Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Supratracheal partial laryngectomy (STPL) has been described as a function-sparing surgical procedure for laryngeal cancer with sub-glottic extension. The aim of the present multi-institutional study was to focus on the indications and contraindications, both local and general, for this type of surgery based on the long-term oncological and functional results. We analysed the clinical outcomes of 142 patients with laryngeal cancer staged pT2-pT4a who underwent STPL. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and loco-regional control (LRC) rates were: glottic pT2 [71.4%, 95.2%, 76.0%, 76.0%], glottic-transglottic pT3 [85.3%, 91.1%, 86.4%, 88.7%], and pT4a [73.2%, 88.1%, 52.7%, 60.7%], respectively. DFS and LRC prevalences at 5 years were greatly affected by pT4a staging. Five-year laryngeal function preservation (LFP) and laryngectomy free survival (LFS) were: glottic pT2 [90.9%, 95.2%], glottic-transglottic pT3 [84.4%, 93.1%], and pT4a [63.7%, 75.5%], respectively, being affected by pT staging and age 65 ≥ years (LFP 54.1%). As a result of Type III open horizontal partial laryngectomies (OPHLs) (supratracheal laryngectomies), the typical subsites of local failure inside the larynx were the mucosa at the passage between the remnant larynx and trachea, the mucosa at the level of the posterior commissure and the contralateral cricoarytenoid unit as well as outside the larynx at the level of the outer surface of the remnant larynx. For patients with glottic or transglottic tumours and with sub-glottic extension, the choice of STPL can be considered to be effective, not only in prognostic terms, but also in terms of functional results.

Il cancro della laringe in fase intermedio / avanzata rappresenta ancora una grande sfida in termini di controllo della malattia e di preservazione d’organo. La laringectomia parziale sopratracheale (STPL) e stata descritta come procedura chirurgica di function-sparing per il cancro della laringe con estensione sub-glottica. Lo scopo del presente studio multi-istituzionale e di concentrarsi sulle indicazioni e controindicazioni, sia locali che generali, per questo tipo di chirurgia sulla base dei risultati oncologici e funzionali a lungo termine. Abbiamo analizzato i risultati clinici di 142 pazienti con cancro della laringe in stadio pT2-pT4a sottoposti a STPL. A cinque anni i tassi di sopravvivenza globale (OS), di sopravvivenza malattia specifica (DSS), di sopravvivenza libera da malattia (DFS) e di controllo loco-regionale (LRC) sono risultati rispettivamente: pT2 glottici [71,4%, 95,2%, 76,0%, 76,0%] , pT3 glottici-transglottici [85,3%, 91,1%, 86,4%, 88,7%], e pT4a [73,2%, 88,1%, 52,7%, 60,7%]. La DFS ed il LRC a 5 anni sono risultati fortemente influenzati dallo stadio pT4a. A cinque anni i tassi di conservazione della funzione laringea (LFP) e la sopravvivenza libera da laringectomia (LFS) sono risultati: pT2 glottici [90,9%, 95,2%], pT3 glottici-transglottici [84,4%, 93,1%] e pT4a [63,7%, 75,5%], risultando negativamente influenzati dal pT staging e dall’eta di 65 ≥ anni (LFP 54,1%). A seguito di laringectomia parziale sopratracheale le sedi tipiche di recidiva sono risultate all’interno della laringe la mucosa al passaggio fra laringe residua e trachea , la mucosa a livello della commissura posteriore, l’unita cricoaritenoidea controlaterale e all’esterno la superficie esterna della laringe residua. Per i casi di tumore glottico con estensione subglottica o di tumore con importante estensione transglottica, la scelta di una STPL puo essere considerata efficace, non solo in termini prognostici, ma anche in termini di risultati funzionali.

Supratracheal laryngectomy: current indications and contraindications [Laringectomia sopratracheale: Indicazioni e controindicazioni] / Succo, G.; Bussi, M.; Presutti, Livio; Cirillo, S.; Crosetti, E.; Bertolin, A.; Giordano, L.; Molteni, Gabriele; Petracchini, M.; Sprio, A. E.; Berta, G. N.; Fornari, A.; Rizzotto, G.. - In: ACTA OTORHINOLARYNGOLOGICA ITALICA. - ISSN 1827-675X. - ELETTRONICO. - 35:3(2015), pp. 146-156.

Supratracheal laryngectomy: current indications and contraindications [Laringectomia sopratracheale: Indicazioni e controindicazioni]

PRESUTTI, Livio;MOLTENI, Gabriele;
2015

Abstract

Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Supratracheal partial laryngectomy (STPL) has been described as a function-sparing surgical procedure for laryngeal cancer with sub-glottic extension. The aim of the present multi-institutional study was to focus on the indications and contraindications, both local and general, for this type of surgery based on the long-term oncological and functional results. We analysed the clinical outcomes of 142 patients with laryngeal cancer staged pT2-pT4a who underwent STPL. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and loco-regional control (LRC) rates were: glottic pT2 [71.4%, 95.2%, 76.0%, 76.0%], glottic-transglottic pT3 [85.3%, 91.1%, 86.4%, 88.7%], and pT4a [73.2%, 88.1%, 52.7%, 60.7%], respectively. DFS and LRC prevalences at 5 years were greatly affected by pT4a staging. Five-year laryngeal function preservation (LFP) and laryngectomy free survival (LFS) were: glottic pT2 [90.9%, 95.2%], glottic-transglottic pT3 [84.4%, 93.1%], and pT4a [63.7%, 75.5%], respectively, being affected by pT staging and age 65 ≥ years (LFP 54.1%). As a result of Type III open horizontal partial laryngectomies (OPHLs) (supratracheal laryngectomies), the typical subsites of local failure inside the larynx were the mucosa at the passage between the remnant larynx and trachea, the mucosa at the level of the posterior commissure and the contralateral cricoarytenoid unit as well as outside the larynx at the level of the outer surface of the remnant larynx. For patients with glottic or transglottic tumours and with sub-glottic extension, the choice of STPL can be considered to be effective, not only in prognostic terms, but also in terms of functional results.
2015
35
3
146
156
Supratracheal laryngectomy: current indications and contraindications [Laringectomia sopratracheale: Indicazioni e controindicazioni] / Succo, G.; Bussi, M.; Presutti, Livio; Cirillo, S.; Crosetti, E.; Bertolin, A.; Giordano, L.; Molteni, Gabriele; Petracchini, M.; Sprio, A. E.; Berta, G. N.; Fornari, A.; Rizzotto, G.. - In: ACTA OTORHINOLARYNGOLOGICA ITALICA. - ISSN 1827-675X. - ELETTRONICO. - 35:3(2015), pp. 146-156.
Succo, G.; Bussi, M.; Presutti, Livio; Cirillo, S.; Crosetti, E.; Bertolin, A.; Giordano, L.; Molteni, Gabriele; Petracchini, M.; Sprio, A. E.; Berta, G. N.; Fornari, A.; Rizzotto, G.
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