[An evaluation of surgical techniques and oncologic results in early glottic cancers]. / Erken evreli glottik kanserlerde cerrahi tedavi seçimi ve onkolojik sonuçlar.

OBJECTIVES: We evaluated the surgical techniques employed and survival rates in patients who were treated for early glottic cancer. PATIENTS AND METHODS: The study included 29 patients (28 males, 1 female; mean age 59 years; range 47 to 73 years) who underwent surgery for early glottic cancer. Surgical techniques were employed in view of factors such as involvement of the anterior commissure, the extent of sub- or supraglottic invasion, and cord mobility. Two- and five-year survival rates were calculated. TNM classification was made according to the 1992 AJCC staging system. RESULTS: Preoperative tumor stages were TisN0 (n=2, 7%), T1N0 (n=20, 69%), and T2N0 (n=7, 24%). Surgical techniques included laryngofissure and cordectomy (n=9, 31%), frontolateral laryngectomy (n=18, 62%), and vertical hemilaryngectomy (n=2, 7%). Positive surgical margins were reported postoperatively in 10 patients, eight of whom remained tumor-free with (n=4) or without (n=4) radiation therapy during the follow-up period, while two patients underwent total laryngectomy because of local recurrences. Three patients died due to causes other than the primary disease. Two- and five-year survival rates were 88.8% and 80%, respectively. CONCLUSION: Involvement of the anterior commissure, and the extent of invasion to the subglottis, supraglottis, and the laryngeal ventricle seem to play a major role in selecting the most appropriate surgical technique in early glottic cancer.

[Patient selection for near-total laryngectomy and oncologic results]. / Near-total larenjektomi için hasta seçimi ve onkolojik sonuçlar.

OBJECTIVES: We reviewed preoperative, perioperative, and postoperative findings and the survival data to determine which patients may be appropriate for near-total laryngectomy. PATIENTS AND METHODS: We reviewed hospital records of 20 patients (all males; mean age 56.6 years; range 35 to 73 years) who underwent near-total laryngectomy. Indications for patient selection for near-total laryngectomy and survival data were evaluated in comparison with literature reports. RESULTS: The site of the tumor was the sinus pyriformis in two, and the larynx in 18 patients. Thirteen patients had T3, seven patients had T2 tumors. The lesions were localized in the sinus pyriformis in two patients with T2 tumors. The locoregional control rate at the end of two years was 75%; two- and three-year survival rates were 81.2% and 64.2%, respectively. CONCLUSION: Following a detailed and meticulous investigation in the preoperative period, near-total laryngectomy seems to be appropriate in selected patients with advanced laryngeal and hypopharyngeal tumors in which partial laryngectomy procedures are not considered. It may both provide cure and preserve phonation. It may also be considered for functional purposes in patients whose pulmonary functions are insufficient for partial laryngectomy, in those in whom food aspiration is inevitable after partial laryngectomy, and in those suffering from lifelong food aspiration due to neurologic causes, and for oncologic reasons in patients who develop local recurrences after partial laryngectomy.