A historical overview of laryngeal carcinoma and the first total laryngectomies.

Laryngeal cancer was a well known entity since antiquity and its treatment evolved through several phases. The lack of knowledge in anatomy and pathology as well as the absence of anesthesia and proper instrumentation made the treatment almost impossible. Ancient physicians were performing laryngotomy or tracheotomy in an attempt to prevent the suffocation symptoms produced by tumoral masses. In 19th century the invention of laryngoscope and the advent of pathology and anesthesiology encouraged surgeons to operate on man. In 1873 Theodor Billroth (1829-1894) performed the first laryngectomy followed by several other colleagues among which Enrico Bottini (1837-1903) and Themistocles Gluck (1853-1942). Thanks to their contribution a new era came in laryngeal cancer treatment: the conservation laryngeal surgery.

[Mortality from respiratory diseases in the provinces of Apulia Region (Southern Italy) from 1933 to 2010]. / La mortalità per patologie respiratorie nelle province pugliesi dal 1933 al 2010.

OBIETTIVI: valutare l'andamento temporale della mortalità per patologie respiratorie nelle province pugliesi utilizzando dati omogenei per fonte e metodologia di calcolo. DISEGNO: analisi ecologica storica degli andamenti temporali di mortalità per tumori e patologie dell'apparato respiratorio nelle province pugliesi, in Puglia e nelle ripartizioni geografiche italiane dal 1933 al 2010. SETTING E PARTECIPANTI: i dati di mortalità e le popolazioni residenti sono di fonte Istat. Sono state esaminate tutte le cause di decesso, il tumore della laringe, il tumore del polmone, l'insieme dei tumori respiratori, la bronchite, la polmonite e la broncopolmonite considerate congiuntamente, e l'insieme delle patologie respiratorie. Le analisi sono disaggregate per sesso dal 1969. PRINCIPALI MISURE DI OUTCOME: rapporti standardizzati di mortalità (SMR%) in riferimento all'Italia, con intervalli di confidenza al 95%, e tassi di mortalità standardizzati col metodo diretto (TSD ) in riferimento alla popolazione standard europea. RISULTATI: dal 1933 al 2010, i TSD per tumori respiratori e per bronchiti diminuiscono in tutte le aree analizzate. Tuttavia, nelle province di Taranto, Brindisi e Lecce, l'SMR% per tumori respiratori, inferiore al riferimento nazionale fino agli anni Sessanta, si allinea (a Brindisi) e supera (a Lecce e Taranto) il riferimento negli anni successivi. Nelle province di Foggia e Bari il numero dei decessi per tumore del polmone è costantemente inferiore all'atteso. CONCLUSIONI: la ricostruzione storica e l'analisi dei trend temporali di mortalità dal 1933 al 2010 mostrano alcune criticità sanitarie in periodi specifici. L'elaborazione dei dati di mortalità per un arco temporale di circa 80 anni ha messo in evidenza la maggiore rilevanza di queste criticità con l'avvio dello sviluppo industriale.

The laryngeal disease of the German Emperor Friedrich III: treatment failure or fateful course.

