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Salvage Total Laryngectomy (salvage + total_laryngectomy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Treatment of Laryngeal Carcinomas by Laser Endoscopic Microsurgery ,

THE LARYNGOSCOPE, Issue 6 2000
Pierre R. Moreau MD
Abstract Objectives To determine if laser endoscopic microsurgery is a reliable and appropriate approach in the treatment of laryngeal cancers. Study Design Retrospective study of 160 patients treated from 1988 to 1996 at Liège. Analysis of indication, technique, and oncologic results. Methods Glottic tumors were treated with either type I, type II, or type III cordectomy, with or without conservation of an inferior muscular band, and extended if necessary to all or part of the contralateral cord. For supraglottic cancers, an excision limited to a part of the vestibule, a trans-preepiglottic resection, or a radical supraglottic resection was carried out. Results Our corrected actuarial survival at 5 years was 97% for the 98 infiltrative glottic tumors and 100% for the 18 infiltrative supraglottic and 27 in situ carcinomas. No local recurrences were noted, in either the group of 118 infiltrating cancers (in whom two precancerous lesions were treated with a further laser excision), or in the 27 in situ carcinomas. Local control was thus 100%. One patient died of his cancer, with lung metastases after neck recurrence. Conclusions Like Steiner and Rudert, this series demonstrates the oncologic validity of this surgical approach to the treatment of unadvanced glottic tumors. Unlike these authors' study, however, strict case selection, as in cases with significant involvement of the anterior commissure, has allowed us to avoid local recurrences and consequently to avoid salvage total laryngectomies. Our experience with supraglottic cancers is too small to confirm the oncologic validity of this type of surgery but seems promising. [source]

Prevention of wound complications following salvage laryngectomy using free vascularized tissue

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007
FRCS(C), Kevin Fung MD
Abstract Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups,4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source]

Factors influencing long-term survival following salvage total laryngectomy after initial radiotherapy or conservative surgery,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2006
B. Zach Fowler MD
Abstract Background. This retrospective study investigated survival outcomes of salvage total laryngectomy (STL) after initial radiation therapy (RT) or larynx conservation surgery (CS) at an academic center. Methods. A chart review yielded 64 patients with STL: 53 with RT failures, six with CS failures, and five after RT + CS. Median potential follow-up after STL was 9.4 years (mean, 9.2 years; range, 0.3,17.4 years). Results. Five- and 10-year actuarial overall survival (OS) after STL was 65.2% and 37.7%, respectively. Mean survival after STL was 7.2 years (median, 6.8 years; range, 0.2,17.4 years). No significant survival difference was found between the three treatment groups (p = .50). For 21 patients with nodes assessed at STL, 9-year OS was 45.4% for patients with N0 disease versus 26.7% for patients with N+ disease (p = .25). Conclusion. These data suggest that STL after radiation failure is associated with equivalent long-term survival as STL after RT + CS or after failure of CS alone. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]