Supratracheal laryngectomy: a multi-institutional study

Abstract Introduction: Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective: To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods: This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results: Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion: Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.

摘要 引言：气管上喉切除术（Supratracheal laryngectomy）作为一种手术术式，被用于治疗侵犯声门下区域和/或累及环杓关节的声门型或声门上型喉癌，其目标在于保留喉功能（呼吸、发声与吞咽），同时不降低局部区域的癌症控制效果。针对此类病例选择环状软骨上喉切除术（Supracricoid laryngectomy），可能会大幅增加手术切缘受累的风险。研究目的：本研究旨在通过回顾巴西三家不同医疗机构的手术数据，评估气管上喉切除术治疗中晚期喉癌的安全性、可行性、手术切缘充分性及临床疗效。研究方法：本研究为回顾性研究，分析了1997年10月至2017年6月期间接受气管上喉切除术的29例患者的病历资料。手术类型根据欧洲喉科学会（European Laryngological Society）的水平喉切除术分类标准进行划分。研究对手术的早期及远期疗效进行了评估，并计算了总生存率、疾病特异性生存率、无病生存率及无全喉切除术生存率。患者的平均随访时长为44个月。研究结果：在接受气管上喉切除术的29例患者中，25例未接受过前期治疗。1例（3.4%）患者出现手术切缘受累。4例（13.8%）患者出现肿瘤复发，其中3例为局部复发，1例为区域复发。17.2%（5例）的患者后续需行全喉切除术，其中2例因固定缝线断裂，3例因局部复发。该5例患者中4例（80%）成功完成了全喉切除术。13.8%（4例）的患者死亡，其中2例死于术后并发症，2例死于肿瘤复发。术后5年的总生存率、疾病特异性生存率、无病生存率及无全喉切除术生存率分别为82.1%、88.2%、83.0%及80.2%。研究结论：针对经筛选的中晚期喉癌患者，气管上喉切除术可使其获益，该术式的无全喉切除术生存率及疾病特异性生存率分别可达80.2%与88.2%。