BACKGROUND: Since the death of the Emperor Friedrich III in June 1888, there are still controversial discussions whether the Crown Prince could have been healed from his laryngeal cancer by a thyrotomy planned by his German physicians for May 21, 1887. METHODS: In order to find an answer to this historical question, the Emperor's biographies, the literature on laryngology published in the late nineteenth and early twentieth century, German manuals on laryngology and ENT, the BMJ and Lancet were thoroughly studied where in particular not only Mackenzie but also Virchow had published several articles on the disease of Friedrich III. RESULTS: Prof. Gerhardt had decided not to perform biopsies of the tumor. Furthermore, he did not perform iodine potassium treatment ex juvantibus as it was common practice at that time in order to confirm the diagnosis of carcinoma by excluding syphilitic gumma. So Mackenzie was perfectly right when insisting on performing excisional biopsy before surgery. It is tragedy that Virchow by making the diagnosis of pachydermia laryngis provided the justification for canceling the surgical intervention that had already been decided. It was also mistake that Prof. Gerhardt did not accompany the Crown Prince during his stay in England in summer 1887. The authority of the delegated medical officer Dr. Landgraf did not suffice to persuade Mackenzie to discuss again the matter of performing surgery together with Gerhardt and von Bergmann. The drawings made by Dr. Landgraf show an impressive tumor growth. The refusal of new consultations with Gerhardt and von Bergmann by Mackenzie can only be explained by the fact that Mackenzie was generally against such a surgical intervention. Regarding the question of the chances of such a surgery it can be said that thyrotomy and laryngectomy had been refused by the majority of laryngologists since the Congress of London in 1881 and the publication of P. v. Bruns in 1878. In Berlin, however, the improvement of surgical and anesthetic techniques by E. Hahn led to a positive opinion. F. Semon, who had strictly refused thyrotomy until 1886, supported the indication of thyrotomy of the Crown Prince since Hahn had successfully operated one of his patients in London. So the chance of healing a limited carcinoma of the vocal folds by thyrotomy was given. However, it may be questioned if partial resection had the desired outcome. The limited mobility of the left vocal fold that had been diagnosed already in May 1887 indicates that probably laryngectomy would have been necessary. The prognosis of this procedure, however, was extremely poor at that time. It is irony of history that T. Gluck who performed the separation of the airways from the digestive pathways in an animal model already in 1880 under von Langenbeck could not further develop his technique under von Bergmann. CONCLUSIONS: The Crown Prince acquired his disease at a time when the acceptance of surgical treatment of laryngeal carcinomas had reached its lowest point. Ten years later, the technique of thyrotomy was successfully established by Hahn, Butlin, and Semon so that Morell Mackenzie would probably have agreed to the intervention. Ten years later, due to Gluck and Sörensen, even the technique of laryngectomy had reached the performance that is still valid today so that the Emperor could have been treated successfully even with an advanced laryngeal carcinoma.

Laryngeal cancer incidence and mortality in China, 2010.

PURPOSE: To analyze the incidence and mortality of laryngeal cancer in cancer registration areas of China in 2010. MATERIALS AND METHODS: Until June 1, 2013, 219 population-based cancer registries submitted data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 120 cancer registries were selected after quality evaluation for this analysis. Laryngeal cancer cases were selected from the database according to International Classification of Diseases 10th Revision coded as "C32." We calculated the crude incidence and mortality rates of laryngeal cancer by sex, age, and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age-standardized rates. RESULTS: In 2010, it was estimated that there were 20,272 new cases diagnosed as laryngeal cancer in China, including 17,703 males and 2569 females. The crude incidence rate of laryngeal cancer was 1.54/100,000 in 2010, accounting for 0.66% of overall new cancer cases. The age-standardized by China population (ASRcn) and by world population (ASRwld) were 1.18/100,000 and 1.20/100,000, respectively. Cumulative rate (0-74 years old) and truncated age-standardized rate (35-64 years old) were 0.15% and 1.98/100,000, respectively. Moreover, it was estimated that there were 11 914 cases died in laryngeal cancer in China, including 10,038 males and 1876 females. The crude mortality rate was 0.91/100,000, accounting for 0.61% of overall cancer deaths. The ASRcn and ASRwld were 0.68/100,000 and 0.69/100,000, respectively. Cumulative rate and truncated age-standardized rates were 0.08% and 0.88/100,000, respectively. CONCLUSIONS: Both incidence and mortality of laryngeal cancer in China were still low in 2010.

Incidence and mortality of laryngeal cancer in Zhejiang cancer registry, 2000-2011.

