Hemilaryngectomy for T3 (fixed cord) epidermoid carcinoma of larynx

This clinicopathologic study was undertaken to determine whether true vocal cord fixation produced by epidermoid carcinoma is an absolute contra-indication to treatment by hemilaryngectomy. In a consecutive series of 114 hemilaryngectomies performed at McMillan Hospital (1960-1967) for previously untreated epidermoid carcinoma, 18 patients had fixation of the involved true vocal cord. Each hemilaryngectomy specimen (serial step sections in the longitudinal plane) was re-examined to ascertain the cause of vocal cord fixation; the adequacy of margin; and the presence of blood vessel, nerve sheath and cartilage invasion. Clinical follow-up on each patient was current through December, 1972 (5-12 years postop). All of these cases were seen initially by one of the authors (J.H.O.). Serial sections revealed that true vocal cord fixation was caused by muscle invasion in 14 of the 18 patients. "Positive margins" were present in eight patients but no immediate treatment was given. Two of these patients developed biopsy proven local recurrences, and both were cured with Co60 irradiation. Among the 18 patients with T3 epidermoid carcinoma treated by hemilaryngectomy: a. Three local recurrences developed, all in the anterior commissure. Two were cured with irradiation. The third had a laryngectomy but died from persistent cancer. b. Two patients developed cervical metastases (without local recurrence), and one was salvaged with radical neck dissection. c. Four patients died of other causes, cancer free, three to five years postoperatively. Of the 14 determinant patients, two patients died of cancer. Twelve (85 percent) were alive and free of cancer five years postoperatively. Two had received full course irradiation; one had a radical neck dissection, and all 12 had a functioning larynx. When Ogura's patients are added to the reports of other hemilaryngectomies performed despite true vocal cord fixation (Leroux-Robert [1950] 18/24, Kirchner, Som [1971] 13/19), a determinant salvage rate of 78 percent can be expected. True vocal cord fixation is generally caused by invasion of the vocalis muscle and thus may be well encompassed by a hemilaryngectomy. The precise anatomical limits of the lesion should dictate the type of surgery required for cure.