[Endolaryngeal surgery and photodynamical therapy of using flexible videoendoscopic devices to treat laryngeal cancer and premalignancy].

Patients with laryngeal cancer (LC) and premalignancy admitted to P.A. Gertsen Moscow Research Oncological Institute were treated by the methods of endolaryngeal surgery making use of flexible videoendoscopic devices, Nd:YAG laser-assisted thermal ablation, argon plasma coagulation, electroresection, and photodynamical therapy. A total of 129 patients were given treatment by these techniques following distant radiotherapy including 23 with grade I-III laryngeal dyskeratosis and dysplasia, 36 with virus-associated recurrent laryngeal papillomatosis, 37 with early cancer (Tis-T1NoMo) in the middle part of the larynx, 17 with a residual tumour, and 16 with mid-laryngeal cancer (T1-2NoMo). The above treatments resulted in complete regression (CR) of dyskeratosis and grade I-III dysplasia in 22 (95%) of the 23 patients and CR of recurrent papilllomatosis in 27 (75%) of the 36 patients. Moreover, complete regression was achieved in 34 (92%) of the 37 patients with laryngeal cancer. It recurred in 3 (9%) of the 34 patients. In all cases, the vocal function was completely restored. In groups with residual and recurring laryngeal tumours, complete remission was documented in 27 (82%) of the 33 patients. LC recurred in three patients within 1-5 years after completion of the treatment.

[Reestablishment of the vocal function in patients with pharyngospasm after laryngectomy for laryngeal cancer].

Tracheoesophageal bypass was made in 114 patients after laryngectomy for reestablishment of voice. Of them, 17 (14.4%) patients had pharyngospasm which hinders voice recovery. To prevent this complication, the authors propose a special surgical policy which is different for delayed and primary (intraoperative) prosthesis.

[Establishment of acannular tracheostoma].

Creation of flat tracheostoma of a stable size is one of the key moments of tracheoesophageal bypass with prosthesis. The authors present original techniques of creation of a wide acannular tracheostoma for rehabilitation of voice function and providing adequate respiration after laryngectomy.

[Clinical and acoustic characteristics of tracheoesophageal bypass with prosthesis]. / Klinicheskie i akusticheskie kharakteristiki trakheopishchevodnogo shuntirovaniia s protezirovaniem.

The authors analyse different aspects of tracheoesophageal bypass with prosthesis, how to prolong operation of voice prostheses. It is shown that replacement of the prostheses is frequently necessary not because of wear but rather due to fungal or microfloral affection. Radiotherapy had no adverse effects on prosthesis. Complications of tracheoesophageal bypass with prosthesis, acoustic characteristics of the repaired voice are described.

[Microflora of the voice prostheses]. / Mikroflora golosovykh protezov.

The study was made of the condition of voice prostheses Provox and Blom-Singer in 27 patients wearing them. The prostheses were to be replaced by new ones as they lost impermeability for water. The prostheses were used for 6 months to 2 years. At the prosthesis removal from the tracheoesophageal bypass it was found that the esophageal flange and protective valve were contaminated with fungi and pathogenic bacteria. The valve was deformed, had limited motility and did not close tightly the esophageal opening of the prosthesis as the result of which liquid leaked into the airways. Bacteriological examination identified C.albicans, C.krusei, C.glabralis in 11 patients. Nistatin, flucostat, fluconasol, amphotericin were used in antifungal therapy. Prophylactic use of these drugs against fungi prolonged use of the prostheses 2-fold.

[Laryngeal reconstruction using endoprostheses for benign stenosis]. / Rekonstruktsiia gortani s primeneniem endoprotezov po povodu stenozov nerakovoi etiologii.

A clinical trial was made of two types of laryngeal endoprostheses in surgery of stenosis caused by benign diseases. A total of 15 patients were operated on. In 11 patients endoprosthesis of biocompatible polymers was inserted, in 4 patients the stenosis was corrected with endoprosthesis of silicon rubber. Most of the patients had stenosis as a result of complication of thyroid surgery. The operative technique is described. In extensive defects of the anterior wall of the larynx and trachea, advanced scar stenoses a new operation is proposed-autoalloplasty using body and manubrium of the sternum.

[Functionally sparing surgery in locally spread malignant maxillary tumors and the use of local chemotherapy]. / Funktsional'no-shchadiashchie operatsii pri mestno-rasprostranennykh zlokachestvennykh opukholiakh verkhnei cheliusti s ispol'zovaniem lokal'noi khimioterapii.

53 patients underwent functionally sparing operations which imply electrosurgical maxillectomy with alveolar process and hard palate left intact as well as eyeball preserving resections. At termination of the surgical intervention cyanoacrylate glue compounds incorporating cytostatics bleomycin or carminomycin were applied to the walls of the postoperative cavity. Maxillary alveolar process and hard palate were preserved when the tumor arose from maxillary posterior superior segments, ethmoidal labyrinth and upper nasal cavity. In orbital direction of the tumor spread the eyeball was spared when the lesion was confined to orbital wall and if intraorbital fat was uninvolved. 3-year survival after the above operations made up 60.4%. The method is believed oncologically effective and functionally, cosmetically sparing.

[Laryngeal resection in cancer using endoprosthesis]. / Rezektsii gortani po povodu raka s éndoprotezirovaniem.

The authors have developed an original prosthetic appliance made of silicone rubber which makes it possible to conduct resections in advanced laryngeal tumors. Endoprosthetic resections have been performed in 21 patients. Frontal and lateral endoprosthetic laryngeal resections carried out in 15 patients enabled decanulation in 12 (80%) and voice recovery in 14 (93.3%) patients. 6 patients have undergone horizontal endoprosthetic resection after which 5 of them recovered respiratory and defense function. Vocal function returned to normal condition in all of them.

[Surgical aspects of recovery of vocal function after radical removal of the larynx in cancer]. / Khirurgicheskie aspekty vosstanovleniia golosovoi funktsii posle polnogo udaleniia gortani po povodu raka.

The paper is devoted to surgical procedures aimed at voice reestablishment in patients without larynx removed for cancer. Original surgical techniques practiced by the authors are proposed: tracheoesophageal shunt with creation of the defense valve from the esophageal mucosa, esophagus and lower lip mucomuscular graft, bypass repair. The procedures were used in 79 patients with removed cancer-affected larynx. Vocal function recovery occurred in 90%, the defense function restored in 80% of the patients treated.

[Function-sparing surgery in the combined therapy of laryngeal cancer]. / Funktsional'no-shchadiashchie operatsii pri kombinirovannom lechenii raka gortani.

The reports deals with the principle and methods of making a two-stage diagnosis of laryngeal tumor evolved on the basis of the data on two calibrated groups of 250 patients each and a computer-supported procedure of mathematical analysis. Two programs for a MC-52 microcalculator are suggested to select the scope of surgical intervention. Such procedures of preoperative radiation therapy as exposure under hyperbaric oxygenation conditions, cutting down the preoperative radiation dosage and shortening the interval between ir radiation course and surgery have been improved. Five improved procedures of saving therapy for tumors of the supraglottic area and four--for glottic cancer were used in 142 patients. The functional and oncological results of saving surgery were evaluated in 458 patients receiving combined treatment for laryngeal tumors. Said results were found to be beneficial.

[A method of combined horizontal resection of the larynx with removal of the arytenoid cartilage and its primary reconstruction]. / Sposob kombinirovannoi gorizontal'noi rezektsii gortani s udaleniem cherpalovidnogo khriashcha i pervichnogo ego rekonstruktsiei.

A modified technique of combined laryngeal resection in vestibular cancer T3-T4 (involvement of the arytenoid cartilage) was tried in 8 patients. To compensate for laryngeal separative function after the radical surgery, the reconstruction of the posterior laryngeal wall was performed by mobilization of the upper corniculum of the thyroid cartilage. In satisfactory functional results the method did not contribute to the disease aggravation.

[The current status of the problem and the treatment possibilities in disseminated malignant neoplasms of the maxilla]. / Sovremennoe sostoianie problemy i vozmozhnosti lecheniia rasprostranennykh zlokachestvennykh novoobrazovanii verkhnei cheliusti.

A study of the results of treatment of 170 patients makes a case for combined electrosurgical resection of the maxilla and local chemotherapy with deposited cytostatic drugs for localized malignant tumors of this site. No recurrences were detected within the first 12 months in 75.4% of patients and 52%--in control. Three-year survival in treated patients and controls was 67 and 48%, respectively.

[Experience in the use of extracorporeal correction of the immune system in the treatment of patients with LOR cancer]. / Opyt ispol'zovaniia ékstrakorporal'noi korrektsii immunnoi sistemy v lechenii LOR-onkologicheskikh bol'nykh.

Correction of the immune status is one of the burning problems of current otorhinolaryngology. Recent developments in immunology allow interference at the cellular level. However, otorhinolaryngological practice is still based on oral, parenteral or local use of ineffective drugs. This paper presents early results of the application of extracorporeal cytapheresis combined with the modulator treatment of lymphocytes for the surgical therapy of 25 patient with ENT malignant neoformations of different stage and localization. Leukocytapheresis, i. e. separation of leukocytes, was performed by means of an Aminco (USA) or FK-3,5 (USSR) cell separator and the separated cells were treated with diuciphone. This method yielded good results as suggested by immunological, immunochemical, biophysical, and cytological measurements of blood. The method seems promising for ENT-cancer therapy.

[Combined treatment of stage III laryngeal cancer with different schedules of radiotherapy and surgery. Evaluation of preventive methods of the treatment of regional areas (cooperative randomized study)]. / Kombinirovannoe lechenie raka gortani III stadii s razlichnoi posledovatel'nost'iu oblucheniia i operatsii. Otsenka preventivnykh metodov vozdeistviia na regionarnye zony (po materialam kooperirovannogo randimizirovannogo issledovaniia).

In 1980-1987, a cooperative randomized study of 363 patients with stage III laryngeal cancer (T1-3N0-1M0) was carried out. In 249 patients tumor was located in the vestibular space and in 114 in the vocal cord area; 78.5% of the patients had no regional metastases (N0) and 21.5% had metastases (N1). Combined therapy was applied to 251 patients, 135 of which were first exposed to radiotherapy and then to surgery and 116 were first exposed to surgery and then radiotherapy. In 71 patients, regional zones underwent preventive treatment (in 24 patients elective radiotherapy and in 47 preventive removal of the cervical fat were used). In 112 patients, the therapeutic protocol was modified due to different reasons (69 patients underwent only surgery and 43 radical radiotherapy). The therapeutic results were assessed in terms of three parameters: incidence of relapses and regional metastases, relapse-free time, and survival. This approach revealed no significant differences in the efficacy of the different protocols of the combined treatment. The 5-year survival rate of the patients with vestibular and cord space tumor was 77.9% and 80.7% respectively, when treated according to the radiotherapy + surgery protocol, and 82.8% and 89.2%, respectively, when treated according to the surgery + radiotherapy protocol. Comparison of preventive approaches showed that the 5-year survival rate increased by 92% as a result of removal of the subcutaneous fat from the neck area.

[Comparative evaluation of the effectiveness of radiotherapy, surgery and combined treatment of stage I-II laryngeal cancer (T1-2NoMo) based on the data of a cooperative randomized study]. / Sravnitel'naia otsenka éffektivnosti luchevogo, khirurgicheskogo i kompleksnogo lecheniia raka gortani I-II stadii (T1-2NoMo) po materialam kooperirovannogo randomizirovannogo issledovaniia.

During 1979-1987 269 patients with laryngeal cancer stage I-II were included into a cooperative randomized study: 111 patients had T1 and 158 patients, T2 tumor; 13% of patients showed cancer of the vestibular cord and 87% of them of the true vocal cord. 76 patients underwent surgery, 129 patients--radiotherapy, and 64 patients received combined treatment, i.e. radio- and chemotherapy (prospidine). The rate of relapses and regional metastases was 11.8 +/- 3.7% and 2.6 +/- 1.8% after surgery, 21.4 +/- 3.8% and 1.6 +/- 1.1% after radiotherapy, and 23.4 +/- 5.3% and 6.3 +/- 3.0% after combined treatment. In terms of the recurrence-free time surgical intervention showed the highest efficacy. With respect to the 5-year survival, measured in the above patients plus 42 patients operated on because of relapses and regional metastases, surgery of vocal cord cancer was effective in 100% in case of stage I, 97.4% in case of stage II; radiotherapy was effective in 91.7% in case of stage I, 88.8% in case of stage II, and combined treatment was effective in 100% in case of stage I and 70.3% in case of stage II; surgery of vestibular cord cancer stage II was effective in 100%, combined treatment in 88.9%, and radiotherapy in 68.6%. When vocal cord cancer involves the anterior commissure, ventricle, and space, preference should be given to surgery because relapses after radiotherapy were seen in 38-42%. Combined radio- and chemotherapy did not reduce the recurrence rate and therefore cannot be recommended for practical purposes.

[Clinical and endoscopic aspects of surgically treated laryngeal cancer]. / Kliniko-éndoskopicheskaia semiotika operirovannoi po povodu raka gortani.

This paper presents the results of fibroendoscopic examinations of 74 patients with laryngeal cancer of II-IV degree. Tumor dissemination was T2NO in 25 patients, T3NO in 36 patients, and T4NO in 13 patients. All the patients underwent modified resection patterns: 53 patients--horizontal resection (4 modifications) and 21 patients--frontolateral resection in the lower modification. Altogether 170 fibroendoscopic examinations were performed. Fibrolaryngoscopy helps to examine all laryngeal structures, evaluate and differentiate changes after various modifications of organ-preserving operations in the case of laryngeal cancer, and to detect at an early postoperative stage further tumor growth. Correct assessment of postoperative changes in the larynx prior to fibrolaryngoscopy can be carried out on the basis of reliable information about the operation, amount of tissue removed, and organ reconstruction.