Near total laryngectomy: a single institutional experience

Background: Near total laryngectomy (NTL) aims to remove cancer of larynx and hypopharynx while maintaining a lung powered, prosthesis free voice. The oncological and functional outcomes of NTL have been encouraging but the surgical procedure is complex. In this study, we present our experience with NTL in order to encourage more ENT and head and neck surgeons to take up the procedure.Methods: Twenty-eight patients, who had undergone NTL at State cancer institute, Guwahati are analysed retrospectively for survival, disease free status, functional outcomes and complications.Results: There were two recurrences: one local recurrence which was salvaged by a completion total laryngectomy. The other patient had distant metastasis and died eventually. Overall survival (OS) was 96.43% and event free survival (EFS) was 92.86%. The patient who died had extra-nodal extension (ENE) on post op histology (p=0.274). Two patients failed to develop any speech had stenosis of the shunt. One of these was the only Salvage NTL case (p=0.057). Tracheostome stenosis, poor swallow and shunt stenosis were the common complications in our series. Most of them resolved with some intervention. Multiple complications were seen in the salvage NTL cases.Conclusions: Careful case selection and well executed surgery leads to acceptable results following NTL. Special attention should be paid to the salvage cases as they are prone to develop complications and failure to attain speech. Patients with adverse post-op histopathological examination (HPE), like ENE should be kept under close follow up

Comparison of post-operative complications in oral cancer treated with and without neoadjuvant chemotherapy

Aim: The aim of the present study was to compare the treatment outcome in oral cancer cases treated with neoadjuvant chemotherapy (NACT) and upfront surgery in localized advance disease. Materials and Methods: A randomized, prospective study was conducted in 20 cases. Patients were divided into two groups. Group A was taken up for upfront surgery and group B was taken up for surgery after two to three cycles of NACT based on patients' response, performance, and compliance. Results: Neither group showed statistically significant differences in clinical characteristics. In the present study, satisfactory outcomes were seen in nine patients belonging to NACT group and eight patients of non-NACT group had satisfactory outcomes after surgery, which were found to be statistically significant (P = 0.001). Conclusion: NACT may be considered as a treatment option for oral squamous cell carcinoma patients, particularly those with locally advanced tumors. Further prospective studies are needed to validate these findings in patients