Outcome after supracricoid laryngectomies in the material of ENT Department, Poznan University of Medical Sciences

All patients with T1 and T2 laryngeal cancer should be treated with the intent to preserve the larynx. In T3 glottic low-volume tumors, larynx preservation is an appropriate standard treatment option. Supracricoid partial laryngectomy remains a reasonable alternative to radiotherapy for patients with T2–T3 glottic cancer. Prospective clinical study aims to evaluate the oncological results of supracricoid partial laryngectomy as a treatment for selected glottic and supraglottic carcinoma, and to determine the different prognostic factors that may influence local control and survival. In the period of 2000–2007, 145 patients were treated at the academic tertiary referral medical center: ENT Department, University of Medical Sciences, Poznán, Poland. The ages of the analyzed group of patients ranged from 23 to 79, with mean 56.5 age for men and 25 for women. All of the patients had biopsy proven squamous cell carcinoma. Of the 145 patients 82 had glottic cancer and 63 had supraglottic cancer. The patients were staged according to the 2003 edition of the TNM classification established by the AJCC. The pathological TNM classification was additionally taken into consideration. All patients were treated by means of supracricoid and transglottic partial laryngectomy. The type of supracricoid partial laryngectomy was based on tumor localization and extension. Four patients underwent cricohyoidopexy, 57 cricohyoidoepiglottopexy, 65 reconstruction modo Calearo, and 19 modo Sedlacek-Tucker. We performed 21 unilateral selective neck dissections and none bilateral. A nasogastric feeding tube was inserted in all patients, and removed in patients that regained proper swallowing. As a result, we took into consideration the oncological and functional results. Histopathological examination of the operating specimen revealed the presence of dysplasia or invasive carcinoma at the margins, or a close margin of less than 5 mm from the edge of the resection (16 cases). The metastases were found on the neck in three cases, predominantly in the level II (2 cases) and III (1 case). Metastasis was found in one patient that had undergone CHP, Sedlacek-Tucker, and Calearo, respectively. Five patients received postoperative radiotherapy. The decision to use adjuvant radiotherapy was based on the presence of invasive carcinoma at the resection margin and on the presence of multiple positive neck nodes or extracapsular spread of the disease. The Kaplan–Meier estimated 3- and 5-year overall survival rates in the group of 122 because 23 patients did not report for medical check-ups

Dysphagia evaluation and treatment after head and neck surgery and/or chemoradiotherapy of head and neck malignancy

Tumors of the head and neck represent 3.2% of newly diagnosed cancer; both surgery and chemoradiotherapy are valid treatment options for head and neck cancer. In many head and neck cancer patients dysphagia, malnutrition, and aspiration pneumonia are found and significantly impact the quality of life. Dysphagia is related to the tumor itself or its treatment consequences. A large number of surgical procedures according to tumor site and extension, patient age, and general conditions have been developed and are reviewed in this chapter. Swallowing disorders are related to both the surgical approach (open or endoscopic) and the tissue removed; while surgery of oral and oropharyngeal cancers mainly impact the oral control, oral peristalsis, and mastication, partial laryngeal surgery interferes with airway protection mechanisms, and complete laryngeal removal may be complicated with hypopharyngeal strictures. Different chemoradiotherapy protocols are available nowadays and are here reviewed; dysphagia may arise in the first 2 years as well as many years afterwards and is mainly related to increased oropharyngeal transit time, reduced tongue and pharyngeal strength, restricted laryngeal and hyoid elevation, poor vestibule and true vocal fold closure, and possibly abnormal upper esophageal sphincter function. The primary treatment goal of dysphagia in head and neck cancer patients is to maintain functional oral feeding and prevent aspiration and thoracic complications. All patients treated for a head and neck cancer should have access to a dysphagia specialist and to an instrumental investigation in order to establish adequate treatment