Conservation surgery for recurrent carcinoma of the glottic larynx

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Background

Partial laryngectomy following previous irradiation is an oncologically sound procedure with excellent local control and survival rates. Several reports suggest an increased complication rate in previously irradiated patients.

Methods

To analyze whether previous irradiation affected complications, disease control, or survival we performed a retrospective analysis of all patients who underwent vertical partial laryngectomy (VPL) for squamous cell carcinoma of the glottic larynx between January 1984 and August 1993.

Results

Sixty-eight patients had adequate followup. The overall 5-year survival rates were 79% for previously treated patients and 95% for primary VPL patients (P = NS). The local control rates with surgical salvage were 93% and 98%, respectively. No increase in wound complications, time to decannulation, length of hospitalization, or ability to swallow were found.

Conclusions

VPL can be performed safely in selected patients following previous radiotherapy without a significant increase in complications or cost.

References (14)

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    One meta-analysis review found better rates of local control in select patients without impairment of vocal fold immobility or significant extension to the subglottis or supraglottis.10 VPL as salvage surgery for early-stage glottic cancers that recur after RT has been shown to have rates of local control ranging from 55% to 100%, without significantly different functional outcomes from those who had VPL as the primary surgery.11–13 Laccourreye and colleagues14 observed a 78.1% laryngeal preservation rate for VPL in the salvage setting, strictly in patients in whom the tumor has not enlarged.

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    2011, Oral Oncology
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    Can TLE be used in the face of RT failure? Lydiatt et al [24] reported on 78 patients treated by vertical partial laryngectomy following RT failure. There was no increase in wound complications, time to decannulation, length of hospital stay, or ability to swallow.

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Current address (WML, KML): University of Nebraska Medical Center, VA Hospital and Methodist Hospital, Omaha, Nebraska.

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