BACKGROUND: Laryngeal cancer is the one of the most prevalent cancer of the upper respiratory tract. Aiming to get a better understanding of the epidemiological characteristics and trends of laryngeal cancer in Zhejiang cancer registry in China during 2000-2011, we used the standardized quality control and statistical methods to analyze the incidence and mortality that were vital for making decision about laryngeal cancer prevention and control. MATERIALS AND METHODS: Comparably high-quality data from eight population-based cancer registries in Zhejiang from 2000 to 2011 were qualified for analysis. The pooled data were stratified by area, sex, and age group. All incidence and mortality rates were age-standardized to the 2000 Chinese standard population and Segi's population, which were expressed per 100,000 populations. Average annual percent changes (AAPCs) and 95% confidence intervals of laryngeal cancer incidence and mortality were calculated for the temporal trends. The logarithmic trend line was also drawn to reflect the time trends of incidence and mortality. RESULTS: During the 12 years, the 8 cancer registries covered a total of 81,758,277 person-year population (65,500,842 in urban and 16,257,435 in rural areas) including 41,315,911 person-year males and 40,442,366 person-year females. The age-standardized incidence rates were 1.10/10(5) by Chinese population and 1.12/10(5) by world population, respectively. The incidence of laryngeal cancer was relatively low in subjects under 44 years old. Then, it increased sharply after 45 years old and finally reached the peak in subjects of 75-79 years old. The age-standardized mortality rates of the Chinese population and world population were 0.28/10(5) and 0.35/10(5), respectively. The mortality of laryngeal cancer was at a low level in subjects under 49 years old. The rate dramatically increased in subjects over 50 years old, and then peaked in the age group of 80-84 years. The crude incidence of laryngeal cancer in Zhejiang cancer registration areas in 2000 was approximately 1.39/10(5), and it reached 1.78/10(5) in 2011, with the AAPC of 2.47%; the temporal trend line indicates that the incidence remained steady during the 12 years. The crude mortality of laryngeal cancer in Zhejiang registration areas in 2000 was about 0.30/10(5) and increased to 0.66/10(5), with the AAPC of 4.24% which showed no statistical significance; the temporal trend line indicates that mortality was going up to a certain extent, but not evident. CONCLUSIONS: Laryngeal cancer significantly influenced the quality of life for the patients. The comprehensive measures should be carried out to prevent the upward trend of laryngeal cancer.

[The Malady of Emperor Frederick III. and Virchow's diagnostic role]. / Die Krankheit Kaiser Friedrichs III. und Virchows Rolle.

Crownprince Frederick Wilhelm of Prussia was once the hope of the liberal movement in Germany. He embodied and lived a humanistic ideal based on the spirit of the enlightenment. Starting in January 1887 the passionate pipe smoker suffered on an unusual long hoarseness. A polyp of the vocal cord was diagnosed. Although this diagnosis seemed harmless, an odyssee was launched that made history. Rudolf Virchow-the foremost pathologist of that time-was involved in the following histological diagnosis. His role and that of the sprouting histopathology will be presented in this essay.

From cancer to cookbooks: the story of Clementine Paddleford.

Clementine Paddleford overcame laryngeal cancer to become the most famous culinary journalist of her time. Through archival research, her long-forgotten tale may be shared anew. Perhaps no individual better encapsulates the consequences of head and neck cancer than does a food reporter, for whom speech and swallowing are truly indispensable. In an era in which vocal rehabilitation after total laryngectomy was limited, and when conservation procedures were still being developed, Paddleford underwent partial laryngectomy in 1931. Thereafter, her tracheotomy morphed into a fashion statement, and her dysphonia became her calling card, as she traveled the world in pursuit of original recipes and the stories behind them. Paddleford reminds us that cancer survivorship is not simply measured in months or years. Her legacy is a testament to both individual willpower and the ability of doctors and patients to balance risks and benefits in pursuit of partnerships with common goals.

The Kaiser's cancer revisited: was Virchow totally wrong?

On 15 June 1888, the German Emperor, Kaiser Friedrich III, died of laryngeal cancer. Three biopsies of his laryngeal lesion had been taken by the British laryngologist, Morel Mackenzie, in 1887 and diagnosed by Rudolf Virchow as "pachydermia verrucosa laryngis", confirming Mackenzie's assessment that the Kaiser's disease was benign. A fourth specimen coughed up by the patient was considered by Virchow to be nondiagnostic. A further specimen expectorated by the patient 3 months before his death was diagnosed as carcinoma by Wilhelm Waldeyer. The autopsy revealed squamous carcinoma in the larynx with a cervical lymph node metastasis. The discrepancies between the initial diagnoses and the final outcome of the Kaiser's disease gave rise to a never-ending medical controversy. Our investigations on this historical case were limited to the official German documents and publications and their English translations and to subsequent literature sources of the time, after having received confirmation that the histological slides and Virchow's original reports had been lost. Based on current surgical pathology knowledge, we propose that the tumour that challenged the diagnostic skills of the founder of pathology was hybrid verrucous carcinoma (HVC), an extremely rare, metastasizing variant of verrucous carcinoma (VC) composed of pure VC mixed with clusters of conventional squamous cell carcinoma. As we see it now, Virchow was therefore not totally wrong. Our retrospective evaluation suggests that Virchow's detailed description of the Kaiser's cancer preceded the paper that contributed to the full understanding of HVC of the larynx by 110 years.

