[Results of operations of salvage laryngectomy]

The surgery of the larynx in an irradiated neck changed since 30 years by an evolution of the radiotherapeutic technics and the surgical procedures. At the Curie Institute, from 1960 to 1986, 230 patients were operated with laryngectomy for failure of the first treatment (average doses: 70 Gy). 29 had partial laryngectomy. The feeding tube was removed before 6 weeks in 78% of the patients. 19 patients (8%) died in the 3 months after surgery (8 carotid blow-up). The crude survival rates are 70% at 1 yr, 42% at 3 tr, 37% at 5 yr. These rates are identical in patients with persistent disease two months after irradiation (90), in patients with recurrence (110) and for those with second primary in the larynx (21). 54% of T1 and T2 patients are NED at 3 yr and 47% at 5 yr. For T3 and T4 rates are only 22% and 17%. Best results are in glottic cancers (74% at 3 yr); poorest in advanced supra-glottic (17%). Salvage procedure is effective in larynx and neck in 62% of the patients. Early detection of a failure after irradiation is a major condition for the application of a protocol of definitive radiotherapy in laryngeal cancer.