Clinical outcome of supracricoid laryngectomy with cricohyoidoepiglottopexy: radiation failure versus previously untreated patients.
OBJECTIVE
A history of radiation therapy is known to be a major risk factor promoting post-surgical complications. By comparing the clinical outcomes of supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in irradiated and non-irradiated patients, we investigated the usefulness of salvage SCL-CHEP.


METHODS
73 patients who received SCL-CHEP between 1997 and 2010 (30 had received radiation therapy preoperatively and 43 had not). Staging error, wound infection, accuracy of surgical margin determination, acquired laryngeal function, and prognosis were compared between the two groups.


RESULTS
Staging error occurred in 6/30 (20%) irradiated and 14/43 (33%) non-irradiated patients. An intraoperative margin study demonstrated a dysplastic or positive margin in 15/30 (50%) irradiated and 13/43 (30%) non-irradiated patients. Wound infection developed in 12/30 (40%) irradiated and 7/43 (16%) non-irradiated patients (P<0.05). Delayed wound infection was identified in four patients with a radiation dose over 65Gy. Swallowing function (ability to eat in public) was acquired in 28/30 (93%) irradiated and 39/43 (91%) non-irradiated patients. Five-year larynx preservation rates were 94% in irradiated and 91% in non-irradiated patients. Five-year overall survival rates were 81% in irradiated and 87% in non-irradiated patients.


CONCLUSIONS
Risk of infection was significantly higher in irradiated patients; delayed infection should be appropriately managed. Functional and oncological results were stable regardless of radiation history. We encourage head and neck surgeons to take reasonable risks in performing salvage SCL-CHEP.
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan. meijin@med.kitasato-u.ac.jp
Meijin
M
Nakayama
Makito
M
Okamoto
Kazushige
K
Hayakawa
Hiromichi
H
Ishiyama
Shouko
S
Kotani
Shunsuke
S
Miyamoto
Yutomo
Y
Seino
Tabito
T
Okamoto
Itaru
I
Soda
Akane
A
Sekiguchi
D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005931:Glottis; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D011832:Radiation Injuries / Q000150:complications*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D017211:Treatment Failure; D016896:Treatment Outcome