RESUMEN
Over the last 2 decades, the paradigm of laryngeal cancer management has pivoted toward preserving laryngeal function without sacrificing oncologic outcomes. Transoral laser microsurgery has diminished the role of open laryngeal surgery. For early-stage laryngeal cancer, the common primary modalities are endoscopic laryngeal surgery and narrow field radiation. Total laryngectomy followed by either radiation or chemoradiation is option for advanced laryngeal cancer. In experienced hands and following meticulous patient selection, supracricoid laryngectomy may serve as a viable alternative to total laryngectomy to preserve laryngeal function. Total laryngectomy is still the recommended treatment in those with airway compromise and/or laryngeal dysfunction.
Asunto(s)
Neoplasias Laríngeas , Laringectomía , Humanos , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/terapia , Neoplasias Laríngeas/patología , Laringectomía/métodos , Tratamientos Conservadores del Órgano/métodos , Laringe/cirugía , Laringe/patologíaAsunto(s)
Laringectomía , Humanos , Hipofaringe/cirugía , Neoplasias Hipofaríngeas/cirugía , Neoplasias Hipofaríngeas/patología , Enfermedades de la Laringe/cirugía , Enfermedades de la Laringe/diagnóstico , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Tráquea/cirugía , LaringoscopíaRESUMEN
RATIONALE: Laryngeal neuroendocrine neoplasm (NEN) is a rare and heterogeneous disease that originates from neuroendocrine cells. It mainly occurs in middle-aged and elderly men. Due to the lack of specific clinical and imaging manifestations, diagnosis and treatment of the disease pose a challenge. Therefore, a consensus on the diagnosis and treatment of the disease is necessary. By discussing this case, we will be able to gain further insight into laryngeal NEN and will be able to provide some recommendations for the future management of this rare disease. PATIENT CONCERNS: A 67-year-old man was admitted to our department with a history of sore throat and dyspnea. After admission, the patient experienced acute airway obstruction and experienced an emergency bedside tracheotomy. DIAGNOSES: Flexible fiberoptic laryngoscopy and enhanced CT showed a cauliflower-like mass in the left supraglottic region and obstructed most of the laryngeal cavity. We biopsied the mass, and the pathology showed a poorly differentiated adenocarcinoma. INTERVENTIONS: A horizontal hemilaryngectomy and left neck dissection were performed. At 4 weeks after the operation, the patient underwent chemotherapy and radical radiotherapy. OUTCOMES: After a 1-year postoperative follow-up, the patient recovered well and showed no signs of recurrence. LESSONS: Laryngeal neuroendocrine neoplasm is very rare, early diagnosis remains difficult. Radical surgery combined with postoperative chemoradiotherapy is currently the most appropriate treatment.
Asunto(s)
Obstrucción de las Vías Aéreas , Neoplasias Laríngeas , Tumores Neuroendocrinos , Humanos , Masculino , Anciano , Neoplasias Laríngeas/complicaciones , Neoplasias Laríngeas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Tumores Neuroendocrinos/complicaciones , Tumores Neuroendocrinos/diagnóstico , Laringoscopía/métodos , LaringectomíaRESUMEN
BACKGROUND: This review aimed to investigate the surgical, functional, and oncological outcomes of transoral laser microsurgery supraglottic laryngectomy (TOLM-SGL) for cT1-T3 laryngeal cancers. METHODS: PubMed, Scopus, and Cochrane Library were searched by two independent investigators for studies investigating the surgical, functional, and oncological outcomes of TOLM-SGL using the PRISMA statements. A bias analysis was carried out with MINORS. RESULTS: Twenty-four studies were included (937 patients), including 206 (25.9 %) cT1, 467 (58.7 %) cT2, and 123 (15.4 %) cT3 cases. Most patients were cN0 (63.9 %). The mean hospital stay of TOLM was 10.1 days. Aspiration (5.5 %), and bleeding (5.3 %) were the most prevalent complications. The laryngeal preservation rate was 93.7 %. Temporary tracheotomy was performed in 18.0 % of patients, with a mean time of decannulation of 6.8 days. A feeding tube was placed in 59.9 % of patients. The oral diet restarted after 6.4 days. Definitive gastrostomy was necessary in 2.4 % of cases. The 5-year OS and DFS were 70.1 % and 82.0 %, respectively. Distant metastasis, local, and regional recurrence occurred in 4.6 %, 11.6 %, and 5.1 % of patients. There was an important heterogeneity between studies for inclusion criteria, patient profiles, TOLM indications, and details of surgical, functional, and oncological outcomes. CONCLUSION: TOLM supraglottic laryngectomy is a safe, and effective procedure associated with adequate functional, surgical, and oncological outcomes. Future studies are needed to define the place of TOLM in advanced LSCC; the role and timing of concomitant bilateral neck dissection, the indications of tracheotomy and feeding tube.
Asunto(s)
Neoplasias Laríngeas , Terapia por Láser , Microcirugia , Humanos , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/mortalidad , Microcirugia/métodos , Terapia por Láser/métodos , Resultado del Tratamiento , Laringectomía/métodos , Femenino , Masculino , Estadificación de NeoplasiasRESUMEN
BACKGROUND AND OBJECTIVES: To analyze oncological and functional results of transoral minimally invasive surgery (TMIS) for supraglottic laryngeal carcinoma (SGLC), and investigate independent prognostic factors. METHODS: Seventy SGLC patients treated with TMIS were included. The overall survival (OS), recurrence-free survival (RFS), and postoperative functions were analyzed. RESULTS: Sixty-two patients were early-stage (Tis, T1, and T2) and eight patients were T3. Eleven patients received preoperative induction chemotherapy (IC). Sixty patients received transoral laser microsurgery (TLM), and 10 patients received transoral robotic surgery (TORS). Fifty-eight patients were scored Grade-1 by water swallow test, and 49 patients were scored Grade 0 by grade, roughness, breathiness, asthenia, strain. The 1, 3, and 5 year OS of all were 95.450%, 84.877%, and 78.026%, and RFS were 89.167%, 78.052%, and 75.451% respectively. Kaplan-Meier survival analysis showed N stage and clinical stage were associated with OS, smoking, clinical stage, surgical margins, and Ki-67 index were associated with RFS. There were no significant differences in preoperative IC or direct surgery, TLM, or TORS. Cox analyses showed smoking and surgical margins were independent prognosis factors for RFS. CONCLUSIONS: The positive margin, Ki-67 index ≥40% and P53(+)&Ki-67 index ≥40% are worse factors affecting recurrence for SGLC patients. Both smoking and surgical margins are independent prognostic factors affecting recurrence.
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Neoplasias Laríngeas , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Robotizados/métodos , Estadificación de Neoplasias , Terapia por Láser/métodos , Adulto , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Microcirugia/métodos , Pronóstico , Estudios Retrospectivos , Cirugía Endoscópica por Orificios Naturales/métodos , Laringectomía/métodos , Recurrencia Local de Neoplasia/prevención & control , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/epidemiología , Supervivencia sin Enfermedad , Estimación de Kaplan-MeierRESUMEN
This article revisits the notion of behaviour settings, coined by Roger G. Barker (Barker 1968, Ecol. Psychol. 28, 39-55 (10.1080/10407413.2016.1121744)), as a useful concept for the analysis of situations and communicative needs of persons after larynx removal surgery (laryngectomy). We claim that behaviour settings offer a way to characterize types of situations and types of participation, which, in turn, helps to identify aspects of communication where compensation is needed; these steps are crucial in the design process of reliable and context-sensitive speech aids. Moreover, we advocate complementing the behaviour setting concept as a unit of analysis with modern developments in the cognitive sciences, such as conversational analysis of co-operative actions (Goodwin 2017, Co-operative action (learning in doing: social, cognitive and computational perspectives). Cambridge: Cambridge University Press (10.1017/9781139016735)) and the analysis of multi-perspectival experience (De Jaegher 2021, Phenomenol. Cogn. Sci. 20, 847-870 (10.1007/s11097-019-09634-5)). Such an integration of macro- and micro-level patterns should help discover the relevant relations and values in particular situations. We illustrate our claims with examples from Barker's own work and from our ongoing analyses of the everyday life of persons after laryngectomy. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.
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Laringectomía , Humanos , ComunicaciónRESUMEN
Laryngeal transplant (LT) is a promising option to restore quality of life in patients with severe laryngeal dysfunction or a laryngectomy. These patients may be tracheostomy tube dependent or gastrostomy tube dependent and may lose their ability to verbally communicate. The loss of these important functions frequently results in social isolation and a severe decrease in quality of life. Laryngeal transplant has the potential to restore all of these important laryngeal functions. Herein, we report the first known documented LT performed in the setting of laryngeal chondrosarcoma.
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Condrosarcoma , Neoplasias Laríngeas , Laringe , Humanos , Neoplasias Laríngeas/cirugía , Condrosarcoma/cirugía , Masculino , Laringe/cirugía , Persona de Mediana Edad , Laringectomía/métodos , Calidad de VidaRESUMEN
BACKGROUND AND PURPOSE: Changes in treatment approaches, characterised by the shift from laryngectomy to a focus on organ-preserving methods may have potentially resulted in lower survival. We aim to identify differences in survival trends for laryngeal cancer (LC) in the Nordic countries over a period of 50 years, and discuss the potential impact of factors such as changes in treatment protocols. MATERIALS AND METHODS: Five-year relative survival (RS) data from 1972 to 2021 were obtained from the NORDCAN database 2.0 which included 33,692 LC cases, of which 85% were diagnosed among men. In the NORDCAN database, the age-standardised RS is calculated using the Pohar Perme estimator with individual International Cancer Survival Standards weights. Joinpoint regression models were used to assess potential shifts in trend over the years in RS. RESULTS: While Denmark and Norway demonstrated an increasing trend in 5-year RS from 1972 to 2021, in Finland and Sweden, the 5-year RS among men remained static, without any discernible significant trend. Over the 30-year period from 1992-1996 to 2017-2021, RS improved by 9, 4, 13, and 2 percentage points in Denmark, Finland, Norway, and Sweden, respectively. Among women in Sweden, a linear negative trend was observed, noticeable as a 16 percentage-point decline in 5-year RS from the earliest to the latest period. INTERPRETATION: The underlying causes for the differences in survival trends remain unclear. Besides differences in treatment protocols, several other factors can affect RS making the interpretation of RS trends challenging.
Asunto(s)
Neoplasias Laríngeas , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/terapia , Neoplasias Laríngeas/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Países Escandinavos y Nórdicos/epidemiología , Anciano , Tasa de Supervivencia , Sistema de Registros , Anciano de 80 o más Años , Laringectomía/mortalidad , Laringectomía/estadística & datos numéricos , Adulto , Bases de Datos Factuales , Finlandia/epidemiología , Dinamarca/epidemiología , Noruega/epidemiologíaRESUMEN
BACKGROUND: Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting. METHODS: We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL. RESULTS: Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference). CONCLUSIONS: In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.
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Fuga Anastomótica , Neoplasias Esofágicas , Esofagectomía , Laringectomía , Faringectomía , Humanos , Masculino , Esofagectomía/efectos adversos , Esofagectomía/métodos , Femenino , Neoplasias Esofágicas/cirugía , Estudios Retrospectivos , Laringectomía/efectos adversos , Laringectomía/métodos , Anciano , Persona de Mediana Edad , Japón/epidemiología , Faringectomía/métodos , Faringectomía/efectos adversos , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Neoplasias Primarias Secundarias/epidemiología , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Neumonía/epidemiología , Neumonía/etiología , Pueblos del Este de AsiaRESUMEN
Objective: To investigate the use of folded flap for repair of laryngeal and hypopharyngeal defect and the clinical efficacies of laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer. Methods: A retrospective analysis was performed for 10 cases of piriform sinus cancer that were treated in the Second Norman Bethune Hospital of Jilin University from January 2020 to April 2023 and all patients were males, aged 42-68 years. The first choice of treatment for all patients was surgery. After function neck dissection and tracheotomy, partial laryngectomy and hypopharyngectomy were carried out. The folded island flaps were prepared and used for the repairs of laryngeal and hypopharyngeal defects and the reconstructions laryngeal and hypopharyngeal functions. The patients were followed up. Results: The laryngeal and pharyngeal cavities were reconstructed well in 10 patients, and all the flaps survived, with no case of pharyngeal fistula. All patients were able to eat normally through the mouth at 2 weeks after surgery without obvious choking, and 4 patients completed the swallowing function evaluation without aspiration or only a small amount of aspiration. All the 10 patients underwent postoperative radiotherapy. The postoperative follow-up time was 5.4-41.4 months, and there was no case with tumor recurrence or death. Laryngoscopy showed that 8 patients had a spacious new laryngeal orifice, which met the conditions for extubation, of whom 7 patients had their tracheal tubes removed and 1 patient was still under observation, and that 2 patients had a slightly narrowed new laryngeal orifice due to a thick skin flap, with further follow-up observation. All patients retained their phonatory functions after surgery. Conclusion: Folded island flap can be used for the function reconstructions of the larynx and hypopharynx after surgery of pyriform sinus cancer.
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Hipofaringe , Laringe , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Anciano , Hipofaringe/cirugía , Procedimientos de Cirugía Plástica/métodos , Laringe/cirugía , Seno Piriforme/cirugía , Neoplasias Hipofaríngeas/cirugía , Laringectomía/métodosRESUMEN
BACKGROUND: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used. OBJECTIVES: Compare the oncological results of patients with early stage laryngeal squamous cell carcinoma (LSCC) treated with TOLS or RT. DESIGN: Retrospective. SETTINGS: Tertiary training and research hospital. PATIENTS AND METHODS: The participants were divided into patients who underwent TOLS and RT treatment. The groups were compared with each other in terms of local recurrence, regional recurrence, distant metastasis, 3 and 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and laryngectomy-free survival rates (LFS). MAIN OUTCOME MEASURES: The effects of TOLS and RT treatment on local control, regional control, OS, DFS, DDS and LFS in early stage laryngeal cancers. SAMPLE SIZE: 261. RESULTS: The mean follow-up time was 48 (26) months. There were 186 patients who underwent TOLS and 75 patients who underwent RT treatment. Gender, cigarette/alcohol consumption, tumor localization, anterior commissure involvement, tumor grades, recurrence rates and recurrence localizations of the groups were similar. The 5-year overall, disease specific, disease free and laryngectomy-free survival rates were 85.9%, 88%, 79.4%, 96.3% in the TOLS group and 74.3%, 76.7%, 72.3%, 85.2% in the RT group (P=.034, .065, .269, .060, respectively). CONCLUSIONS: TOLS had equal and good oncological outcomes on OS and DFS compared to RT. Anterior commissure involvement was statistically significant independent prognostic risk factor for DFS in both groups. The 5-year OS rate was greater in the TOLS groups (P=.034). LIMITATIONS: Retrospective, but to the best our knowledge, this is the first study in Turkey with a high patient volume and a long follow-up time.
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Carcinoma de Células Escamosas , Neoplasias Laríngeas , Terapia por Láser , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/mortalidad , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/mortalidad , Terapia por Láser/métodos , Supervivencia sin Enfermedad , Anciano , Laringectomía/métodos , Resultado del Tratamiento , Tasa de Supervivencia , Adulto , Estudios de SeguimientoRESUMEN
BACKGROUND: Tyrosine-rich or tyrosine-like crystalloids (TC) were initially described in salivary gland pleomorphic adenoma. The presence of TC in non-neoplastic tissues is rare, and it has been reported exclusively in the larynx. This study aims to characterize the frequency and anatomical localization of TC in total laryngectomy specimens. METHODS: Review of consecutive laryngectomy specimens in which the cassette summary documented parasagittal section sampling of the right and left vocal folds and the anterior commissure. Data collected included patient demographics, underlying diagnoses, history of radiation therapy, presence, and location of TC. RESULTS: Of 86 laryngectomy specimens, 16 (19%) contained amphophilic to eosinophilic TC. The study cohort included 11 males and 5 females, aged 37 to 85 years (mean 62, median 63). Laryngectomy surgery was performed for advanced untreated squamous cell carcinoma (SCCa) (7/16, 43.75%), recurrent post-treatment SCCa (7/16, 43.75%), previously untreated laryngeal large cell neuroendocrine carcinoma (1/16, 6.25%), and non-functional larynx post-chemoradiation (1/16, 6.25%). According to the macroscopic cassette summary, TC were predominantly found in the anterior commissure Sect. (13/16, 81.25%), with fewer cases in sections containing the left (2/16, 12.5%) or the right (1/16, 6.25%) vocal folds. Microscopically, TC localized to the anterior macula flava and/or adjacent vocal ligament (12/16, 75%) and the anterior commissure tendon (4/16, 25%). CONCLUSIONS: TCs are predominantly reported as admixed with a neoplasm, however this study confirms that TC can also occur in non-neoplastic tissues of the larynx. There was no clear relationship between the presence of TC and prior radiation therapy. TC in the specialized connective tissues of the macula flava and true cord tendinous insertions distinct from tumor may form in response to alterations in mechanical stress, though an age-related change within the spectrum of normal laryngeal microanatomy also remains a possibility.
