Organ preservation surgery for advanced unilateral glottic and subglottic cancer.
OBJECTIVE
Functional surgery of unilateral T(2b) to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007.


METHODS
Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T(2b) to (3)N(0). Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4-cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect.


RESULTS
Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow-up period of 33 (range, 1-66) months or almost 3 years, 23 patients remained free of tumor recurrence.


CONCLUSIONS
Tracheal autotransplantation can be recommended as a functional treatment for selected T(2b) to T(3) glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function.
Delaere
Pierre
P
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital K.U. Leuven, Leuven, Belgium. pierre.delaere@uz.kuleuven.ac.be
Goeleven
Ann
A
Poorten
Vincent Vander
VV
Hermans
Robert
R
Hierner
Robert
R
Vranckx
Jan
J
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000453:epidemiology / Q000473:pathology; D003413:Cricoid Cartilage / Q000473:pathology; D005260:Female; D005931:Glottis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011884:Radius; D016879:Salvage Therapy; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000098:blood supply; D015996:Survival Rate; D014132:Trachea / Q000637:transplantation; D014182:Transplantation, Autologous; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery