ABSTRACT
OBJECTIVE: We aim to assess the correlation of tumor and nodal staging to survival in pT3N+ and T4aN0 laryngeal cancer with subgroup analysis within stage IVa (pT4N0 and pT3N2). STUDY DESIGN: Retrospective cohort study with systematic review of the literature. SETTING: Hotel Dieu de France University Hospital (tertiary referral center). SUBJECTS AND METHODS: Laryngeal cancer patients' registries were reviewed from 1998 to 2012 selecting pT3N+ and pT4aN0 patients treated by primary total layngectomy. Overall survivals were compared using Log rank and Kaplan-Meier analysis. A systematic review was performed by 2 reviewers including all the articles reporting the outcome of these categories of patients. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. RESULTS: Thirteen T3N+ patients and 19 T4aN0 patients treated by primary total laryngectomy were included. Five-year overall survival for T3N+, T3N2 and T4aN0 was respectively 33%, 32.1% and 73.7%. Due to the small sample, the difference was not significant. The systematic review revealed three articles reporting overall survival outcome for the T4N0 group and 6 articles for the T3N+. At 5years, the survival ranged from 62.5% to 73% in T4N0 and from 32.2% to 77% in T3N+. CONCLUSION: In advanced stage laryngeal cancer, T4aN0 tends toward a better survival than T3N+ especially when compared to T3N2 although they are grouped in the same TNM stage IVa.
Subject(s)
Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Lymph Nodes/pathology , Adult , Carcinoma, Squamous Cell/therapy , Chemoradiotherapy , Cohort Studies , Female , Humans , Laryngeal Neoplasms/therapy , Laryngectomy , Lebanon/epidemiology , Lymphatic Metastasis , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVES/HYPOTHESIS: To assess the survival outcomes of a homogeneous group of pT4a laryngeal cancer patients treated at our institution by primary total laryngectomy and neck dissection with adjuvant therapy when indicated, and to systematically review studies reporting overall survival outcomes in T4a laryngeal cancer. STUDY DESIGN: Systematic review of PubMed and Embase databases. METHODS: Records of 108 laryngeal cancer patients treated by total laryngectomy were reviewed. pT4a cases treated by primary total laryngectomy between 1998 and 2010 were included. Overall and disease-free survival at 2 and 5 years were reported. A systematic review was performed including all published studies reporting overall survival outcomes by treatment modality in T4 laryngeal cancer patients. RESULTS: Thirty cases met the inclusion criteria. At 2 years, overall and disease-free survival were 81.3% and 78%, respectively. The 5-year overall and disease-free survival rates were 60%. The systematic review retrieved 24 articles. Overall survival at 2 years ranged from 12% to 21.2% with radiotherapy, <30% to 65% with chemoradiotherapy, and from 30% to 100% with surgery. At 5 years, it ranged from 0% to 75% with radiotherapy, 16% to 50.4% with chemoradiotherapy, and 10% to 80.9% with surgery. CONCLUSIONS: Primary total laryngectomy provides a high survival rate for pT4a laryngeal cancer patients. Randomized controlled trials including homogenous patients are still needed before shifting to organ preservation protocols in these patients. LEVEL OF EVIDENCE: NA.
Subject(s)
Hospitals, University/statistics & numerical data , Laryngeal Neoplasms , Neoplasm Staging , Combined Modality Therapy , Humans , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/therapy , Lebanon/epidemiology , Retrospective Studies , Survival Rate/trendsABSTRACT
We report a unique case of ectopic gastric mucosa (EGM) in the cervical esophagus. The patient presented with a recurrent cervical abscess communicating through a fistula with the EGM. Surgical treatment consisted of complete excision. The postoperative course was complicated by a breach in the hypopharynx, which was treated conservatively, and a stenosis of the esophagus requiring balloon dilation.