Comparison of functional outcomes after endoscopic versus open-neck supraglottic laryngectomies.
OBJECTIVE
Endoscopic supraglottic laryngectomy (ESL) by carbon dioxide laser for selected T1-T3 supraglottic squamous cell carcinomas is a sound procedure with oncological results comparable to those obtained by open-neck supraglottic laryngectomy (ONSL). The aim of this study was to retrospectively evaluate functional outcomes after ESL in comparison with ONSL.


METHODS
We performed perceptual voice evaluation by GRBAS (grade, roughness, breathiness, asthenicity, strain), subjective analysis by Voice Handicap Index, objective analysis with the Multidimensional Voice Program, swallowing evaluation with the M. D. Anderson Dysphagia Inventory, video nasal endoscopic examination of swallowing, videofluoroscopy, and analysis of hospitalization time, need for and duration of feeding tube and tracheotomy, and complication and aspiration pneumonia rates in a group of 14 patients treated with ESL. These results were compared to those obtained in a historical group of 14 patients matched for T category who were treated with ONSL at the same institution. Statistical analysis was performed with the Mann-Whitney U and Pearson chi(2) tests.


RESULTS
Comparison of comprehensive voice analysis, M. D. Anderson Dysphagia Inventory, and complication and aspiration rates showed no statistically significant differences between the two groups. However, significant differences were found for video nasal endoscopic examination of swallowing (p = .03), videofluoroscopy (p = .03), hospitalization (p = .0001), feeding tube duration (p = .0001), and tracheotomy duration (p = .0001).


CONCLUSIONS
Endoscopic supraglottic laryngectomy had a significantly lower functional impact on swallowing than ONSL, even though it was not subjectively perceived by patients, and was associated with less morbidity and a shorter hospitalization time.
Peretti
Giorgio
G
Department of Otolaryngology, University of Brescia, Brescia, Italy.
Piazza
Cesare
C
Cattaneo
Augusto
A
De Benedetto
Luigi
L
Martin
Eva
E
Nicolai
Piero
P
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003679:Deglutition / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014833:Voice Quality / Q000502:physiology