Horizontal partial laryngectomy for supraglottic squamous cell carcinoma

Abstract

Between 1981-1999, 75 patients treated for supraglottic SCC with horizontal supraglottic laryngectomy (HSL) at the Otolaryngology Head and Neck Surgery Department of Lausanne University Hospital were retrospectively studied. There were 16 patients with T1, 46 with T2 and 13 with T3 tumors. Among these, 16 patients (21%) had clinical neck disease corresponding to stage I, II, III and IV in 12, 39, 18 and 6 patients, respectively. All patients had HSL. Most patients had either elective or therapeutic bilateral level II-IV selective neck dissection. Six patients (8%) with advanced neck disease had ipsilateral radical and controlateral elective II-IV selective neck dissections. Adjuvant radiotherapy was given to 25 patients (30%) for either positive surgical margins (n=8), pathological nodal status (n=14) or both (n=3). Median follow-up was 48 months (range, 24-199). Five-year disease-specific survival and locoregional and local control were 92, 90 and 92.5%, respectively. Among five patients who were diagnosed with local recurrence, one had a total laryngectomy (1.4%); the others were treated by endoscopic laser surgery. Two patients had both a local and regional recurrence. They were salvaged with combined surgery and radiotherapy, but eventually died of their disease. Cartilage infiltration seems to influence both local control (P=0.03) and disease-specific survival (P=0.06). There was a trend for worse survival with pathological node involvement (P=0.15) and extralaryngeal extension of the cancer (P=0.1). All patients except one recovered a close to normal function after the treatment. Aspiration was present in 16 patients (26%) in the early postoperative period. A median of 16 days (7-9) was necessary to recover a close to normal diet. Decannulation took a median of 17 days (8-93). Seven patients kept a tracheotomy tube for up to 3 months because of persistent aspiration. There was no permanent tracheostomy or total laryngectomy for functional purposes. Horizontal supraglottic laryngectomy remains an adequate therapeutic alternative for supraglottic squamous cell carcinoma, offering an excellent oncological outcome. The postoperative functional morbidity is substantial, indicating the need for careful patient selection, but good laryngeal function recovery is the rule. The surgical alternative is endoscopic laser surgery, which may offer comparable oncological results with less functional morbidity. Nevertheless, these two different techniques need to be compared prospectively.

Functional organ preservation in laryngeal and hypopharyngeal cancer

“…The local control rate was 90.3% and the 5-year overall survival rate 52%. Similar results were published by Bron et al [163] for 75 patients with T1-T3 supraglottic carcinomas. In this series, the 5-year local control rate was 92.5%, the organ preservation rate was 98.5%, and the 5-year overall survival rate was 75%.…”

The impact of preepiglottic space invasion on cervical lymph node metastases in open supraglottic laryngectomy revisited

“…In other studies including ours, although the presence of nodal metastasis did reveal worse prognosis and low DFS, it did not reach significant levels. [14] Suoglu et al [8] and Joo et al, [3] both mentioned that in patients with PES invasion there were higher incidences of cervical nodal metastasis compared to patients with no invasion. We know that laryngeal cancers arising from the supraglottic larynx metastasize to lymphatics via the PES draining through the thyrohyoid membrane.…”

“…[11,12] There are few well-known factors that influence survival rates in patients who underwent open SGL such as pathological stage, pathological nodal status, cartilage invasion, extralaryngeal invasion and PES invasion. [5,6,[13][14][15][16] Among these negative prognostic factors, cervical lymph node metastasis was stated to cause worse prognosis by upgrading the disease to an advanced stage. Joo et al [3] showed a significant correlation between cervical nodal metastasis and DFS in patients who underwent supracricoid laryngectomy.…”

The Comparison Of Functional Outcomes Between Supraglottic Horizontal Laryngectomy And Supracricoid Partial Laryngectomy

“…The respiration function was interpreted based on the decannulation time. Different authors, including Ulusan et al (11) and Bron et al, [12] have reported a mean decannulation time of 17 days for patients who undergo SGHL. This time for patients in the present study was consistent with the literature.…”