Oncologic and functional results of near-total laryngectomy (original) (raw)
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The functional and oncologic effectiveness of near-total laryngectomy
American Journal of Otolaryngology, 2002
To investigate the oncologic efficiency of near-total laryngectomy for advanced laryngeal and neighboring organ cancers and to evaluate the functional results. Materials and Methods: A retrospective review of 135 cases of near-total laryngectomy carried out in a tertiary university hospital between 1989 and 2000 was undertaken. The original operation was carried out in 3 groups: classic "near-total laryngectomy" for endolaryngeal lesions; "near-total laryngectomy and partial pharyngectomy" for lesions originating from the pyriform sinus or lesions with extension to the pharynx or tongue base but reconstructed primarily; and "near-total laryngopharyngectomy" for lesions requiring pedicled flap reconstruction after resection. Oncologic success was evaluated according to the location and extent of the tumor and the particular operation. Functional outcome was evaluated according to phonation and its quality as well as to the severity of aspiration. Results: Of the 135 cases, 121 were men, and 14 were women (age range, 33-80 years; mean, 56.2 years). Mean phonation time was 35.2 days, and mean onset of oral intake was 18.5 days. Of the 135 cases of the series, 124 were evaluated for survival. Thirteen of 26 (50.0%) cases of T2, 34 of 53 (64.2%) cases of T3, and 33 of 45 (73.3%) cases of T4 carcinomas survived by the end of the evaluation period. Likewise, 46 of 77 (59.7%) cases of N0, 16 of 19 (84.2%) cases of N1, and 18 of 27 (66.7%) cases of N2 survived the same period; however, none with N3 metastatic neck disease survived. The probability of survival with regard to the T and N stages of the disease did not reveal a statistically significant result (P ϭ .15 and .49, respectively). Conclusions: According to these results, near-total laryngectomy is a valid alternative for extended laryngeal and neighboring organ cancers with an acceptable morbidity and a high success rate for voice preservation. Near-total laryngectomy should be offered as a surgical treatment alternative for these patients.
A nine-year institutional experience with near-total laryngectomy
American Journal of Surgery, 2004
Pearson's near-total laryngectomy (NTL) is an alternative procedure to total laryngectomy in selected patients with advanced laryngeal cancer. Based on our experience with NTL for Ͼ9 years, we present here the functional results, complications, and survival rates. Methods: A retrospective study was carried out from January 1993 to May 2002. We studied 15 patients with advanced laryngeal, oropharyngeal, and hypopharyngeal cancer who underwent NTL. Survival rates were calculated using the Kaplan-Meier method. Results: The most common complication was fistula (8 of 15) followed by minor aspiration (4 of 15 patients). Eleven patients (73.5%) attained a good voice; 3 patients (19.9%) obtained a bad voice; and 1 did not achieved vocal ability. Three patients (19.9%) had local recurrence; no patients had neck recurrence; and 2 patients (13.3%) had distant metastasis. Six patients (40%) died from their disease, and 2 (13.3%) patients died from other causes. The 3-year actuarial survival rate was 81.6%. Conclusions: NTL is useful in the treatment of selected patients with advanced laryngeal, oropharyngeal, and hypopharyngeal cancer and results in good control and survival rates. Satisfactory functional results can be attained in the majority of patients. When the surgical margins are positive or close, TL must be carried out.
Long-Term Results of Partial Laryngectomized Patients
The Journal of craniofacial surgery, 2016
This study was to present long-term oncological results, as well as the variables, that can increase nodal metastasis and reduce survival in patients diagnosed in the early and late stages of laryngeal cancer. A total of 85 patients were included in the study. These patients were grouped as supracricoid partial laryngectomy (PL), supraglottic horizontal PL, and vertical frontolateral PL. Furthermore, at least 3 years of the long-term outcomes of the patients in these 3 groups were compared. Twenty-two of the patients (26%) had nodal metastasis, 16 (72%) of these patients were in Group I (P = 0.017); 14 patients (51%) had preepiglottic space (P = 0.075); 12 patients (50%) had paraglottic space involvement (P = 0.002); 9 (45%) patients with nodal metastasis had a depth of invasion more than 20 mm (P < 0.001). Out of the 16 patients who had positive intraoperative surgery margins, 5 (18%) of them had nodal metastasis (P = 0.589) and 14 (16%) patients were positive for perineural inv...
Clinical outcome following total laryngectomy for cancer
ANZ Journal of Surgery, 2003
in the past. Increasingly, these patients are being managed with organ-sparing protocols using chemotherapy 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 hypopharynx 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.
Clinical outcomes of total laryngectomy for laryngeal carcinoma
Kathmandu University Medical Journal, 2010
Background: Controversy exists as to the management of advanced laryngeal carcinoma. In general primary radical surgery is favoured. Objective: The aim of this study was to analyse the clinical outcome of patients having total laryngectomy for cancer of larynx. Materials and methods: This study was a retrospective case note review and questionnaires were used for evaluating voice handicap. These laryngectomies included in this study were performed by the senior author (CJW) from January 2001 till June 2007 at Leeds General Infi rmary, Leeds. Some of the patients had partial or total pharyngectomy in addition to total laryngectomy. Results: In this study a total of 59 patients were included. Seventeen (28.8%) of these patients had preoperative radiotherapy and laryngectomy was performed for residual or recurrent disease. The initial TNM staging of the tumour ranged from T 1 N 0 to T 4 N 2C . Tracheoesophageal puncture for speech prosthesis was done in 48/59 (81.4%) patients. Post-operative complications were seen in 30.5% (18/59) patients. In this study group 9 patients (15.2%) developed pharyngocutaneous fi stulas. For communication 31/51 (60.8%) patients were using speech valves. In this study 30.4% had minimal, 26.1% moderate and the rest 43.4% feeling severely handicapped with regards to voice use after total laryngectomy. Five year survival after laryngectomy in this study was 65.2%. Conclusion: Long term disease control and survival is achievable with total laryngectomy with or without postoperative radiotherapy with minimal risks in patients with advanced carcinoma of larynx.
Medical review, 2002
Introduction Patients with advanced T3 and T4 laryngeal and hypopharyngeal carcinoma need surgical treatment - total laryngectomy. Excision of the larynx affects enormously the quality of patient's life. Near total laryngectomy appeared about twenty years ago, and was accepted worldwide during the last decade of the twentieth century. Two years ago we started performing this operative procedure. Although we still don't have great experience, first results are satisfying. We point to the importance of this procedure especially in developing countries, where phonatory protheses are expensive, patients' education of esophageal speech is not satisfactory and number of those who were successfully trained is small. The aim of this paper was to introduce near total laryngectomy as a surgical procedure which improves quality of life of patients with advanced stages of laryngeal and hypopharyngeal carcinoma. Near total laryngectomy The original procedure described by Pearson was ...
Survival after Salvage Total Laryngectomy: The Influence of Previous Treatment
Journal of Nuclear Medicine & Radiation Therapy, 2017
Purpose: To compare the complications and survival rate after different treatment modalities of advanced laryngopharyngeal cancer. Methods: Retrospective study included 619 advanced laryngopharyngeal carcinoma, treated with either primary total laryngectomy (PTL), or salvage (STL) after partial laryngectomy, radio, chemoradiotherapy. Complications and survival rate were documented. Results: Five years disease free survival rate amounted 60.9% for PTL, 54.3% for STL after partial laryngectomy, 50% for STL after radiotherapy and 43.8% for STL after chemoradiotherapy. Histologically positive neck was highly significantly associated with worse prognosis, much more than recurrence within larynx. Conclusion: PTL gives the best survival rate with low complications for advanced laryngopharyngeal squamous cell carcinoma. Complications and survival rate of STL significantly depend on previous treatment of laryngopharyngeal cancer.
Total laryngectomy - past, present, future
Mædica, 2014
In a period in which therapeutic approaches for malignant laryngeal tumors are focused on the principle of "organ preservation", total laryngectomy is a well coded surgical procedure, addressed to the advanced laryngeal cancer which is not suitable for conservative techniques or in case of their failure. The main objective of this work is to summarize the important events that have marked the evolution of this surgical technique to the current formula. Also this paper aims to identify, in our own casuistry, some elements of strategy and surgical technique required, in our opinion, for a successful therapeutic intervention. The fundamental significance of the study is that we must learn from the past, perform our surgeries at contemporary standards and look to the future for new solutions and approaches of the advanced laryngeal malignancies.
American journal of otolaryngology
Purpose: The most appropriate treatment of laryngeal nonsquamous malignancies is a controversial subject, mainly because of the limited number of cases diagnosed. Surgery, which is an obligatory choice in nearly all cases, is sometimes indiscriminately demolitive despite the relatively low locoregional aggressiveness that characterizes certain histotypes and locations. Even in extremely aggressive tumors, where the prognosis is almost invariably unfavorable because of distant metastasis, the suitability of radical surgery should be carefully assessed, especially considering the patient's remaining life quality. The aim of the present investigation was to evaluate the postsurgical oncological results in a series of consecutive patients with laryngeal nonsquamous primary malignancy. Methods: We analyzed retrospectively 29 consecutive patients with laryngeal nonsquamous malignancies of whom 10 underwent total laryngectomy and 19 conservative surgery (partial laryngectomies). Results: Of the 29 patients with of laryngeal nonsquamous malignancies, 16 were alive and free from disease after treatment, 5 died of other causes, 1 was lost at follow-up, and 7 died of the disease. Statistical analysis failed in disclosing a significantly different local recurrence rate after conservative surgery vs radical surgery after a mean follow-up period of 5.5 years. Conclusions: From the preliminary data emerging from the study, it seems that in nonsquamous malignancies of the larynx, the surgical approach should be the most conservative surgery possible, tailored to neoplasm extent and patient conditions. Although cervical lymph node metastases are unusual, long-term follow-up is mandatory considering the relatively high incidence of distant metastases even after years.
A Prospective Study of Total Laryngectomy and associated Complications
International Journal of Phonosurgery & Laryngology, 2012
A prospective study conducted over a period of 2 years at a tertiary care hospital on all patients who underwent total laryngectomy to study the complications of the surgeries, their possible etiology. Laryngectomy is one of the most frequently done oncological surgeries in this part of the world, with high incidence of morbidity. Through improved techniques and preand postoperative protocols the incidence of complications have reduced, none the less they occur. Aim of the present study is to note the incidence of complications and their management in our setup. How to cite this article Reddy SL, Reddy SD, Prasad AVVSL. A Prospective Study of Total Laryngectomy and associated Complications. Int J Phonosurg Laryngol 2012;2(1):20-22.