Supracricoid partial laryngectomy with cricohyoidoepiglottopexy in patients with radiation therapy failure

Abstract

BackgroundTo assess functional results, complications, and success of larynx preservation in patients with recurrent squamous cell carcinoma after radiotherapy.MethodsFrom a database of 40 patients who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) from June 2001 to April 2006, eight patients were treated previously with radiotherapy due to squamous cell carcinoma of the glottic region and were treated for recurrence at the site of the primary cancer.ResultsSCPL with CHEP was performed in six men and two women with a mean age of 67 years due to recurrence and/or persistence at a mean time of 30 months postradiotherapy (in case #8 after concomitant chemoradiotherapy). Bilateral neck dissection at levels II-V was performed in six patients. Only case #8 presented metastasis in one node. In case #5, Delphian node was positive. It was possible to preserve both arytenoids in five cases. Definitive surgical margins were negative. Complications were encountered in seven patients. Follow-up was on average 44 months (range: 20-67 months). Organ preservation in this series was 75%, and local control was 87%. Overall 5-year survival was 50%.ConclusionsIn selected patient with persistence and/or recurrence after radiotherapy due to cancer of the larynx, SCPL with CHEP seems to be feasible with acceptable local control and toxicity. Complications may occur as in previously non-irradiated patients. These complications must be treated conservatively to avoid altering laryngeal function.

Diagnosis and treatment of recurrent laryngeal cancer following initial nonsurgical therapy

“…Published series on conservation salvage surgery, both endoscopic and open approaches, are summarized in Table 1 8, 9, 32, 36, 37, 40–61. The series are heterogeneous because of different selection criteria; therefore, the results are not always comparable.…”

Supracricoid laryngectomy and dysphagia: A systematic literature review

“…Other limitations of this literature search result from our inclusion and exclusion criteria. A lot of studies were excluded because of their limited patient population, whereas a few studies were excluded because TNM stage was not well documented or the study was published in or before 1990 …”

“…Other limitations of this literature search result from our inclusion and exclusion criteria. A lot of studies were excluded because of their limited patient population, [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] whereas a few studies were excluded because TNM stage was not well documented [64][65][66][67] or the study was published in or before 1990. 68,69 CONCLUSION Although a high incidence of dysphagia was observed after SCL, the results showed good recovery rates after 3 months of surgery, with a small rate of severe complications after a long follow-up period.…”

Delphian node metastasis in head and neck cancers—Oracle or myth?

“…The rates of DN positivity are much lower in patients with early‐stage laryngeal cancers or in selected patient groups undergoing voice‐preservation procedures: 7–13% (Table I) 15–18. Nonetheless, metastatic disease to the DN was associated with much poorer prognosis, bearing in mind that these are patients who should otherwise have excellent prognosis.…”

“…Nonetheless the importance of evaluating the pre‐laryngeal and pre‐cricoid region for nodal metastasis have been emphasized from the 1960s, especially when operating on patients with transglottic and subglottic cancers, or dissecting the thyroid isthmus and pyramidal lobe 7, 8. Data from studies examining the incidence and significance of DN positivity in laryngeal and hypopharyngeal cancers are summarized in Table I 2, 3, 7, 9–18. Nine of these studies have examined an unselected group of patients undergoing laryngectomy for laryngeal and hypopharyngeal tumors 2, 3, 7, 9–14.…”