[Clinical review of supracricoid laryngectomy with CHEP and CHP: 50 patients treated in 11 years].
An analysis of clinical data on 50 patients undergoing supracricoid laryngectomy (SCL) between 1997 and 2008 i.e., cricohyoidoepiglottopexy (CHEP) in 47 and cricohyoidopexy (CHP) in 3 cases showed that the number of SCL cases operated on within a year surpassed that of Total Laryngectomy after 2003. Selection criteria included performance status 0-1 and blood gas PO2>80 torr, especially in those patients over 70-years-old. Postoperative wound infection occurred in 16 patients (32%), with four requiring additional surgical intervention (two ruptured pexis and two chondritis induced by C3-C4 osteophytes). A history of radiotherapy and systemic complications, i.e., diabetes and renal failure, added to the risk of wound infection. Introducing a clinical pathway shortened hospitalization. Vocal function was achieved in 96% and swallowing function in 89% of patients. Five-year crude survival in CHEP was 69% and in TL 51%. Laryngeal preservation was 70%, increasing to 89% after the introduction of SCL. SCL-CHEP is thus indicated for unfavorable T2 (ASCO 2006), well-selected T3, T4, and rT1-4 (radiation failures). Effort should emphasize a good balance in prognosis and function in organ preservation for laryngeal cancer.
Nakayama
Meijin
M
Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara.
Seino
Yutomo
Y
Hayashi
Seiichi
S
Miyamoto
Shunsuke
S
Takeda
Masahiko
M
Masaki
Takashi
T
Yokobori
Satoru
S
Okamoto
Makito
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications