Abstract
Purpose
The aim of this study is to evaluate the evolution of supracricoid partial laryngectomy (SCPL) in indications, surgical techniques and outcomes through last decades.
Materials and methods
A retrospective analysis of 146 patients affected by laryngeal cancer treated with SCPL was carried on. We defined: (1) group A, 100 patients treated by cold instruments between 1995 and 2004; (2) group B, 46 patients treated by harmonic scalpel between 2005 and 2010. Complications rate, and functional and oncological results were documented and a comparison between the two groups was made; histopathological analysis of surgical margins was evaluated and correlated with local incidence of recurrence.
Results
Significant differences in age mean-value ( p = 0.02), T classification ( p = 0.007), and in indication for more advanced-staged patients were found in group B ( p = 0.001). Surgical procedure was shorter in group B ( p < 0.001), with shorter swallowing recovery ( p = 0.003). Oncological outcomes did not report any significant differences. Group B showed a higher incidence of post- operative arytenoid edema ( p = 0.03) associated with a lower rate of pneumonia ( p = 0.038). Despite a higher rate of close or positive-margins found in group B no higher incidence of local-recurrence was reported ( p = 0.02) compared to group A.
Conclusions
We documented changing in indications and surgical technique for SCPL because of the development of modern diagnostic techniques and the introduction of low-thermal injury device allowing a more challenging tumor excision as well as with a shorter swallowing recovery in our series.
1
Introduction
Treatment options for laryngeal cancer include different radiation and surgical techniques, whose choice depends on extension of the disease, clinical presentation and general health of patients. The main concern is tumor control together with organ function preservation when it is possible. Supracricoid partial laryngectomy (SCPL) provides a good surgical alternative to the conventional radiotherapy and total laryngectomy in the treatment of specific glottic and supraglottic cancers . Supracricoid partial laryngectomy was initially introduced by Hofmann–Saguez in 1950 and further discussed by Mayer and Rieder in 1958 . In addition, the procedure was refined and found a practical validity and application by Labayle and Bismuth in 1971 , Alajmo in 1971 in Florence , and Piquet et al. in 1972 . All of these surgeons proposed supracricoid partial laryngectomy as valid surgical alternative to total laryngectomy in elective T1 and T2 laryngeal cancer patients, describing it as a technique able to ensure recovery from the disease and laryngeal function preservation together.
So far, surgical indications have been changed and extended to more advanced staged cancers because of the improvement of diagnostic technologies such as CAT scan and MRI , a more precise stage of the disease by endoscopic fiberoptic together with fluorescence or narrow banding imaging (NBI) exams , as well as because of the advent of new surgical devices which allowed the improvement of the intraoperative management of the operation and the surgical technique as well. All of these changes, together with the help of frozen section analysis in the intraoperative control of resection margins , have determined a radical turn in the management of these laryngeal cancer patients during the last 40 years, furthermore, with the new concept that recurrent irradiated cancer has to be treated as a primitive one, with no worsening in staging status and surgical indication, with no absolute contraindication for SCPL .
Accordingly, here we critically evaluated our personal experience in the last decades with SCPL with the aim to underline changing in indications, potential improvement in functional and oncological results and the impact of new surgical devices recently used at out Institute.
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