Laryngotracheoplastic resection for primary tumors of the proximal airway.
BACKGROUND
Primary tumors of the airway with proximity to vocal cords and recurrent laryngeal nerves can be resected with sparing of the larynx. Long-term data on survival and local recurrence after laryngotracheal resection are scarce.


METHODS
We conducted a retrospective study of laryngotracheal resection and reconstruction for primary tumors of the airway since 1972.


RESULTS
Twenty-five patients aged 15 to 77 years presented with adenoid cystic carcinomas (n = 9), squamous cell carcinomas (n = 6), and other airway tumors (n = 10). Subglottic resection consisted of anterior cricoid in 5 patients; posterior cricoid mucosa in 9 patients, with resection of the posterior cricoid plate in 3 patients; lateral resection in 7 patients; and combined anterior and posterior elements in 4 patients. Vascularized trachea was tailored to reconstruct the defect. Seven patients without hoarseness required resection of the recurrent laryngeal nerve, and 4 other patients with hoarseness did not. There were no operative deaths. Two (8.0%) patients who had received prior high-dose cervical radiation had anastomotic separation, one requiring laryngectomy. One patient needed permanent tracheostomy, and temporary (<2 months) airway tubes were used in 5 patients. Sixteen patients received postoperative radiation. Median follow-up was 101 months. Four (16%) patients died of disease. Overall survival at 5 and 10 years was 79% and 64%, respectively. No patient underwent laryngectomy for recurrence.


CONCLUSIONS
Laryngotracheal resection and immediate reconstruction for subglottic tumors is achieved with good preservation of voice, low morbidity, and no compromise of long-term survival.
Gaissert
Henning A
HA
Division of Thoracic Surgery, Massachusetts General Hospital, Blake 1570, 55 Fruit Street, Boston, MA 02114, USA. hgaissert@partners.org
Grillo
Hermes C
HC
Shadmehr
Behgam M
BM
Wright
Cameron D
CD
Gokhale
Manjusha
M
Wain
John C
JC
Mathisen
Douglas J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery; D018277:Carcinoma, Mucoepidermoid / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002813:Chondrosarcoma / Q000601:surgery; D003371:Cough / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology; D010146:Pain / Q000209:etiology; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D016019:Survival Analysis; D014134:Tracheal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome