Analysis of clinicopathological stage in supracricoid partial laryngectomy patients: Need for adjuvant therapy in clinically understaged cases.

OBJECTIVE

The aim of this study is to evaluate the impact of pre-operative T-understaging on clinical outcome in supracricoid partial laryngectomy (SCPL).

METHODS

The medical records of 92 patients who underwent SCPL were evaluated. By comparing clinical and pathologic stages, the causes of pre-operative T-understaging and its relationship with local recurrence and survival were examined.

RESULTS

Fifteen patients (16.3%) were found to be underestimated in terms of pre-operative T-stage, primarily due to failure to identify thyroid cartilage invasion (11 cases). Among these, radiation treatment at the primary site was offered in only two cases, including one case with a positive surgical margin. Among 82 patients followed for over 1 year, local recurrence occurred in seven patients (8.5%); five of these (71.4%) had been understaged pre-operatively due to failure to detect thyroid cartilage invasion. The local recurrence rate was higher and the overall survival rate was lower in patients who were understaged pre-operatively, compared to those who were staged accurately (p=0.006 and p=0.001, respectively).

CONCLUSION

SCPL should be conducted only after a thorough pre-operative evaluation in locally advanced laryngeal cancer. Additionally, adjuvant treatment is necessary to reduce local recurrence in cases where thyroid cartilage invasion is determined pathologically after SCPL.