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PubMed1998

[Supraglottic laryngectomy with or without one arytenoid in epiglottic carcinoma. A report of 40 cases].

OBJECTIVE: Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottic squamous carcinoma. This procedure consists of resection of the thyroid cartilage, epiglottis and the entire preepiglottic space. METHODS: Between 1990 and 1996, supraglottic laryngectomy was used to treat 40 patients with epiglottic carcinoma. The data were collected by a review of patient records and follow-up. The cancers were in stages T1(17), T2(17) and T4(6) according to the 1987 UICC cancer staging criteria. RESULTS: Twelve ipsilateral and one bilateral functional neck dissection were performed simultaneously of which 7 patients had metastasis in lymph nodes. No patient died postoperatively. Only 8(20%) had slight aspiration before the 20th day. All patients had decannulated. Twenty-nine cases received radiotherapy and chemotherapy. A follow-up analysis showed survival rate of 74% at 3 years. CONCLUSION: We propose supraglottic laryngectomy for the surgical treatment of early supraglottic carcinomas, which could acquire almost normal laryngeal function.

Adult↗
PubMed2000

[Prophylactic postoperative radiotherapy in the treatment of supraglottic tumors].

The appropriateness of treatment of supraglottic carcinoma with post-operative radiotherapy is still a controversial issue. The purpose of the present work has been to define the effectiveness of post-operative radiotherapy in the treatment of supraglottic carcinomas and to discuss, on the basis of the data reported in the literature, the usefulness of combined surgery-radiotherapy. The study involved 97 subjects suffering from spinocellular carcinoma of the laryngeal vestibule (95 males, 2 females; average age: 58; age range: 38-89 years) who underwent horizontal supraglottic laryngectomy together with bilateral laterocervical lymph node dissection. Of these patients 35 (36%, group A) had undergone a cycle of prophylactic radiotherapy (60-70 Gy in fractions of 2 Gy/die, administered with two side fields), after surgery. The remaining 62 cases (64%, group B) did not have any additional therapy after surgery. For both groups the overall actuarial survival and 5-year corrected survival rates were calculated; statistical significance was calculated using the Wicoxon test. For group A the overall actuarial survival and corrected actuarial survival rates were, respectively, 74% and 90%. For group B these rates were, respectively 61% and 80%. A statistical comparison of both parameters did not show any statistically significant difference (p = 0.2 and 0.4, respectively). In reference to tumor extension, established both on the basis of clinical (T) and surgical-anatompatholgical (pT) findings, no significant differences were encountered between the overall actuarial survival and corrected actuarial survival rates for the two groups of patients (p > 0.05). In NO patients significantly higher overall actuarial survival rate in those patients who underwent the combined surgery-radiotherapy treatment than in those treated with surgery alone (p = 0.01) was seen. This was not, however, confirmed by the corrected actuarial survival rates and comparative analysis of the groups for surgical staging of the lymph node metastases (p > 0.05). Most likely the different behavior seen in the two groups depends on possible errors in the clinical staging of N due to the presence of reactive lymphadenitis and micrometastases. In conclusion, the data derived from the present research indicate that post-operative radiotherapy, performed as prophylaxis in cases undergoing supraglottic laryngectomy does not yield any statistically significant improvement in prognosis. Therefore, the radiotherapy association should be ruled out in those patients where the oncological radicality of the surgery is reasonably certain. It can possibly be considered as integration to surgery, only in those cases where radicality is in doubt.

Adult↗
PubMed2001

Pathologic features of occult lymphatic metastasis in supraglottic carcinoma.

OBJECTIVE: To study the pathologic features of occult lymphatic metastasis in supraglottic carcinoma. METHODS: Serial sections of 153 neck dissection specimens in 100 patients with supraglottic carcinoma were evaluated under the microscope. RESULTS: In 100 patients, 38 had occult metastatic lymph nodes. 51 metastatic lymph nodes were found in pathology, and their sizes ranged from 0.5 cm to 2.6 cm (average 1.1 cm). The distribution of 51 lymph nodes was 1 in level I (2%), 37 in level II (73%), 12 in level III (24%), and 1 in level IV (2%). Among the 51 nodes, 21 (41%) were early stage, 18 (35%) were growth stage, 7 (14%) were tull stage, and 5 (10%) were extracapsular stage. The differentiation degree and appearance of supraglottic carcinoma was not directly related with occult metastasis. CONCLUSION: The occult metastatic rate of supraglottic carcinoma is high, and selective neck dissection may be necessary.

Adult↗
PubMed1999

[Selective neck dissection in the treatment of supraglottic carcinoma].

OBJECTIVE: To study the effectiveness of selective neck dissection (upper neck dissection, UND) in the treatment of N0 neck of supraglottic carcinoma. METHOD: The upper neck dissection was designed according to the lymphatic drainage of the supraglottic larynx for the management of N0 neck. The records of the supraglottic carcinoma of T1-4 N0-1 M0 cases (168 patients), who were treated in 1976-1990 at this hospital, were analysed retrospectively. RESULT: In this seires of 168 patients with no neck metastases pathologically a follow-up of five years after an upper neck dissection revealed a neck recurrence rate of 10.1% (17/168), which is comparable with those reported in the literature after selective neck dissection. Five year survival rate was 72.6% (122/168). CONCLUSION: Long-termed observation after UND for supraglottic carcinoma (T1-4 N0-1) resulted in satisfactory survival rates and regional control. It seems justifiable to do a selective neck dissection for N0 and selected N1 patients in order that more patients were exempted from enduring the morbidity following a comprehensive neck dissection.

Adult↗
PubMed2000

[Supraglottic horizontal partial laryngectomy].

OBJECTIVE: To evaluate the long-term result of supraglottic horizontal partial laryngectomy. METHODS: Fifty-five patients with supraglottic laryngeal carcinoma were treated surgically by supraglottic horizontal partial laryngectomy from 1986 to 1995. There were 32 males and 23 females with an average age of 56. Eleven cases were staged I, 26 staged II, 11 staged III and 7 staged IV. Closure of the surgical defect begins by covering the thyroid cartilage with mucosa of the medial wall of the pyriform sinus. The outer perichondrium of thyroid cartilage was approximated with the mucosa of laryngeal ventricle. The hyoid cartilage was excised. The base of tongue was sutured to the reserved thyroid cartilage to take the place of epiglottic cartilage. RESULTS: The 3- and 5-year survival rates were 85% (47/55) and 77% (37/48) respectively. The decannulation rate was 96%. Most cases had acquired good speech and swallow function after 8-30 days. Complications included granulation and polyp formation at the base of tongue or at the anterior commissure in 4 cases. CONCLUSIONS: Supraglottic horizontal partial laryngectomy is very effective both in eradicating disease and in preserving laryngeal function.

Adult↗
PubMed2003

A prospective, observational evaluation of a new supraglottic airway: the PAXpress.

AIM: Little information is available on efficacy and safety of the new supraglottic device, PA(Xpress), in anesthetized patients. The aim of this prospective observational study was to evaluate the use of this new supraglottic device in clinical practice. METHODS: Ninety-one patients (mean age: 45+/-11 years) undergoing extremity or minor peri-phery procedures (mean duration 53+/-18 min), with a supraglottic airway were prospectively studied in 10 hospitals, using a simple questionnaire with data concerning anthropometric variables, surgical procedure, and occurrence of untoward events during PA(Xpress) placement, anesthesia maintenance, or postoperative period. RESULTS: First attempt placement was achieved in 74 patients (82.2%), while 9 patients (10%) required 2 attempts, and 7 patients (7.7%) required more than 2 attempts. In only 2 patients (2%) airway control was not achieved with the studied device. The mean time required to achieve successful placement was 49+/-18 s (range 4-300 s). Mechanical ventilation was effectively maintained in all studied patients, and no severe adverse events were reported during the procedure. Blood on the device was observed in 54% of cases, and this was associated with an incidence of sore throat of 26% in the recovery area and 13% after 6 hours from the end of surgery. CONCLUSION: Although further comparative, randomized studies should be advocated to better evaluate the use of this new supraglottic device, this prospective, observational study demonstrated that PA(Xpress) provides safe and effective airway control during mechanical ventilation in up to 98% of cases.

Adolescent↗
PubMed2003

The management of glottic and supraglottic cancers of the larynx in relation to neck metastasis.

OBJECTIVES: We evaluated the management of glottic and supraglottic laryngeal cancers in relation to neck metastasis. PATIENTS AND METHODS: Fifty-two patients (51 males, 1 female; mean age 59.2 years; range 27 to 82 years) underwent surgery for primary laryngeal cancers. Preoperative and postoperative TNM classification and staging were made according to the AJCC 1997 criteria. The mean follow-up period was 39.4 months (range 6 to 74 months). RESULTS: The tumors were glottic in 31 patients and supraglottic in 21 patients. Laryngectomies were partial in 34 patients and total in 18 patients. All the patients with supraglottic tumors and those with glottic T2-4 tumors underwent neck dissection, as well. Radiotherapy was administered to 22 patients with established N2 or N3 tumors. Clinical assessment was in agreement with the pathological result in 63.5%; 13.5% and 23.1% of cases were underdiagnosed and overdiagnosed, respectively. The rates of neck metastasis were 0% in T1, 25% in T2, 75% in T3, and 66.7% in T4 supraglottic tumors. The corresponding rates for glottic cancers were 0%, 16.7%, 28.6%, and 60%, respectively. The overall rate of N+ tumors was 28.9%. Four patients (7.7%) developed local, two patients (3.9%) developed regional recurrences. Mortality occurred in eight patients (15.4%) due to following causes: laryngeal recurrence (T4N2, T4N2, T3N1), regional recurrence (T4N2), a second primary malignancy in one patient, and other causes in three patients. Five- and two-year disease-specific survival rates (Kaplan-Meier analysis) were 90.7%, and overall survival rates were 73.7% and 87.3%, respectively. CONCLUSION: Neck metastasis and advanced stage of the tumor were the most effective prognostic factors.

Adult↗
PubMed2006

[Neck relapse-related factors of cN0 stage supraglottic cancer].

BACKGROUND & OBJECTIVE: The occult lymph node metastasis rate of supraglottic cancer is high, and the treatment of occult lymph node metastasis is important. This study was to explore the related factors, treatment, and prognosis of occult lymph node metastasis of supraglottic cancer. METHODS: Clinical data of 104 patients with cN0 supraglottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 1999, were retrospectively reviewed. The occult lymph node metastasis rate, distribution of metastatic lymph nodes, related factors, and treatment of the neck were analyzed. RESULTS: The occult lymph node metastasis rates were 23.1% (24/104) in the whole group, and 23.9% (11/46) in stage T2 patients, 30.8% (8/26) in stage T3, 18.5% (5/17) in stage T4. The metastatic lymph nodes mainly located at lateral levels II-III(22/24). The prognosis of the patients with occult lymph node metastasis was poor (log-rank=10.66, P=0.001). Positive margin increased occult lymph node metastasis rate (Chi(2)=10.015, P=0.002), while pathologic differentiation (Chi(2)=3.349, P=0.175), T stage (Chi(2)=2.701, P=0.440), and treatment of primary lesion (Chi(2)=1.093, P=0.296) had no effects on it. Selective neck dissection reduced occult lymph node metastasis rate (Chi(2)=4.070,P=0.044). CONCLUSIONS: The occult metastatic lymph nodes of cN0 supraglottic cancer mainly locate at lateral levels II-III. The prognosis of the patients with occult lymph node metastasis is poor. Positive margin increases occult lymph node metastasis rate. For patients at stage T1N0, observation is enough; for patients at stage T2-4N0, lateral neck dissection (levels II-IV) is effective.

Adult↗
PubMed2006

[Expression of CD44 and nm23-H1 protein in the primary and metastatic lymph node lesions in supraglottic and hypopharyngeal cancer].

OBJECTIVE: To study the metastasis feature of the primary and metastatic lymph node lesions in supraglottic or hypopharyngeal cancer. METHODS: The expression of CD44 and nm23-H1 in specimens from the primary and metastatic lymph node lesions of the 41 cases with supraglottic or hypopharyngeal cancer were studied with immunohistochemistry method and flow cytometry. RESULTS: No correlation was found between the expression of CD44, nm23-H1 and the tumor differentiation of the supraglottic or hypopharyngeal cancer, but their expression related with the clinical staging. The CD44 and nm23-H1 positive expression rates in the primary and metastatic lymph node lesions were 75.6% (31/41), 85.4% (35/41) and 34.1% (14/41), 26.8% (11/41) respectively (P >0.05). The average fluorescence index of CD44 and nm23-H1 in the primary and metastatic lymph node lesions were 1.27 +/- 0.18, 1.33 +/- 0.16 and 1.11 +/- 0.19, 1.08 +/- 0.15 (x +/- s) respectively (P >0.05). CONCLUSIONS: The expressions of CD44 and nm23-H1 in the metastatic lymph node tumor had no difference compared with that in primary tumor of the supraglottic or hypopharyngeal cancer. The difference of metastasis potentials between the primary and metastatic lymph node lesions in the same patient was not proved in this study and should be further investigated from multiple oncogens markers.

Adult↗
PubMed1991

Deciding on optimal management of supraglottic carcinoma.

The management of supraglottic carcinoma is controversial. Laryngectomy with or without a radical neck dissection as the sole therapy is usually inappropriate. After supraglottic partial laryngectomy plus neck dissection, many patients are troubled with aspiration and often do poorly if postoperative radiation therapy is administered. Likewise, advocating radiation therapy alone for all lesions is inappropriate, although conventional once-daily radiation therapy is highly effective in eradicating early supraglottic carcinomas. However, for large T3 and T4 lesions, local control is poor with conventional radiation therapy. Thus these advanced lesions have been managed by total laryngectomy plus radiation therapy. To avoid loss of voice, a program of accelerated split fractionated radiation therapy was initiated at Massachusetts General Hospital in 1979. The results have shown marked improvement in local control of most moderately advanced supraglottic carcinomas.

Combined Modality Therapy↗
PubMed1988

Analysis of prognostic variables and results after supraglottic partial laryngectomy.

A consecutive series of 78 patients who underwent conservation surgery for squamous cell carcinoma of the supraglottic larynx is analyzed. The majority of the patients were middle-aged men who had early-stage disease, with only 18 patients in stage III and 6 in stage IV. The epiglottis was the most frequent site, followed by the aryepiglottic fold and other sites in the supraglottic larynx. There was no operative mortality and the complication rate was low. Univariate analysis showed no influence of tumor stage, tumor differentiation, or involved surgical margins on survival. Determinate survival rates of 85 percent at 3 years and 72 percent at 5 years were observed. Local recurrences took place in 12 patients, 4 of whom were salvaged by total laryngectomy; neck failure occurred in 13 patients, 7 of whom were salvaged after further treatment; and 1 of the 2 patients with distant metastasis was salvaged after further treatment. We believe that every patient with a favorable lesion of the supraglottic larynx should be considered for conservation surgery, specifically, supraglottic partial laryngectomy, adhering to the criteria mentioned. Initial surgical treatment offers excellent local control and 5 year survival. Adjuvant postoperative radiotherapy may be considered in those patients with bulky primary tumors, positive surgical margins, and histologically confirmed cervical lymph node metastases.

Adolescent↗
PubMed1985

Epiglottic reconstruction after supraglottic laryngectomy.

It has been well established that supraglottic laryngectomy is an effective treatment of laryngeal cancer arising above the vocal cords with cure rates equaling total laryngectomy. Although there is preservation of a near normal voice after supraglottic laryngectomy, chronic aspiration occurs in some patients particularly after extended supraglottic laryngectomy or when there is associated compromised pulmonary function. During normal deglutition, the epiglottis serves to divert food to the pyriform fossae and partially covers the inlet to the airway. These important functions can be accomplished after supraglottic laryngectomy by reconstructing a neoepiglottis from an epiglottic remnant whenever one third or more of the epiglottis can be preserved which is microscopically free of tumor. Our results in 14 patients have shown no clinically significant aspiration after epiglottic reconstruction.

Deglutition↗
PubMed1994

[Investigation on invasion of preepiglottic space by supraglottic carcinoma].

This study, based on analysis of 100 whole-organ serial sections of the larynx, concluded that preepiglottic space invasion is involved in 60% of supraglottic carcinoma. The preepiglottic space is involved either by invasion through the adjacent structures of the epiglottis, or more frequently by destroying the epiglottic cartilage and the thyro-epiglottic ligament. The preepiglottic space is involved mainly by epiglottic and epiglottic-ventricular carcinomas, accounting for 95% of carcinomas which invade the space. The involvement of preepiglottic space by supraglottic carcinoma is intimately related to the morphologic features, marginal growth patterns, and T classification. Ulcerative carcinoma is the commonest, accounting for 65%. The incidence of the infiltrative carcinomas is the highest. With increase in T stage, the percentage of invasion of preepiglottic space is increased. We believe that the easy invasion of the preepiglottic space by the supraglottic carcinoma is due to the fact that the epiglottic and epiglttic-ventricular carcinomas which account for 83% of supraglottic carcinomas are located in front of the larynx. In addition, the carcinoma easily destroys the epiglottic, cartilage and enters the preepiglottic space because the embryonic barrier which exists below the glottis and the perichondrium of the epiglottic cartilage is quite fragile.

Adult↗
PubMed1996

[External radiotherapy in early stage squamous cell carcinoma of the supraglottic larynx. Report of 28 cases].

The Authors reviewed a group of 28 pts with early-stage supraglottic carcinoma (T1-T2N0), classified according to UICC (1987), and treated exclusively with radiotherapy (RT) between 1980 and 1991. Until 1990 RT was employed for such tumors when surgery was refused or controindicated, while since 1991 primary irradiation (with surgery in reserve) has been considered the treatment of choice. The total dose ranged from 66 to 70 Gy on the larynx and up to 50 Gy on neck nodes. RT was applied in a daily fraction of 2 Gy five times a week. No significant early complications were observed. Only 1 pt showed residual cronical oedema in the arytenoid region. In none of the pts was tracheostomy necessary. The local control rate obtained after 30 months was 85.7% (24/28). Salvage surgery (horizontal supraglottic laringectomy, HSL) was performed in 3 out of 4 pts with local failure and achieved complete control of the disease. In the last pt the surgery was controindicated because of poor general health conditions. The actuarial survival rate after 5 years is 86.2%. The present series was compared to a group of 152 pts with T1-T2N0 supraglottic cancer treated surgically (HSL) at the same Istitution. In these pts local control and the actuarial survival rates are 85.6% and 89% respectively. According to recent Literature data, the present findings confirm that RT may be administered for the treatment of selected early stage (T1-T2N0) supraglottic squamous cell carcinoma of the larynx with oncologic results equivalent to those obtained with radical surgery. The importance of imaging techniques (TC, MRI) in the correct staging of the tumor is emphasised.

Aged↗
PubMed1996

[Conservative surgery for supraglottic carcinoma. Surgical technique. Oncologic and functional results].

