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

Abstract

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. © 2000 John Wiley & Sons, Inc. Head Neck 22: 12–16, 2000.

Current status of near-total laryngectomy: review

“…4,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] CURRENT STATUS OF NEAR-TOTAL LARYNGECTOMY…”

“…The incidence of successful speech outcomes ranges from 74 to 100 per cent. 4,8,9,11,12,[14][15][16][17][18]20,21,[23][24][25][26][27][28][29][30][31][32][33][34] The results of various studies are summarised in Table II. In the previously published series, we analysed the speech outcomes of 150 patients with carcinoma of the larynx and pyriform fossa who underwent neartotal laryngectomy at our institution. Intelligible speech was acquired by 90 per cent of these patients.…”

Laringectomía casi-total: Experiencia en Cuba

“…Se observa que el porcentaje de éxito es de forma general bastante elevado, superando el 80% en la mayoría de los reportes [2][3][4][5][6][7][8][9][10][11][12] . Es significativo aclarar que el fracaso en la rehabilitación con esta técnica no impide al paciente rehabilitarse por otros métodos convencionales, como la laringe eléctrica, la voz esofágica o la prótesis fonatoria.…”

“…Con sólo dejar un aritenoides en su respectiva articulación con un segmento de cricoides y una porción variable de tráquea, se puede realizar una fístula fonatoria tubulizando estos tejidos y dejando su desembocadura dentro de la faringe, sin arriesgar en lo absoluto el margen oncológico de la resección tumoral y sin afectar la función deglutoria 1,[13][14][15] . Como se evidencia en la Tabla II, con una buena selección de casos según los criterios establecidos para las indicaciones de la técnica, los resultados oncológi-cos son similares a los que se logran con la laringectomía radical en estos casos 3,5,6,9,10,12 . En nuestra serie tuvimos 1 fallecido por la enfermedad debido a recurrencia periestomal no resecable, otro fallecido por trombosis cerebral y 2 pacientes que se encuentran vivos en actividad tumoral.…”

Practice of laryngectomy rehabilitation interventions

“…Such approaches can be considered technically demanding and are suitable for a small and highly selected group of patients [11,12]. Also, most patients with advanced disease initially treated by surgery will need postoperative radiation therapy, which can worsen the functional ,10].…”