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Pliegues Vocales , Humanos , Masculino , Anciano , Persona de Mediana Edad , Femenino , Adulto , Anciano de 80 o más Años , Pliegues Vocales/patología , Laringectomía , Tirosina , Neoplasias Laríngeas/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/patologíaAsunto(s)
Laringectomía , Humanos , Hipofaringe/cirugía , Neoplasias Hipofaríngeas/cirugía , Neoplasias Hipofaríngeas/patología , Enfermedades de la Laringe/cirugía , Enfermedades de la Laringe/diagnóstico , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Tráquea/cirugía , LaringoscopíaRESUMEN
This paper presents a unique clinical observation of 16 years of use without replacement of a domestic voice prosthesis in a patient after laryngectomy. Long-term recurrence-free survival was achieved as a result of treatment of laryngeal leiomyosarcoma.
Asunto(s)
Neoplasias Laríngeas , Laringectomía , Laringe Artificial , Humanos , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Masculino , Leiomiosarcoma/cirugía , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Objective: To investigate the feasibility, safety and effectiveness of colonic interposition with vascular anastomosis in reconstructing the entire esophagus and hypopharynx after resection of hypopharyngeal cancer with esophageal cancer. Methods: We conducted a retrospective analysis of 4 male patients with simultaneous multiple primary cancers of the hypopharynx and esophagus, aged 47 to 58, treated in the Department of Head and Neck Surgery at the Hunan Cancer Hospital from February to August 2019. All cases underwent total hypopharyngectomy and total esophagectomy, of whom, three cases presented with total laryngectomy and one case with larynx preservation. Colonic interposition was performed using the left colic artery as a pedicle, with an average colonic length of 48.5 cm. The colon was elevated through the esophageal bed to the neck, and the branch of the colonic mesenteric artery was anastomosed to one of the neck arteries, including the inferior thyroid artery in one case, the transverse cervical artery in two cases, and the superior thyroid artery in one case, and all venous anastomoses were performed with the internal jugular veins. Results: The postoperative neck and abdominal wounds healed well without anastomotic leakage, and all patients were able to resume a regular oral diet within 21-30 days postoperatively. During the follow-up of 48-52 months, two cases died due to tumor recurrence, while the remaining two cases were disease-free survivals. Conclusion: Colonic interposition with vascular anastomosis is a safe and reliable reconstruction method suitable for repairing long-segment upper digestive tract defects after resection of hypopharyngeal cancer with esophageal cancer.
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Anastomosis Quirúrgica , Colon , Neoplasias Esofágicas , Esofagectomía , Neoplasias Hipofaríngeas , Procedimientos de Cirugía Plástica , Humanos , Neoplasias Hipofaríngeas/cirugía , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , Anastomosis Quirúrgica/métodos , Neoplasias Esofágicas/cirugía , Procedimientos de Cirugía Plástica/métodos , Esofagectomía/métodos , Colon/cirugía , Esófago/cirugía , Hipofaringe/cirugía , Laringectomía/métodosRESUMEN
BACKGROUND: The purpose of this multicenter study was to retrospectively investigate the prognostic significance of the tumor microenvironment, in relation to survival in a large cohort of patients with laryngeal squamous cell carcinoma (LSCC), using the method proposed by the International TILs Working Group in breast cancer. METHODS: All consecutive patients with biopsy-proven LSCC who underwent total laryngectomy (TL) between January 2014 and January 2023 were retrospectively included in the study. A retrospective review of medical records including surgical, pathological and follow-up reports was performed. The density of TILs was determined according to the recommendations of the International TILs Working Group. RESULTS: The study group included 186 patients with LSCC. High TILs were statistically correlated with reduced size and extension of primary tumor (pT stage) with a statistically significant value (S: p = 0.01; P: p = 0.0003) and without needs of salvage therapy (S: p = 0.03; P: p = 0.004). Low TILs were indicative of worse prognosis. CONCLUSIONS: Our study confirmed the protective value of TILs and the prognostic role of the tumor microenvironment in LSCC; furthermore, our results showed that the score proposed by the International TILs Working Group for breast cancer can be applied to LSCC.
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Carcinoma de Células Escamosas , Neoplasias Laríngeas , Laringectomía , Microambiente Tumoral , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/cirugía , Femenino , Estudios Retrospectivos , Microambiente Tumoral/inmunología , Persona de Mediana Edad , Masculino , Pronóstico , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/cirugía , Adulto , Linfocitos Infiltrantes de Tumor , Anciano de 80 o más Años , Estadificación de Neoplasias , Análisis de SupervivenciaRESUMEN
Circular pharyngolaryngectomy for oncologic resection requires a tubular reconstruction. Different options can be proposed to the patient: digestive free flap, fasciocutaneous flap, or musculocutaneous flap. The jejunum free flap is a tubular flap commonly used in esophageal and pharyngeal reconstruction with good functional outcomes and an acceptable rate of complications. Reconstruction with a jejunum free flap is an ideal choice. Patients at Gustave Roussy Institute (Villejuif, France) were offered a jejunum flap free flap for all circular pharyngolaryngectomies. The surgical technique is explained with a step-by-step video. The jejunum flap free flap has many advantages in circular pharyngolaryngectomy. This video article explains surgical steps for other teams.
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Colgajos Tisulares Libres , Yeyuno , Laringectomía , Procedimientos de Cirugía Plástica , Humanos , Yeyuno/cirugía , Procedimientos de Cirugía Plástica/métodos , Laringectomía/métodos , Faringectomía/métodos , Neoplasias de Cabeza y Cuello/cirugía , MasculinoRESUMEN
OBJECTIVES: The aim of this study is to compare voice outcomes in open partial horizontal laryngectomy vs. total laryngectomy (TL) with voice prosthesis. METHODS: In this retrospective monocentric study patients undergoing OPHL or TL with voice prosthesis were enrolled during the usual oncological follow-up consultations at the Otolaryngology and Audiology Unit of a University Hospital in the period between July 2022 and June 2023. Acoustic analysis (F0, HNR, NHR), maximum phonation time, I-SECEL and INFV0 scale were used to assess voice outcome. RESULTS: Forty-three patients were enrolled. Voices of patients undergoing LT were better in quality of voice (V0) at INFV0 scale. The scores in I-SECEL and acoustic analysis were comparable. CONCLUSIONS: Voice quality could be slight better in patients undergoing TL with voice prosthesis than those undergoing OPHL.
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Neoplasias Laríngeas , Laringectomía , Laringe Artificial , Calidad de la Voz , Humanos , Laringectomía/métodos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Neoplasias Laríngeas/cirugíaRESUMEN
OBJECTIVE: Open partial horizontal laryngectomies (OPHLs) represent a comparable alternative to total laryngectomy and nonsurgical protocols in selected cases. While short-term functional outcomes of OPHLs have been widely investigated, few have focused on the effect of aging on residual laryngeal structures. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care academic center. METHODS: Patients who underwent OPHLs after at least 1 year follow-up and optimal functional rehabilitation were included in the study. Swallowing function was assessed according to PAS (Penetration aspiration scale) and Pooling scores. Spectrogram analysis of voice was conducted according to Yanagihara classification and acoustic parameters were also recorded. Subjective questionnaire data about phonation and swallowing were also recorded. Data obtained were compared among patients according to age at time of surgery, evaluation and duration of follow-up. RESULTS: Ninety-seven patients were enrolled with a mean age at surgery and evaluation of 63 and 70 years old, respectively. Median follow-up length was 5 years. OPHL type II was mostly performed. No significant correlation was observed between most of the analyzed variables and patient's age at the time of surgery and at the time of evaluation. Some acoustic parameters were negatively correlated with follow-up length, while Jitter, NHR (Noise-Harmonic Ratio), and Global grade and Roughness were significantly higher in patients >65 years old. CONCLUSION: Patients who complete rehabilitation reach equally good results as their younger peers with stability over time. Finally, the effects of aging on residual larynx are of minor entity compared to the nonoperated patients. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.