title: Extending the inferior limits of supracricoid partial laryngectomy: a clinicopathological correlation.
abstract: OBJECTIVE
  The study examined preoperative clinical characteristics that can be used to predict secure inferior margins of glottic squamous cell carcinoma extending toward the cricoid cartilage when performing organ preservation surgery of the larynx.
  
  
  METHODS
  The study was retrospectively performed using 31 serially sectioned whole-organ total laryngectomy specimens with associated preoperative clinical data.
  
  
  METHODS
  Histopathologic and clinical variables including true vocal cord (TVC) fixation, cricoarytenoid joint invasion, subglottic extension (SGE) of tumor, and prior radiation were examined as independent and multivariate correlates of cricoid cartilage invasion.
  
  
  RESULTS
  All tumors with subglottic extension of 15 mm or less and without arytenoid fixation were free of cricoid invasion. Of tumors invading cricoid with subglottic extension of 15 mm or less, all had a fixed arytenoid cartilage and local cricoid invasion type only. Correcting for subglottic extension using multivariate analysis, cricoarytenoid joint invasion and fixed true vocal cord independently predicted cricoid invasion. However, in a multivariate model together, true vocal cord mobility adds no predictive power to cricoarytenoid joint invasion. Prior radiation of the larynx did not significantly change the predictive capacity of these variables.
  
  
  CONCLUSIONS
  Preoperative assessment of arytenoid mobility and extent of subglottic extension are reliable predictors of cricoid invasion by glottic squamous cell carcinoma. Organ preservation surgery is oncologically safe in the setting of glottic squamous cell carcinoma with subglottic extension of 15 mm or less and without arytenoid fixation.
authors.affiliation: Departments of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sparano
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chernock
authors.forename: Michael
authors.initials: M
authors.lastname: Feldman
authors.forename: Olivier
authors.initials: O
authors.lastname: Laccourreye
authors.forename: Daniel
authors.initials: D
authors.lastname: Brasnu
authors.forename: Gregory
authors.initials: G
authors.lastname: Weinstein
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D003413:Cricoid Cartilage / Q000473:pathology*; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness