Organ preservation surgery for laryngeal cancer

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented

Laringectomia supracricóide (chep) para câncer glótico

OBJETIVOS: Com a intenção de se avaliar os resultados funcionais e terapêuticos da laringectomia supracricóide com crico-hióide-epiglote-pexia (CHEP) foram estudados 50 casos de pacientes com carcinoma epidermóide da glote classificados como T2/T3 submetidos a esta técnica em nossa instituição. MÉTODOS: Foi realizada uma análise retrospectiva entre 1996 e 1999. Classificamos 18 pacientes como T2N0M0 e 32 pacientes como T3N0M0. Quarenta e um pacientes foram submetidos a esvaziamento cervical seletivo lateral bilateralmente, quatro foram submetidos ao mesmo esvaziamento unilateralmente, e cinco não foram esvaziados. Analisamos as complicações e a sobrevida livre de doença pelo método de Kaplan-Meyer. RESULTADOS: Dez pacientes tiveram complicações pós-operatórias, dois foram tratados com complementação da laringectomia. Os 48 pacientes restantes mantiveram a via aérea normal, deglutição e a voz. Três pacientes no grupo submetido a esvaziamento cervical apresentaram linfonodo metastático. Quatro pacientes tiveram recidiva da doença, três com recidiva local, sendo dois tratados com laringectomia total e estão vivos e sem doença, o outro com doença avançada alcançou o óbito pela doença. O paciente que teve recidiva no pescoço foi tratado com esvaziamento cervical mais radioterapia e morreu com doença. Dois pacientes tiveram um segundo tumor primário em orofaringe, sendo um tratado com radioterapia paliativa e morreu com doença e o outro tratado com cirurgia está vivo e sem doença. A sobrevida livre de doença em três anos foi de 88% para pacientes T2 e 72% para pacientes T3. CONCLUSÕES: Esta técnica é útil no tratamento de casos selecionados de carcinoma epidermóide da glote T2/T3 sempre se considerando a extensão da doença. A incidência de complicações necessitando laringectomia total de resgate não compromete a funcionalidade desta técnica. A sobrevivência é comparável aos pacientes submetidos a laringectomia total e laringectomia "near-total"

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