth follow-up year. Of the 96 recurrences documented until now, 91 were loco-regional (19 at the tracheostomy), and only 5 involved distant metastases. Sixteen of the 308 patients (5%) subjected to total laryngectomy have since developed second primary neoplasms, most often involving the lungs (10 patients). CONCLUSIONS: Prognostic factors for recurrence following total laryngectomy include: performance of total laryngectomy as salvage surgery, degree of tumour extension, infiltration of cervical lymph nodes at the time of initial diagnosis, poor initial tumour differentiation and trans-glottic/sub-glottic tumour localization.

Disease-Free Survival↗
PubMedDate not supplied

[Partial laryngectomies].

After introduction of partial laryngectomies into the treatment of malignant larynx tumors, within a research project we analyzed symptoms, occurrence and the type of partial larynx resections for the two year period (October 1990 to September 1992). During this period of time 111 patients with malignant tumors were operated, while total laryngectomy was performed in 50 (45.0%). Laryngomicroscopy was performed in 14 patients (12.6%), and in 47 patients (42.3%) one of the partial resections of larynx was performed. Horizontal laryngectomy was performed in 25 patients (22.5%), while one of the vertical laryngectomies in 22 patients (19.8%). Concerning horizontal laryngectomies the following were performed: horizontal glossectomy, horizontal supraglottic laryngectomy and horizontal supraglottic laryngectomy spread to the tongue base, arytenoid and vocal cord. Concerning vertical laryngectomies the following were performed: hordectomy, frontal, frontolateral laryngectomy, vertical laryngectomy and hemilaryngectomy.

Adult↗
PubMedDate not supplied

Is emergency laryngectomy a waste of time?

INTRODUCTION: Patients who present with airway obstruction due to carcinoma of the larynx may be managed by tracheotomy followed by definitive tumor surgery at a later date. An alternative is emergency laryngectomy, defined as total laryngectomy performed within 24 hours, for a previously untreated and undiagnosed malignancy. In this study, we compare and contrast the outcome of 13 patients managed by tracheotomy and delayed laryngectomy to another group of patients, previously reported, managed by emergency laryngectomy. MATERIALS AND METHODS: Stridor due to malignant laryngeal neoplasm was treated by tracheotomy and delayed definitive laryngectomy in 13 patients. In every case, the tracheostomy site was removed with a surgical specimen. A comparison of the survival data was performed with earlier reported series of 13 emergency laryngectomies using the Wilcoxon log rank method. RESULTS: All patients were followed for a minimum of 24 months. Seven patients underwent postoperative radiotherapy. Two of these patients (15%) developed peristomal recurrence at 6 and 22 months respectively. Both died of disease. Six patients from each group survived disease free for a minimum of 24 months. No significant correlation was found between the time delay of definitive surgery and survival (P > .5). DISCUSSION: This series suggests that emergency laryngectomy offers patients no survival advantage. Emergency laryngectomy does, however, have several disadvantages. These include the necessity to rely on frozen section analysis, the difficulty in obtaining expert anesthetic support, and the inability to provide thorough and complete nutritional and metabolic work up before major surgery. Finally, the psychologic aspects of radical surgery for patient and family cannot be adequately addressed. We conclude that stomal recurrence is as much a function of extensive disease at presentation as of preliminary tracheotomy. Emergency laryngectomy is not a superior treatment modality and offers no particular survival advantage.

Aged↗
PubMed2003

Changes of esophageal motility after total laryngectomy.

OBJECTIVE: Total laryngectomy completely interrupts the continuity of the proximal digestive tract and may lead to derangement in esophageal motility. The purpose of this investigation was to find out how total laryngectomy changes the resting and the maximum contracting pressures of the upper esophageal sphincter muscle and how it affects the coordination of the contraction and the relaxation between the pharynx and the upper esophageal sphincter muscles. If changes in the function of the upper esophageal sphincter muscle should occur, this study will also demonstrate how it affects the motility of the esophagus and the lower esophageal sphincter muscle. METHODS: In an attempt to explain postoperative motility changes, the stationary pull through method of manometric evaluation was used to quantify the alteration in esophageal motility. For the manometric evaluation of the esophagus, a polyethylene catheter with 8 internal tubes was used. The study was performed on a group of 15 patients with total laryngectomy and 15 people without esophageal disease or symptoms as the control group. RESULTS: There was a statistically significant difference between the laryngectomy group and the control group for both the resting and maximum contraction pressures as well as for coordination and relaxation of the upper esophageal sphincter. (P < 0.05) In the laryngectomy group, 3 patients who complained of postoperative dysphasia showed more severe functional changes. The proximal esophageal body pressure and peristaltic waves were significantly decreased in the laryngectomy group. No significant difference between the laryngectomy group and the control group was noted in terms of the lower esophageal resting sphincter pressure and the postdeglution pressure. There also was no significant difference between the two groups in the degree of lower esophageal sphincter coordination and relaxation. CONCLUSION: From these results, it may be concluded that interruption of the cricopharyngeal muscle and pharyngeal plexus after laryngectomy not only may produce local derangement of upper esophageal sphincter function but also may produce abnormalities in peristalsis of the proximal esophageal body. However, the function of lower esophageal sphincter did not show any significant difference between the laryngectomy group and the control group.

Esophageal Motility Disorders↗
PubMedDate not supplied

Completion laryngectomy.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Missouri. Forty-two or 9.4% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed in regards to original conservation surgery, clinical presentation, histopathology and salvage rate. The most common indications for completion laryngectomy were : 1) local recurrence, 2) local recurrence with associated severe upper respiratory obstruction, and 3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44%), and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or 10 patients) associated with completion laryngectomy, particularly in patients with anticedent hemilaryngectomy. Most indications for completion laryngectomy present early, however, all patients must be carefully followed. Both the patient and the otolaryngologist must be ever vigilant following conservation surgery.

Adult↗
PubMedDate not supplied

Completion laryngectomy.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St Louis. Forty-two or 9% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed with regard to original conservation surgery, clinical presentation, histopathology, and salvage rate. The most common indications for completion laryngectomy were (1) local recurrence, (2) local recurrence with associated severe upper respiratory obstruction, and (3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44% and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or ten patients) associated with completion laryngectomy, particularly in patients with antecedent hemilaryngectomy. Most indications for completion laryngectomy appear early; however, all patients must be carefully followed up after conservation surgery.

Adult↗
PubMed2002

[Reconstruction with pyriform sinus mucosa in partial laryngectomy].

OBJECTIVE: To assess the effectiveness of reconstruction with pyriform sinus mucosa in partial laryngectomy and resumed laryngeal function. METHOD: A total of 198 cases of laryngeal cancer who had undergone partial laryngectomy from 1980 to 1995 in our hospital were retrospectively reviewed. Defect of larynx were repaired with pyriform sinus mucosa in all cases. Surgery of local lesions: 87 cases underwent supraglottic horizontal partial laryngectomy, 65 vertical or extended vertical partial laryngectomy, 46 horizontal vertical partial laryngectomy. RESULT: In cases underwent supraglottic horizontal partial laryngectomy, postoperative decannulation rate is 100%, 5 year survival rate is 84.70% and functions of voice, respiration and deglutition were all preserved well. In cases underwent vertical or extended vertical partial laryngectomy, decannulation rate is 87.67% and 5 year survival rate is 86.15%. Functions of respiration and deglutition are good but existent hoarseness. In the earlier stage after operation, there was serious aspiration in the cases underwent horizontal vertical laryngectomy and it took patients more time to overcome aspiration by practice. In this group, decannulation rate is 82.60% and 5 year survival rate is 78.26%. all cases present hoarseness and part of them can't be extubated because of glottic stenosis. CONCLUSION: The authors believe that this method of surgery is safe and beneficial to some patients with partial laryngectomy. Laryngeal functions can be well preserved with this technique.

Adult↗
PubMed2003

[Application of bi-pedicel and bi-muscle flaps for the expanded partial laryngectomy in the patients with T3T4 laryngeal cancer].

OBJECTIVE: To evaluate the application of bi-pedicel and bi-muscle flaps for the expanded partial laryngectomy in the patients with T3T4 larynx cancer. METHODS: From 1990 to 1997, 386 patients of laryngeal cancer were treated by expanded partial laryngectomy and repaired with unilateral or bilateral bi-pedicel and bi-muscle flaps. 322 patients were male and 64 were female. The age ranged from 30 to 84 years old. All the patients were in the stage T3 or T4 of cancer. The operation included expanded horizontal supraglottic laryngectomy, vertical partial laryngectomy, 3/4 laryngectomy and sub-total laryngectomy. RESULTS: After operation, the speech function was still good in all cases. The swallow function recovered in 8 to 12 days post-operation. The extraction rate of tracheal tube was 50.3% (194/386), and the 5-years survival rate was 55.2% (213/386) while the local recurrence rate was 16.6% (64/386). CONCLUSION: With the application of bi-pedicel and bi-muscle flaps, the patients, if treated by total laryngectomy as traditional technique, could be treated by partial laryngectomy. This method could expand the indication of partial laryngectomy and improve the life quality and survival rate.

Adult↗
PubMed2004

[Investigation and analysis of quality of life for patients after laryngectomy].

OBJECTIVE: To institute and test the quality of life for laryngectomy, and evaluate the feasibility of above questionnaire in patients after laryngectomy. METHODS: A questionnaire of quality of life for laryngectomy was instituted. An investigation was conducted in patients treated by partial (36, Group A) or total (45, Group B) laryngectomy for laryngeal cancer with above questionnaire. The feasibility, reliability and validity of the questionnaire was evaluated, the quality of life and the influencing factors in laryngectomy were also analyzed. RESULTS: The questionnaire of quality of life for laryngectomy consists of 22 items, covering six aspects. The questionnaire has a comparatively good reliability, and the criterion-related validity and content validity of the questionnaire is valid. The correlation coefficient of split-half method and Cronback's alpha of questionnaire were 0.842 and 0.889 respectively. The composite quality of life scores of group A were significant higher than those of group B ( P < 0.001). The differences in physical function, laryngeal function, psychological state, the ability of living independently were statistically significant (P < 0.001; P < 0.001; P < 0.01; P < 0.05) as well. Seven factors including operative modality, tumor stage, postoperative complication, coexisted disease, family incomes, voicing modality and wearing tracheo-cannula were related to postlaryngectomy quality of life. CONCLUSIONS: The questionnaire of quality of life for laryngectomy has speciality in laryngectomy and a comparatively good reliability and validity, and it is suitable for quality of life research in patients after laryngectomy.

Adult↗
PubMed2006

Conservation laryngeal surgery versus total laryngectomy for radiation failure in laryngeal cancer.

BACKGROUND: Total laryngectomy is the standard of care for surgical salvage of radiation failure in laryngeal cancer. However, the role of conservation laryngeal surgery in this setting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radiation failure in patients who initially presented with T1 or T2 squamous cancer of the larynx. METHODS: A 21-year retrospective analysis of patients who received surgery at a single comprehensive cancer center after definitive radiation therapy is reported. At recurrence, the patients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary laryngeal cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after surgery was 69.4 months. Most patients with recurrence after radiotherapy required total laryngectomy (69.5%; 73/105). Conservation laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%). RESULTS: In 14 patients, local or regional recurrence developed after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation laryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p = .634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic laryngeal cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who underwent a conservation approach (p = .011 by log-rank test). CONCLUSIONS: Although conservation laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation laryngeal surgery is an oncologically sound alternative to total laryngectomy for these patients.

Adult↗
PubMedDate not supplied

Pearson near-total laryngectomy: a reproducible speaking shunt.

BACKGROUND: Since 1980, Pearson and his associates at the Mayo Clinic have accrued an increasing number of patients whom they have treated with what is now designated as a "near-total" laryngectomy rather than a total laryngectomy. Despite the positive reports of the value of this procedure in providing speech by an internal shunt, the use of this total laryngectomy alternative has not gained wide acceptance. We report our experience with treating 11 patients during a 3-year period using the near-total laryngectomy. METHODS: Between September 1989 and September 1992, 11 patients with the following anatomic lesions were offered and accepted the option of the near-total laryngectomy: (1) T3 or early T4 glottic squamous cell carcinoma that did not involve the interarytenoid space or the vocal process of the opposite arytenoid; (2) T3 supraglottic squamous cell carcinoma with a fixed vocal cord in which a supraglottic laryngectomy could not be performed; (3) T2, T3 pyriform sinus squamous cell carcinomas; (4) radiotherapy failure early glottic lesions in which a vertical hemilaryngectomy for salvage was not able to be performed and met the requirements in (1); and (5) large hypopharyngeal lesions in which the larynx would be sacrificed to prevent aspiration but was not involved with tumor. RESULTS: Nine of 11 patients (82%) attained successful speech in an average of 5.3 months. Two of the 11 patients required a completion laryngectomy, both due to wound complications. All but two of the patients received postoperative radiotherapy. Of the nine successful speakers, five have had an occasional droplet of fluid through the shunt; three have been on a permanent basis and two transient. Eighty-nine percent of the speaking patients (8 of 9) are alive without disease, a mean of 25.5 months after therapy completion. CONCLUSION: The near-total laryngectomy can be performed outside the Mayo Clinic with creditable results, with 82% of the patients attaining successful speech, an average of 5.3 months postoperatively. Eighty-nine percent of the speakers have had a mean disease-free survival of 25.5 months. Analysis of larger series from multiple institutions in conjunction with voice analyses of these patients compared to those with tracheoesophageal punctures is needed to confirm our initial enthusiasm for this procedure.

Carcinoma, Squamous Cell↗
PubMed1996

Stoma recurrence after laryngectomy: an analysis of risk factors.

Data from 130 patients who underwent total laryngectomy for squamous cell carcinoma of the larynx were reviewed. Patients were treated either by primary laryngectomy and planned postoperative radiotherapy or by primary radiotherapy and subsequent salvage laryngectomy. Patients with other treatment modalities and patients with positive margins of resection and laryngectomies for hypopharyngeal cancers were excluded from the study. The stomal recurrence rate with reference to several risk factors, such as primary tumor stage, location of tumor, lymph node metastases, timing of tracheotomy, and presence of a postoperative pharyngoperistomal fistula, was analyzed. The overall incidence of stomal recurrence was 10%. The treatment modality appeared to have an impact on subsequent stomal recurrence: stomal recurrence developed more often after salvage laryngectomy (18.4%) than after primary laryngectomy with planned postoperative radiation (4.8%). Advanced T stage, N stage, subglottic involvement, and preoperative tracheotomy are risk factors for stomal recurrence only in patients with a primary laryngectomy. Stomal recurrence developed in only four patients after primary laryngectomy with planned radiation. All four patients had more than one risk factor: primary tumor stage T4 (four times), subglottic involvement (three times), and preoperative tracheotomy (three times). The presence of a postoperative pharyngoperistomal fistula likewise may represent a risk factor for the development of a stomal recurrence.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

[Patient selection for near-total laryngectomy and oncologic results].

OBJECTIVES: We reviewed preoperative, perioperative, and postoperative findings and the survival data to determine which patients may be appropriate for near-total laryngectomy. PATIENTS AND METHODS: We reviewed hospital records of 20 patients (all males; mean age 56.6 years; range 35 to 73 years) who underwent near-total laryngectomy. Indications for patient selection for near-total laryngectomy and survival data were evaluated in comparison with literature reports. RESULTS: The site of the tumor was the sinus pyriformis in two, and the larynx in 18 patients. Thirteen patients had T3, seven patients had T2 tumors. The lesions were localized in the sinus pyriformis in two patients with T2 tumors. The locoregional control rate at the end of two years was 75%; two- and three-year survival rates were 81.2% and 64.2%, respectively. CONCLUSION: Following a detailed and meticulous investigation in the preoperative period, near-total laryngectomy seems to be appropriate in selected patients with advanced laryngeal and hypopharyngeal tumors in which partial laryngectomy procedures are not considered. It may both provide cure and preserve phonation. It may also be considered for functional purposes in patients whose pulmonary functions are insufficient for partial laryngectomy, in those in whom food aspiration is inevitable after partial laryngectomy, and in those suffering from lifelong food aspiration due to neurologic causes, and for oncologic reasons in patients who develop local recurrences after partial laryngectomy.

Adult↗
PubMed2002

[Clinical observation of 173 cases of partial laryngectomy].

OBJECTIVE: To summarize and study the clinical effect of partial laryngectomy on laryngeal neoplasms. METHOD: 173 cases of partial laryngectomy were performed. 6 kinds of operations were performed, 49 vertical laryngectomy, 39 supraglottic laryngectomy, 4 frontolateral laryngectomy, 47 extended partial laryngectomy ( with reservation of epiglottis and posterior part of thyroid cartilage), 17 pearson's surgery, 17 near-total laryngectomy with cricoglossal anastomosis. RESULT: 168 cases restored their phonation, 145 cases were decannulated in three months after operations. The survival rates of three and five year was 79.77% and 69. 94%, the local relapsing rate was 18.50%. CONCLUSION: Successful partial laryngectomy based on strict indications and correct operation choices. While the laryngeal function was reconstructed, it is necessary to restore the phonation, sphincter and respiratory function.

Adult↗
PubMed2001

[Incidence of salivary fistulas in relation to timing of oral nutrition after laryngectomy].

BACKGROUND AND OBJECTIVE: A pharyngocutaneous fistula is the most common complication after total laryngectomy. In Germany, a traditional recommendation is to use a nasogastric tube for feeding for 10-14 days postoperatively because many surgeons believe that oral feeding after surgery contributes to fistula development. However, there is no international agreement about when to begin oral feeding after total laryngectomy. Some authors begin oral feeding between the 1st and 4th postoperative day without any nasogastric tube, while others using a nasogastric tube delay oral feedings until 7-14 days after surgery. The aim of the present study was to investigate the relationship between the timing of oral feeding and the development of fistulas after total laryngectomy. PATIENTS/METHODS: In a prospective trial with 42 consecutive patients who underwent laryngectomy, oral feeding was started on different postoperative days between the 1st and the 10th. Most patients were selected randomly for the different postoperative days. Furthermore, other potential risk factors predisposing to fistula formation were analyzed retrospectively. RESULTS: Five fistulas occurred in the total group (12%). Early postoperative oral feeding does not increase the incidence of fistulas. The fistula rate was only 9% in patients fed orally in the 1st postoperative week. The analysis of further risk factors for fistula formation showed only a significant correlation between type of resection and fistula occurrence (extended laryngectomy with partial pharyngectomy vs standard laryngectomy; p = 0.018). CONCLUSIONS: Our results indicate that early oral feeding in the 1st postoperative week does not influence fistula formation after laryngectomy.

Adult↗
PubMed2003

Clinical outcome following total laryngectomy for cancer.

BACKGROUND: Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ-sparing protocols using chemo-therapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy. METHODS: Patients who had total laryngectomy for squamous carcinomas of the larynx or hypopharynx between 1987 and 1998 and whose clinicopathological data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, were reviewed. Patients whose laryngectomy was a salvage procedure for failed previous treatment were included. RESULTS: A total of 147 patients met the inclusion criteria for the study, including 128 men and 19 women with a median age of 63 years. Primary cancers involved the larynx in 90 patients and hypopharynx in 57. There were 30 patients who had recurrent (n = 24) or persistent disease (n = 6) after previous treatment with radiotherapy (26 larynx cases and four hypopharynx cases). Pharyngo-cutaneous fistulas occurred in 26 cases (17.7%) and, using multivariate analysis, the incidence did not correlate with T stage, previous treatment or concomitant neck dissection. Local control rates were 86% for the larynx and 77% for the hypo-pharynx groups and neck control was 84% and 75%, respectively. Five-year survival for the larynx cancer group was 67% and this was significantly influenced by T stage and clinical and pathological N stage. Survival in the hypopharynx group was 37% at 5 years and this did not significantly correlate with T or N stage. There was a non-significant trend to improved survival among previously treated patients whose laryngectomy was a salvage procedure. CONCLUSION: Patients with cancer of the larynx had a significantly better survival following total laryngectomy than patients with hypopharyngeal cancer. Those whose laryngectomy was carried out as a salvage procedure following failed previous treatment did not have a worse outcome than previously untreated patients.

Adult↗
PubMed1990

Emergency laryngectomy.

Emergency laryngectomy is a laryngectomy carried out for malignant obstruction of the upper airway within 24 h of admission. This combines relief of the obstruction with definitive primary cancer surgery, and is thought to reduce the risk of post-laryngectomy stomal recurrence. During a 5-year period, 13 patients with upper airway obstruction from squamous cell carcinoma were treated in two departments by emergency laryngectomy. Total laryngectomy was carried out after the diagnosis of squamous cell carcinoma of the larynx (n = 11), or piriform fossa (n = 2), had been confirmed by laryngoscopy and frozen section biopsy. The actuarial 5-year survival was 47%, and no patient in this series developed stomal recurrence. The management of the airway obstruction, and the post-laryngectomy complications, did not differ from those encountered with more conventional treatment. Our experience with this approach suggests that emergency laryngectomy is a satisfactory method of managing airway obstruction due to squamous cell carcinoma of the larynx.

Aged↗