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Supratracheal laryngectomy: current indications and contraindications.

Succo G, Bussi M, Presutti L, Cirillo S, Crosetti E, Bertolin A, Giordano L, Molteni G, Petracchini M, Sprio AE, Berta GN, Fornari A, Rizzotto G - Acta Otorhinolaryngol Ital (2015)

Bottom Line: The aim of the present multi-institutional study was to focus on the indications and contraindications, both local and general, for this type of surgery based on the long-term oncological and functional results.For patients with glottic or transglottic tumours and with sub-glottic extension, the choice of STPL can be considered to be effective, not only in prognostic terms, but also in terms of functional results.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Otolaryngology Service, Oncology Department, "San Luigi Gonzaga" Hospital, University of Turin, Italy;

ABSTRACT
Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Supratracheal partial laryngectomy (STPL) has been described as a function-sparing surgical procedure for laryngeal cancer with sub-glottic extension. The aim of the present multi-institutional study was to focus on the indications and contraindications, both local and general, for this type of surgery based on the long-term oncological and functional results. We analysed the clinical outcomes of 142 patients with laryngeal cancer staged pT2-pT4a who underwent STPL. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and loco-regional control (LRC) rates were: glottic pT2 [71.4%, 95.2%, 76.0%, 76.0%], glottic-transglottic pT3 [85.3%, 91.1%, 86.4%, 88.7%], and pT4a [73.2%, 88.1%, 52.7%, 60.7%], respectively. DFS and LRC prevalences at 5 years were greatly affected by pT4a staging. Five-year laryngeal function preservation (LFP) and laryngectomy free survival (LFS) were: glottic pT2 [90.9%, 95.2%], glottic-transglottic pT3 [84.4%, 93.1%], and pT4a [63.7%, 75.5%], respectively, being affected by pT staging and age 65 ≥ years (LFP 54.1%). As a result of Type III open horizontal partial laryngectomies (OPHLs) (supratracheal laryngectomies), the typical subsites of local failure inside the larynx were the mucosa at the passage between the remnant larynx and trachea, the mucosa at the level of the posterior commissure and the contralateral cricoarytenoid unit as well as outside the larynx at the level of the outer surface of the remnant larynx. For patients with glottic or transglottic tumours and with sub-glottic extension, the choice of STPL can be considered to be effective, not only in prognostic terms, but also in terms of functional results.

No MeSH data available.


Related in: MedlinePlus

a-b) CT scan in axial view of left glottic T3 with fixed vocal cord and hypomobile arytenoid, extending downward and laterally within inferior paraglottic space. Note the intense sclerosis of the arytenoid without evidence of direct invasion of the cricoid. c) The specimen of OPHL type III + left CAU. d) Macrosection of the same specimen: the lesion reaches the crico-arytenoid joint (arrow).
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FS2: a-b) CT scan in axial view of left glottic T3 with fixed vocal cord and hypomobile arytenoid, extending downward and laterally within inferior paraglottic space. Note the intense sclerosis of the arytenoid without evidence of direct invasion of the cricoid. c) The specimen of OPHL type III + left CAU. d) Macrosection of the same specimen: the lesion reaches the crico-arytenoid joint (arrow).

Mentions: glottic-subglottic T3 tumours spreading within the paraglottic space and controlled by the conus elasticus medially and the perichondrium of the thyroid cartilage laterally (Fig. S2 a-d) (tumour growth is directed downward and laterally; sometimes it can infiltrate the inferior edge of the thyroid cartilage or exit the larynx between the thyroid and cricoid cartilages through the cricoarytenoid membrane: the so-called early glottic pT4a) (Fig. S3 a-c). Surface extension toward the posterior commissure can be observed. Typical clinical features are the fixed vocal cord, fixed arytenoid and subglottic swelling.


Supratracheal laryngectomy: current indications and contraindications.

Succo G, Bussi M, Presutti L, Cirillo S, Crosetti E, Bertolin A, Giordano L, Molteni G, Petracchini M, Sprio AE, Berta GN, Fornari A, Rizzotto G - Acta Otorhinolaryngol Ital (2015)

a-b) CT scan in axial view of left glottic T3 with fixed vocal cord and hypomobile arytenoid, extending downward and laterally within inferior paraglottic space. Note the intense sclerosis of the arytenoid without evidence of direct invasion of the cricoid. c) The specimen of OPHL type III + left CAU. d) Macrosection of the same specimen: the lesion reaches the crico-arytenoid joint (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4510940&req=5

FS2: a-b) CT scan in axial view of left glottic T3 with fixed vocal cord and hypomobile arytenoid, extending downward and laterally within inferior paraglottic space. Note the intense sclerosis of the arytenoid without evidence of direct invasion of the cricoid. c) The specimen of OPHL type III + left CAU. d) Macrosection of the same specimen: the lesion reaches the crico-arytenoid joint (arrow).
Mentions: glottic-subglottic T3 tumours spreading within the paraglottic space and controlled by the conus elasticus medially and the perichondrium of the thyroid cartilage laterally (Fig. S2 a-d) (tumour growth is directed downward and laterally; sometimes it can infiltrate the inferior edge of the thyroid cartilage or exit the larynx between the thyroid and cricoid cartilages through the cricoarytenoid membrane: the so-called early glottic pT4a) (Fig. S3 a-c). Surface extension toward the posterior commissure can be observed. Typical clinical features are the fixed vocal cord, fixed arytenoid and subglottic swelling.

Bottom Line: The aim of the present multi-institutional study was to focus on the indications and contraindications, both local and general, for this type of surgery based on the long-term oncological and functional results.For patients with glottic or transglottic tumours and with sub-glottic extension, the choice of STPL can be considered to be effective, not only in prognostic terms, but also in terms of functional results.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Otolaryngology Service, Oncology Department, "San Luigi Gonzaga" Hospital, University of Turin, Italy;

ABSTRACT
Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Supratracheal partial laryngectomy (STPL) has been described as a function-sparing surgical procedure for laryngeal cancer with sub-glottic extension. The aim of the present multi-institutional study was to focus on the indications and contraindications, both local and general, for this type of surgery based on the long-term oncological and functional results. We analysed the clinical outcomes of 142 patients with laryngeal cancer staged pT2-pT4a who underwent STPL. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and loco-regional control (LRC) rates were: glottic pT2 [71.4%, 95.2%, 76.0%, 76.0%], glottic-transglottic pT3 [85.3%, 91.1%, 86.4%, 88.7%], and pT4a [73.2%, 88.1%, 52.7%, 60.7%], respectively. DFS and LRC prevalences at 5 years were greatly affected by pT4a staging. Five-year laryngeal function preservation (LFP) and laryngectomy free survival (LFS) were: glottic pT2 [90.9%, 95.2%], glottic-transglottic pT3 [84.4%, 93.1%], and pT4a [63.7%, 75.5%], respectively, being affected by pT staging and age 65 ≥ years (LFP 54.1%). As a result of Type III open horizontal partial laryngectomies (OPHLs) (supratracheal laryngectomies), the typical subsites of local failure inside the larynx were the mucosa at the passage between the remnant larynx and trachea, the mucosa at the level of the posterior commissure and the contralateral cricoarytenoid unit as well as outside the larynx at the level of the outer surface of the remnant larynx. For patients with glottic or transglottic tumours and with sub-glottic extension, the choice of STPL can be considered to be effective, not only in prognostic terms, but also in terms of functional results.

No MeSH data available.


Related in: MedlinePlus