Supracricoid partial laryngectomies after failure of radiation therapy.

BACKGROUND

Conservation of laryngeal function is a key surgical objective in cases of limited recurrence after previously irradiated T1b or T2 glottic carcinoma. Only a few articles have mentioned the use of supracricoid partial laryngectomies (SCPL) to treat recurrent T1/T2 tumors that cannot be managed with vertical partial laryngectomy.

OBJECTIVES

To evaluate oncologic and functional results of SCPL in selected cases of T1/T2 glottic carcinoma recurrence after primary irradiation therapy.

METHOD

Between 1986 and 2000, 23 selected patients (T1b, 12 cases; T2, 11 cases) underwent SCPL as salvage treatment: cricohyoidepiglottopexy (CHEP) in 18 cases and cricohyodopexy (CHP) in 5 cases.

RESULTS

The mean cannulation time was 28 (14-90) days. The mean nasogastric feeding tube time for CHP and CHEP was 55 (28-96) days and 21 (9-45) days, respectively. Four (17.4%) patients had major swallowing recovery problems. Three patients died in the postoperative period, one of intercurrent disease and two because of aspiration pneumonia. Six (26.08%) patients relapsed and underwent total laryngectomy. Three were subsequently controlled. The T stage was correlated with the onset of a new recurrence (P = .0258). The surgical margins were not correlated with recurrence (P = .0741). At 3 and 5 years, the global survival rate was 82.9% and 69.04%. The success rate for oncologic control and oncologic control with organ preservation was 74% and 66.6%, respectively.

CONCLUSION

In selected cases of limited recurrence after radiation therapy for T1/T2 vocal cord carcinomas, SCPL can be an alternative to total laryngectomy when partial vertical surgery appears unsuitable.