McDonald T J, DeSanto L W, Weiland L H
Laryngoscope. 1976 May;86(5):635-48. doi: 10.1288/00005537-197605000-00003.
The need for additional data regarding the behavior of carcinomas of the supraglottic larynx was recognized during attempts to identify candidates for supraglottic laryngectomy. The crux of the matter was whether supraglottic carcinomas remain confined at the supraglottic larynx. If some do not, can these exceptions be detected preoperatively? Information gained from whole-organ study of 40 larynges with such tumors showed that most tumors do remain confined to the supraglottic larynx; however, there are exceptions, and these are usually high-grade tumors. Preoperative biopsy demonstrating undifferentiation in a tumor suggests a potential for atypical behavior. Patients with these high-grade lesions are not candidates for supraglottic laryngectomy. Fortunately, most supraglottic carcinomas are well-differentiated, behave in a typical manner, and fulfill the expectations gained from the preoperative mucosal appearance. Supraglottic laryngectomy is, therefore, feasible and successful in carefully selected candidates. The conclusions of this study are the following: 1. Most supraglottic cancers behave as expected, being typically well-differentiated tumors that remain confined to the supraglottic larynx. 2. Exceptions to such behavior are exemplified by tumors manifesting submucosal extension some distance away from the main tumor mass, tumors invading the thyroid cartilage, second primaries, and tumors disseminating emboli away from the main tumor. 3. Present preoperative diagnostic measures still fail to detect tumors with atypical behavior. Subsequent supraglottic laryngectomy in patients with such tumors would, therefore, leave residual tumor. 4. Carcinomas exhibiting atypical behavior are characteristically undifferentiated and aggressive. 5. The epiglottis and pre-epiglottic space are easily invaded by supraglottic cancer. The pre-epiglottic space is removed during either supraglottic or total laryngectomy. 6. The thyroid cartilage is an excellent barrier to the spread of supraglottic cancers. Tumors that invade it penetrate the anterior commissure first. 7. The pitfalls in the selection of candidates for supraglottic laryngectomy are assessment problems in which the tumor mass makes it difficult to see its full mucosal extent. Inadequate biopsy may also fail to detect a tumor. 8. In the preoperative assessment of a patient with supraglottic carcinoma, supraglottic laryngectomy is contraindicated if the biopsy does show high-grade differentiation and if the tumor is situated near the petiole. 9. Undetected extension submucosally to the level of the glottis will result in some failures with conservation surgery of the larynx.
在试图确定声门上喉切除术的候选者时，人们认识到需要更多关于声门上喉癌行为的数据。问题的关键在于声门上癌是否局限于声门上喉。如果有些不是，那么这些例外情况术前能否被检测出来？对40个患有此类肿瘤的喉部进行全器官研究获得的信息表明，大多数肿瘤确实局限于声门上喉；然而，也有例外，这些通常是高级别肿瘤。术前活检显示肿瘤未分化提示可能存在非典型行为。患有这些高级别病变的患者不是声门上喉切除术的候选者。幸运的是，大多数声门上癌分化良好，行为典型，符合术前黏膜外观所预期的情况。因此，在精心挑选的候选者中，声门上喉切除术是可行且成功的。本研究的结论如下：1. 大多数声门上癌行为符合预期，通常是分化良好的肿瘤，局限于声门上喉。2. 这种行为的例外情况表现为肿瘤在黏膜下向远离主肿瘤块的一定距离处扩展、侵犯甲状软骨的肿瘤、第二原发肿瘤以及肿瘤向远离主肿瘤处播散栓子。3. 当前的术前诊断措施仍无法检测出具有非典型行为的肿瘤。因此，对患有此类肿瘤的患者进行后续的声门上喉切除术会残留肿瘤。4. 表现出非典型行为的癌具有未分化和侵袭性的特征。5. 声门上癌很容易侵犯会厌和会厌前间隙。在声门上喉切除术或全喉切除术中均会切除会厌前间隙。6. 甲状软骨是声门上癌扩散的良好屏障。侵犯它的肿瘤首先穿透前联合。7. 声门上喉切除术候选者选择中的陷阱是评估问题，其中肿瘤块使得难以看清其完整的黏膜范围。活检不足也可能无法检测出肿瘤。8. 在对声门上癌患者进行术前评估时，如果活检显示高级别分化且肿瘤位于杓会厌襞附近，则声门上喉切除术为禁忌。9. 未检测到的黏膜下扩展至声门水平会导致喉部保留手术出现一些失败情况。
