Supracricoid laryngectomy with cricohyoidoepiglotto-pexy or cricohyoido-pexy: Experience on 32 patients
Introduction
Cancer of the larynx is one of the head and neck malignancies with good prognosis. In Japan, radiation therapy with or without chemotherapy is the main treatment option for early cancers, whereas total laryngectomy is the standard treatment for radiation failure or advanced cancers. Although the oncological effectiveness of total laryngectomy has been well recognized, significant alteration of the upper aerodynamic pathway resulting in permanent tracheostoma has an enormous negative impact on the patients. Due to recent increasing interest in organ preservation in medical care, laryngeal preservation has gained in importance in cancer managements.
Supracricoid laryngectomy (SCL) with Cricohyoidoepiglotto-pexy (CHEP) or Cricohyoido-pexy (CHP) is an organ preservation surgery indicated for early and selected advanced laryngeal cancers [1], [2], [3], [4]. In SCL–CHEP, thyroid cartilage is removed along with its intrinsic tissues leaving the epiglottis and one or two arytenoids. Approximately 3/4 of the larynx is removed. The laryngeal defect is closed by approximating and fixing the cricoid cartilage to the hyoid bone. Phonation and deglutition are achieved by approximation of the remaining arytenoids and epiglottis. In CHP, the epiglottis is removed along with thyroid cartilage. The advantages of CHEP or CHP are, (1) the surgical technique is fixed and simple, (2) satisfactory function can be obtained, (3) tracheostoma can be closed and the patient can resume breathing from the natural airway, and (4) surgery can be performed after radiation therapy [5].
After the initial surgical training at the Institut Gustave Roussy in France, we conducted our first case of SCL–CHEP in 1997. In this paper, we summarized the clinical and postoperative data of patients who received SCL over the past 9 years.
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Patients and method
Between 1997 and 2005, 32 patients underwent SCL with CHEP or CHP at the Department of Otorhinolaryngology, Kitasato University Hospital. Details of the patients were summarized in Table 1. There were 30 male and 2 female patients with a mean age of 61 years (age range from 15 to 74 with 13 patients above 65 years). Seven patients were referred to our department from other university hospitals and three from cancer centers in order to receive SCL surgery. SCL–CHEP was performed in 29 and CHP in
Postoperative complications
None of the patients died in the immediate postoperative period. Wound infection was detected in 12 patients (38%). The severity of infection in 3, 5, 4 cases was ranked 1+, 2+, 3+, respectively. Most of the patients, especially those with 1+ or 2+ infection, were managed conservatively by prolonged antibiotics instillation. Those with 3+ infection, which required surgical intervention, included two cases of ruptured pexis (cases 9 and 11) and two cases showing cricoid cartilage necrosis (cases
Discussion
In 1959, Majer and Rieder [1] from Austria described the basic concept of SCL. The surgery was revised in France by Labayle and Bistmuth [2] in 1971 and Piquet and Chevalier [3] in 1974. Through the first English publication of SCL–CHEP in 1990, Laccourreye et al. [4] successfully brought worldwide attention and recognition to this surgical procedure. Before introducing SCL, chemoradiation therapy and conventional partial laryngectomy were the two major treatment modalities for laryngeal
Conclusion
Clinical data of 32 patients who received SCL over the past 9 years were reviewed. Wound infection was detected in 38% of the cases; the ratio of infection decreased in the late stage cases. Those with severe infection, which required surgical intervention, included two cases of ruptured pexis and two cases showing cricoid cartilage necrosis induced by Forestier disease. Wound infection can be avoided by strictly observing the proper surgical techniques and postoperative managements. The 5-year
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