Circumferential pharyngeal reconstruction: history, critical analysis of techniques, and current therapeutic recommendations.

Reconstruction of circumferential pharyngeal defects following total pharyngolaryngectomy presents major challenges with respect to surgical morbidity and restoration of functional deficits, which are often made more demanding by the increasing trend to utilize primary chemoradiation protocols with surgery reserved for salvage cases. The present review evaluates the reconstructive techniques described in the literature, including historical techniques as well as more recent innovative methods. Each technique is critically appraised with particular reference to postoperative morbidity and functional rehabilitation. Treatment recommendations are made based on the available evidence.

Morell Mackenzie and Crown Prince Frederick: an unpublished manuscript from the Royal Society of Medicine Library.

The story of Morell Mackenzie and his involvement in the case of Crown Prince Frederick III (the future Emperor of Germany) is as well known as it is controversial. The consequences of the case were profound, both medically and politically. Most documents concerning the case are affected by varying degrees of bias, and as a result our understanding of the true events is incomplete. We present a brief summary of the case, and review an unpublished manuscript which adds to our understanding of the events. This manuscript is supportive of Mackenzie's early management of the Crown Prince's illness and acknowledges the importance of the case in medical history.

[Cancer or syphilis laryngis, politics or diagnostic failure--problems of Emperor Frederick's III disease]. / Rak czy kila krtani, polityka czy bledna diagnoza--problem choroby cesarza Fryderyka III.

The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported. In spite of fact, that the German laryngologists the patient's pathologic changes diagnosed as laryngeal cancer in early stage, the ultimate diagnosis was made too late for surgery to have any effect. This delay was due to the differences in opinions between the attending laryngologists; particularly between that of the English prominent laryngologist Morell Mackenzie and the Germans, prof. Gerhardt and prof. Bergmann. The roles of the British Queen Victoria as well as her daughter, the wife of Prince Frederick, the princess Victoria, in decisions about the treatment of the disease, are discussed. The behavior and the personality of Sir Morell Mackenzie played also a very important role in the course of the disease. Some medical facts and symptoms render it probable that syphilis was the underlying reason for the development of cancer. Crown Prince Frederick was a pipe smoker for at least 30 years before he died at the age of 57 years, so it may be possible, that the Emperor's laryngeal cancer was induced by tobacco. There are some suggestions, that the premature death of the King of Prussia and German Emperor Frederick III could be a critical turning point in European's history.

[One thousand laryngectomies performed at the Novi Sad University ENT Clinic--historical review and important data on treatment of laryngeal tumors].

INTRODUCTION: The first ENT Department in Novi Sad was established in 1926. In 1960 the ENT Clinic became a part of the Faculty of Medicine Novi Sad and treatment of malignant disease started in 1973 at the Laryngology Department. SURGICAL TREATMENT OF MALIGNANT LARYNGEAL TUMORS: Treatment of laryngeal cancers in Novi Sad started in 1960's. Until 1971, the treatment of choice was radiotherapy, and surgical treatment started in 1971, when the first laryngectomy was performed After the first surgery, 31 years have passed until we have reached the number of one thousand performed laryngectomies at ENT Clinic in Novi Sad. PERIOD: 1971-1988: During this period, 138 laryngectomies were performed at ENT Clinic. Total laryngectomies were done as salvage surgeries in 136 cases, and 2 patients underwent functional partial laryngectomies. Direct laryngomicroscopy was introduced by Zivko Majdevac in 1972. Oncology consilium was founded. PERIOD: 1990-2002: New protocol was adopted. Surgery became the primary treatment of laryngeal carcinoma, while radiotherapy remained a valid therapeutic alternative. All known surgical techniques were introduced, including Pearson's near-total laryngectomy. In this period 834 patients were operated, and 873 laryngectomies were performed, out of which 388 total laryngectomies. Year after year the number of patients increased and in 2002, 90 laryngectomies were performed. The number of functional reconstructive operations has increased to 67.8% in comparison to 32.2 % of total laryngectomies.