Functional outcomes of supraglottic squamous cell carcinoma treated by transoral laser microsurgery compared with horizontal supraglottic laryngectomy in patients younger and older than 65 years.

The treatment of supraglottic carcinoma remains a controversial issue. Five accepted surgical and non-surgical oncological treatments have been currently established: standard horizontal supraglottic laryngectomy (HSL), supraglottic CO2 laser microsurgery (TLM), transoral robotic surgery, radiotherapy alone and radiotherapy in combination with chemotherapy. Some studies have shown that complications of head and neck surgeries increase significantly in patients over 65 years compared to younger patients. We designed a retrospective analysis to assess the rate of complications and functional outcomes of patients treated by TLM and HSL in cases of T1-T3 supraglottic squamous cell carcinomas (SCC) in a tertiary University Hospital. Results were compared between patients younger and older than 65 years. We found significant differences in the rate of aspiration pneumonia (p = 0.026), mean time to decannulation (p = 0.001) and mean hospital stay (p = 0.007) in patients treated by TLM, which was higher and longer in the group of patients over 65 years of age. Regarding HPL, we only found significant differences in the mean time to decannulation (p = 0.001), which was longer in the group of patients younger than 65 years. According to our results, TLM or HPL can both be a safe surgical option for patients older than 65 years, but previous evaluation of lung function before surgery is mandatory because of an increased risk of aspiration pneumonia in patients with lung problems, especially when treated by TLM. Concerning functional outcomes in patients older than 65 years, TLM reduces the postoperative rate of tracheostomy, mean time required for decannulation and mean hospital stay compared with HPL. However, no significant difference in the occurrence of aspiration pneumonia, dysphagia or in the mean length of NGT feeding was found.

[Stapedectomy: our results]. / Estapedectomía: nuestros resultados.

OBJECTIVE: The aim of this study is to value the hearing results obtained in our department following stapedectomy and the reasons of primary failures. MATERIAL AND METHOD: We present a retrospective study of 95 stapedectomies in 82 patients, performed from January 1997 to September 2002 at Hospital Xeral-Cies of Vigo (Pontevedra). RESULTS: Medium presurgical audiometric threshold was 65.71 and postsurgical 26.68. Good results were obtained in 84.21% of cases (air-bone gap closure difference under 20 dB), 10.52% had not change in air threshold and the rest deteriorated. CONCLUSIONS: We compare our results with other authors and we consider that stapedectomy is a safe surgical technique, but it has important complications and they have to be bear in mind to prevent them.

Estapedectomía: nuestros resultados / Stapedectomy: our results

Objetivo: El objetivo del presente estudio es valorarlos resultados audiométricos obtenidos por nuestro servicio en la cirugía de la estapedectomía y los motivos que llevan al fallo de la misma. Material y método: Presentamos un estudio retrospectivo deun total de 95 estapedectomías y 82 pacientes, intervenidos desde enero de 1997 hasta septiembre de 2002 en el Hospital Xeral-Cíes de Vigo (Pontevedra). Resultados: El umbral audiométrico prequirúrgico medio fue de 65,71 y el postquirúrgico de 26,68. Obtuvimos una mejoría de la audición en el 84,21% de los casos (umbral auditivo menor de 20 db), en el 10,52% no encontramos mejoría audiométrica y en el resto el umbral audiométrico postquirúrgico empeoró. Conclusiones: Comparando nuestros resultados con los de otros autores podemos decir que la estapedectomía es una técnica quirúrgica segura, pero con complicaciones importantes y que deben tenerse presentes para evitar si es posible (AU)

Objective: The aim of this study is to value the hearing results obtained in our department following stapedectomy and the reasons of primary failures. Material and method: We present a retrospective study of 95 stapedectomies in 82 patients, performed from January 1997 to September 2002 at Hospital Xeral-Cíes of Vigo (Pontevedra).Results: Medium presurgical audiometric threshold was 65.71 and postsurgical 26.68. Good results were obtained in 84.21% of cases (air-bone gap closure difference under 20dB), 10.52% had not change in air threshold and the rest deteriorated. Conclusions: We compare our results with other authors and but it has important complications and they have to be bear in mind to prevent them (AU)