title: [Evolution of laryngectomy based on a comparison of two cohorts a century apart: an illustration of the progress, difficulties and conflicts encountered in medicine].
abstract: Based on a comparison of two cohorts of patients with laryngeal cancer managed by laryngectomy one century apart, and an analysis of original textbooks from the end of the nineteenth century, we examine the development of laryngectomy, the difficulties encountered in this first therapeutic approach to laryngeal carcinoma, and the conflicts it generated. The overall death rate changed little over the course of a century, although the 5-year actuarial survival estimate improved from 22.6% in 1888 to 75.1% in 1988 (p < .0001). The causes of death also changed (p < .0001), with fewer deaths related to post-operative complications and/or local failure (82.7% in 1888, 9% in 1988). The rate of suicide deaths fell from 1.8% to 0.04%. In contrast, the percentage of deaths due to metachronous second primary tumors and/or intercurrent disease increased from 9% in 1888 to 76.7% in 1998. Analysis of actuarial survival rates demonstrated that 77.4% of patients died before the 60th post-operative month in 1888, while this percentage was only reached 275 months post-operatively a century later. Our research also underscores the importance of patient information and medical ethics.
authors.affiliation: Oto-rhino-laryngologie et chirurgie cervico-faciale, Hôpital européen Georges Pompidou, 20, rue Leblanc 75015 Paris. ollivier.laccourreye@egp.aphp.fr
authors.forename: Ollivier
authors.initials: O
authors.lastname: Laccourreye
authors.forename: Dominique
authors.initials: D
authors.lastname: Garcia
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Maldent
authors.forename: Alfred
authors.initials: A
authors.lastname: Werner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D049672:History, 19th Century; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D007825:Laryngectomy / Q000266:history; D008875:Middle Aged