We present the results of a retrospective study of 817 patients treated with conservative surgery for carcinomas of the supraglottic larynx at ENT department of the Gregorio Maranón Hospital between 1962-1993. The disease was staged using the criteria set forth in 1988 by the AJCC, and 36,2% were stages III and IV. From the 817 patients treated with conservative surgery 230 were extended supraglottic laryngectomies. Our theoretic treatment protocol is presented. The 5 years actuarial uncorrected survival rate related to stage was 83,9%, 83,2%, 78,5% and 55,3% for stages I, II, III and IV respectively. Local-regional failure occurred in 32,9% patients overall, and the most common site for local-regional failure was the cervical nodes. The 5 years local control rate related to stage was 86,97%, 89,1%, 82,15% and 66,55% for stages I, II, III and IV respectively. In extended supraglottic laryngectomies the 5 years uncorrected survival rate was 62,6% in supraglottic laryngectomies (SL) extended to the base of the tongue, 62,5% in SL extended to the hypopharynx, 72,5% in SL extended to the arythenoyd and 79,4% in SL extended to the vocal chord. The 5 years local control rate was 87% in SL extended to the base of the tongue, 85,7% in SL extended to the hypopharynx, 97% in SL extended to the arythenoid and 90,8% in SL extended to the vocal chord. Functional results have been evaluated according to a three grade scale. Good and fair results were 97.6% for swallowing, 90% for respiration and 95.8% for the quality of voice.

Humans↗
PubMed1998

[The effect of primary tumor localization on radiotherapy for supraglottic and glottic cancer].

In the group of 544 patients with squamous cell cancer of supraglottic and glottic larynx the effect of primary tumour localisation on the response to radiotherapy was analysed. There were 156 patients with glottic cancer T1-T3 N0-N2 and 388 patients with supraglottic cancer with T1-T4 N0-N3. The most common site of extralaryngeal involvement was piriform fossa. All patients were treated with the use of external megavoltage beam. The total dose was in range 59-80 Gy. The 5-year actuarial disease-free survival was 36% for supraglottic cancer and 63% for glottic cancer. Primary tumour localisation in glottis correlates with more favourable prognosis than that in supraglottic. Extension from supraglottis to glottis worsened the prognosis more than that in opposite direction. For extralaryngeal involvement the most favourable prognosis was the infiltration of lingual-epiglottidean fossa and the worst one for the base of tongue involvement.

Adult↗
PubMed1976

Carcinoma of the supraglottic larynx. A review of 221 cases.

Between 1962 and 1971, 221 patients (197 men and 24 women) with carcinoma of the supraglottic larynx were treated at our institution. Most of the patients were in the sixth and seventh decades of life. In 89% of the patients, the epiglottis was involved. One hundred ninety patients underwent surgery, 161 for cure initially and 29 for salvage after radiation failure. Definitive surgery included laryngectomy in 117 patients and conservation procedures in 40. Fifty-five patients were treated by radiation for cure. Survival rates after laryngectomy or supraglottic laryngectomy were similar, but radiation therapy carried a poorer prognosis than did definitive surgery. Routine neck dissection was not necessary in all patients with supraglottic carcinoma.

Aged↗
PubMed1981

Contralateral laryngoplasty after supraglottic laryngectomy with vertical extension.

Eight patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord have undergone supraglottic laryngectomy with vertical extension including the resection of an arytenoid. In these patients, the contralateral superior thyroid cornua was used to reconstruct the resulting defect. In this technique, the thyroid cornua is mobilized and green-stick fractured across the posterior commissure, maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor attached. This muscle-cartilage pedicle flap provides bulk for the posterior glottis and can be anchored anteriorly to form the framework for a new vocal cord. Hypopharyngeal and pyriform sinus mucosa is then mobilized to cover the newly reconstructed hemilarynx. This reconstruction has provided a competent glottis with a good vocal baffle in every patient in this series. Preservation of airway, voice, and laryngeal sphincter is comparable with that achieved after routine supraglottic laryngectomy without resection of an arytenoid. Using this technique, the surgeon can rely on a pedicle graft with surprising accessibility, bulk, and reach.

Aged↗