[Surgical management of subglottic carcinoma]

To explore the clinical features and the methods of surgery and functional restoration of subglottic carcinoma.

Thirteen cases with primary subglottic carcinoma were treated surgically in this department from 1981 to 1997. Among them, six had T1-2N0 lesions, one had T3N0 lesion and six had T3-4N1-2 lesions. Four cases underwent total laryngectomy and nine had subglottic partial laryngectomy. The extensive subglottic partial laryngectomy was performed on patients with tracheal invasion. The defects of larynx were reconstructed by using unilateral or bilateral pedicled musculocutaneous flap, myofascial flap accordingly. T-shape silastic tube was placed in to the reconstructed cavity of larynx during the operation and the patients were decannulated in 2 to 6 months. Unilateral radical neck dissection was performed on 4 patients and bilateral on 2.

All cases had restored the function of phonation except for 4 who underwent total laryngectomy. Five out of 9 (55.6%) were decannulated. The swallowing function was restored in all patients. The 3-year and 5-year survival rates were 100% and 66.7% in the cases with total laryngectomy, 88.9% and 75.0% with subglottic partial laryngectomy, respectively.

It is possible to detect early subglottic carcinoma by using fiberoptic laryngoscopy routinely with the combination of stroboscopy, CT, MRI in male patients over 40 with hoarseness. It is practical that the whole or partial function of larynx could be restored in most cases with subglottic carcinoma after partial laryngectomy or subtotal laryngectomy. Unilateral or bilateral neck dissection should be performed on patients with T3 or T4 lesion. Postoperative radiotherapy is necessary.