Function preservation surgery in patients with chondrosarcoma of the cricoid cartilage.
Chondrosarcoma is a rare laryngeal neoplasm that is most commonly encountered in the cricoid cartilage and is optimally treated by surgical excision. It is typically a slow-growing malignancy with well-defined margins and a minimal risk of metastasis; however, radiographic imaging studies often appear ominous if the clinician correlates these findings to the biological behavior of epithelial cancer. Furthermore, the fact that the neoplasm's epicenter is usually under the cricoarytenoid joint can lead to airway and voice deficits before and after operation. Although many surgeons opt for function-sparing resection approaches, it is commonplace for some surgeons to injudiciously perform total laryngectomy as the initial treatment because of the rarity, large size, location, and appearance of these tumors on imaging studies. A retrospective review was done on 10 cases of cricoid chondrosarcoma to gain insight into the treatment strategies designed to preserve laryngeal function while minimizing the risk of local recurrence. We performed surgical resection in 8 of the 10 patients; 2 underwent endoscopic removal and 6 underwent transcervical partial laryngectomy. All are free of disease with good voice and swallowing function. One patient developed a limited recurrence and required a second transcervical partial laryngectomy. Function-sparing surgical treatment of chondrosarcomas of the cricoid cartilage can usually be achieved. Surgeons should carefully modify the core principles of epithelial cancer surgery techniques, adjusting to the different biological behavior of laryngeal chondrosarcomas.
Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Steven M
SM
Zeitels
James A
JA
Burns
John C
JC
Wain
Cameron D
CD
Wright
Andrew E
AE
Rosenberg
D000368:Aged; D002813:Chondrosarcoma / Q000601:surgery*; D003413:Cricoid Cartilage; D004724:Endoscopy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D007830:Larynx / Q000502:physiology; D008297:Male; D009364:Neoplasm Recurrence, Local; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome