Total Laryngectomy in Laryngeal and Hypopharyngeal Malignancy
Article Sidebar
Main Article Content
Abstract
Introduction
Advanced laryngeal and hypopharyngeal malignancies are associated with significant morbidity and mortality for the patients with associated financial burden for the society. Recommended treatment for such malignancies includes total laryngectomy or total laryngectomy with partial pharyngectomy with or without neck dissection, radiotherapy (RT) alone or surgery followed by radio therapy and combined chemotherapy (CT) with radiotherapy (CCRT).
Materials and Methods
This retrospective study was conducted over a period of 5 years, in a tertiary care institute with aim to study the incidence of laryngeal and hypopharyngeal malignancy over a period of 5 years in a tertiary care institute, to assess the proportion of patients who agreed to undergo the proposed modality of treatment with surgery and post-operative radiotherapy, to note the post operative complications and also to assess the 5 year survival of the patients who completed the prescribed regimen.
Result
This study highlights the large gap between the high incidence of this disease (a total of 170 cases of laryngeal and hypopharyngeal malignancy diagnosed in our hospital over a five year period ) and the low turnover of patients actually undergoing surgery for the same (8 out of 38 patients who were advised surgery underwent the same).
Discussion
Vast majority of laryngeal and hypopharyngeal malignancies are squamous cell carcinomas. Though 47 proved cases of hypopharyngeal malignancy and 36 proved cases of laryngeal malignancy were assessed, only 8 patients agreed to undergo surgery, indicating a large disparity between disease burden and treatment beneficiaries, despite an excellent 5 yr survival rate.
Conclusion
The results of this study emphasized the need for increased awareness regarding the favourable surgical outcome when associated with post-operative radiotherapy. A very high five year survival rate can be achieved by combined modality treatment. Late presentation and lack of awareness about the disease are significant hindrances for management of laryngeal and hypopharyngeal malignancy.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Hoffman HT, Karnell LH, Funk GF. et al. The National Cancer Data Base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998; 124(9):951-62. doi: 10.1001/archotol.124.9.951
Chu EA, Kim YJ. Laryngeal cancer: diagnosis and preoperative work-up. Otolaryngol Clin North Am. 2008; 41(4):673-95. doi: 10.1016/j.otc.2008.01.016
Shah JP, Karnell LH, Hoffman HT. et al. Patterns of care for cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg. 1997; 123(5):475-83. doi: 10.1001/archotol.1997.01900050021002
Davis GE, Schwartz SR, Veenstra DL, Yueh B. Cost comparison of surgery vs organ preservation for laryngeal cancer. Arch Otolaryngol Head Neck Surg. 2005; 131:21-6. doi: 10.1001/archotol.131.1.21
Starmer HM, Tippet DC, Webster KT. Effects of laryngeal cancer on voice and swallowing. Otolaryngol Clin North Am. 2008; 41(4):793-818. doi: 10.1016/j.otc.2008.01.018
Sessions DG, Lenox J, Spector GJ, Newland D, Simpson J, Haughey BH, Chao KS. Management of T3N0M0 glottic carcinoma: therapeutic outcomes. Laryngoscope 2002; 112(7 Pt 1):1281-8
Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH. Management of stage IV glottic carcinoma: therapeutic outcomes. Laryngoscope 2004; 114(8):1438-46. doi: 10.1097/00005537-200408000-00024
Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol. 2009; 266(9):1333-52. doi: 10.1007/s00405-009-1028-2
Karatzanis AD, Psychogios G, Zenk J, Waldfahrer F, Hornung J, Velegrakis GA, Iro H. Comparison among different available surgical approaches in T1 glottic cancer. Laryngoscope 2009; 119(9):1704-8. doi: 10.1002/lary.20537
Mantsopoulos K, Psychogios G, Koch M, Zenk J, Waldfahrer F, Iro H. Comparison of different surgical approaches in T2 glottic cancer. Head Neck 2012; 34(1):73-7. doi: 10.1002/hed.21687
Ferlito A, Shaha AR, Lefebvre JL, Silver CE, Rinaldo A. Organ and voice preservation in advanced laryngeal cancer. Acta Otolaryngol. 2002; 122:438-42. doi: 10.1080/00016480260000166
Weir NF. Theodore Billroth: the first laryngectomy for cancer. J Laryngol Otol. 1973; 87(12): 1161-9
Dworkin JP, Hill SL, Stachler RJ, Meleca RJ, Kewson D. Swallowing function outcomes following nonsurgical therapy for advanced-stage laryngeal carcinoma. Dysphagia 2006; 21:66-74. doi: 10.1007/s00455-005-9001-8.