Limited surgery for cancer of the larynx and hypopharynx: options and consequences.
We reviewed surgical options for laryngeal preservation (limited surgery) in laryngeal and hypopharyngeal cancers and the consequences of the options. Of 44 patients with laryngeal cancer, 11 (25%) received limited surgery and 33 (75%) received total laryngectomy. The survival rates were 91% for the limited surgery group and 73% for the total (radical) surgery group. Of 31 patients with hypopharyngeal cancer, 7 (23%) received limited surgery and 24 (77%) received total laryngopharyngectomy. The survival rates were 53% for the limited surgery group and 40% for the total (radical) surgery group. The survival rates associated with limited surgery were thus better than those for total (radical) surgery for cancers of both the larynx and hypopharynx. This was attributed to the limited surgery group comprising well-selected patients with confined lesions. Organ preservation surgery should be technically simple, reliable in terms of its functional impact and, above all, should not jeopardize the patient's survival. Supracricoid subtotal laryngectomy with cricohyoidoepiglottopexy or cricohyoido-pexy has great potential for laryngeal preservation and will become the major limited surgery modality for treating cancer of the larynx. Limited surgery, however, needs to be performed with great care and is indicated only for very well-selected patients with cancer of the hypopharynx.
Nakayama
Meijin
M
Department of Otorhinolaryngology, Kitasato University, School of Medicine, Kanagawa, Japan. meijin@med.kitasato-u.ac.jp
Takahashi
Hiroomi
H
Yao
Kazuo
K
Inagi
Katsuhide
K
Makoshi
Tomohiro
T
Nagai
Hiromi
H
Okamoto
Makito
M
D000328:Adult; D024221:Antineoplastic Protocols; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003413:Cricoid Cartilage / Q000473:pathology / Q000601:surgery; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D007013:Hypopharynx / Q000473:pathology / Q000601:surgery; D007564:Japan; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D007830:Larynx / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate