Surgery and function reconstruction of laryngeal cancer involved supraglottic and glottis area / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the surgery preserving epiglottis, the repair and the postoperative functions in laryngeal carcinoma involving supraglottic and glottic areas.</p><p><b>METHODS</b>A total of 97 cases with laryngeal cancer involving both supraglottic and glottic areas with normal epiglottis underwent surgery between June 2005 and December 2010 was reviewed. Of them 37 cases were stage II, 41 cases were stage III, and 19 cases were stage IV. Vertical partial laryngectomy (VPL) or extended VPL with the repair and functional reconstruction was carried out in 86 cases and cricohyoidoepiglottopexy (CHEP) in 11 cases. Postoperative survival rate, laryngeal functions and quality of life were evaluated.</p><p><b>RESULTS</b>The 3-year and 5-year total cumulative survival rate (Kaplan-Meire survival analysis) were 87.1% and 69.6% in the 97 cases; 86.6% and 68.3% in VPL/EVPL group; 90.0% and 78.8% in CHEP group, respectively, with no significant difference between VPL/EVPL and CHEP groups (P > 0.05). Of 97 cases, 86(88.7%) cases were decannulated postoperatively. The rates of decannulation were 87.2% (75/86) in VPL/EVPL group and 100% (11/11) in CHEP group, with no significant difference (P > 0.05). Average oral diet recovery time of VPL/EVPL group and CHEP group was (5.2 ± 1.3) and (15.7 ± 5.2) days, respectively, with a significant difference (P < 0.01). Voice evaluation showed the mean maximum phonation time of VPL/EVPL group was shorter than that of CHEP group (P < 0.01) and the S/Z ratio of VPL/EVPL group was higher than that of CHEP group (P < 0.01). Perceptual voice evaluation GRBAS ratings showed patients in VPL/EVPL group had higher G and B ratings compared to patients in CHEP group (P < 0.01), but no significant difference in R-rating between two groups (P > 0.05). Voice handicap index-10 (VHI-10) scores of VPL/EVPL and CHEP groups were 29.5 ± 4.7 and 31.6 ± 6.3, respectively, no significant difference (P > 0.05).</p><p><b>CONCLUSIONS</b>For patients with the laryngeal carcinoma involving both supraglottic and glottic areas, VPL has better anatomical and functional outcomes than CHEP. The preservation of at least 2/3 of the lamina of thyroid cartilage on one side and shift-down of epiglottis were key to successful VPL and postoperative decannulation.</p>

Treatment of pyriform sinus carcinoma involving the lateral wall / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To present and discuss the clinical features, treatment, and efficacy of pyriform sinus carcinoma involving the lateral wall.</p><p><b>METHODS</b>Seventy-seven patients with pyriform sinus cancer involving the lateral wall (stage I 8, stage II 10, stage III 32, stage IV 27, according to UICC 2002 staging) were treated from Jun 1997 to Jun 2009 in the department of otorhinolaryngology head and neck surgery, Yuhuangding Hospital. The patients were divided into two groups: Group one 17 cases, simply underwent radiation therapy (R group); Group two 60 cases underwent surgery plus postoperative radiation (SR group). All patients underwent radiotherapy 50-75 Gy. In SR group, hyoid area and lateral pharyngeal approaches were taken according to the lesions for resection. To repair the defects and reconstruct the functions of larynx and pharynx, regional roping in suture, fascial flap/muscular- fascial of strap muscles, glosso-flap, musculocutaneous flap of major pectoral muscle, joint split graft or heterologous (bovine) acellular dermal matrix were used respectively.</p><p><b>RESULTS</b>In group R, the primary tumor and neck lymph node metastasis disappeared at the end of radiotherapy in 15 cases. For one case, the N3 cervical lymph nodes shrank, but failed in local control and died of systemic metastases after 7 months. For another case, the N2 neck lymph nodes significantly reduced after the full course of radiation, PET-CT and biopsy did not find the cancer, but the tumor grew again after 6 months, and died of a neck bleeding 11 months later. All repairing materials used were alive in SR group. Two cases developed postoperative wound infection, and 2 cases suffered from pharyngeal fistula. All patients retained laryngeal functions, and all patients in SR group recovered diet 12 - 30 days, the mean time was 15.6 days. Three and 5 year survival rates for all 77 patients were 59.1% and 41.4%. For stage I + stage II cases in SR group and R group, 3 and 5 year survival rates were 63.6%, 53.0% and 66.7%, 50.0% respectively. There was no significant difference between the two groups (χ(2) = 0.021, P = 0.884). For cases of stage III + stage IV of the SR group and R group, 3 and 5 year survival rates were 63.9%, 43.7%, 16.4%, and 0. There was a very significant difference (χ(2) = 20.496, P = 0.000); all cases in SR group and in R group for 3, 5-year survival rates were 63.6%, 45.8%, 41.5%, and 24.9% respectively. There was also a significant stastical difference (χ(2) = 4.644, P = 0.031).</p><p><b>CONCLUSIONS</b>Pyriform sinus carcinoma involving the lateral wall is characterized with scattered growth on the surface of mucous or submucously, tending to invade lamina cartilaginis thyroidea. Simple radiotherapy can get better therapeutic effect for early stage cases. The comprehensive therapy measures should be taken in advanced cases, especially those with surgical indications should be taken to surgery plus radiotherapy. For the purpose of excising the tumor thoroughly and preserving good laryngeal functions, proper operative approaches and ways of repairing should be selected.</p>