Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord: a 25-year experience.
On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each, significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p <.0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.
Brumund
Kevin T
KT
Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, University of Paris V, Paris, France.
Gutierrez-Fonseca
Raimundo
R
Garcia
Dominique
D
Babin
Emmanuel
E
Hans
Stéphane
S
Laccourreye
Ollivier
O
D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D008175:Lung Neoplasms / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D014140:Tracheotomy / Q000706:statistics & numerical data; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery*