[Horizontal laryngectomy in treatment of laryngeal cancer--oncologic and function results]

The purpose of this paper was the retrospective evaluation of the results after horizontal partial larynx resection of different dimension. The material comprised 468 patients treated according to the described techniques in ENT Clinic Pom. Med. Acad. between 1970-1991. The series of patients subjected to analysis consisted of 35% of all cases treated by surgery and 70% of all conservative operations performed for cancer of the larynx in the above-mentioned period of time. Particulars were obtained from: a) case history, b) control examination, c) correspondence, d) data from USC. The results of the treatment in particular groups were submitted for detailed analysis. The assessment of applied technique from oncologic point of view was done on the basis of local recurrences and percentage of 3 and 5 years survival rate. Functional results were evaluated according to protective, respiratory and phonatory functions of the residual larynx. Results of the investigations were submitted for statistic valuation. In all types of operations satisfactory oncologic results were achieved. They were represented by high percentage of survival rate and low percentage of local recurrences. The longest survival 3- and 5-years respectively (73.90%) and 63.45%) and the lowest index of local failure (4.2%) were seen after classic, supraglottic resection. After horizontal glottic larynx resection 8/10 of patients operated on survived 3 years, 4/6 survived 5 years. Local recurrence was observed in 1/12 patients (Tab. 2). The lowest rate of survival (54.76% and 42.86%) and the highest number of local failures (11.3%) were revented after supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP)--in this group carcinomas staged T3 were predominant. After enlarged supraglottic laryngectomy and supracricoid resection with cricohyoidopexy (CHP) oncologic results were very close (Fig. 1). No substantial statistical difference was recorded in survival percentage after enlarged supraglottic larynx resection (70.51% and 61.66%) and supracricoid one with CHP (68.54% and 58.43%), nor in percentage of local recurrences (4.4% and 5.7%). The efficiency of the residual larynx was dependent on the extent of the resection. From the discussed types of operations the best functional results were achieved after classic supraglottic and glottic larynx resections. This was distinct in the best quality of speech, efficient respiratory tract protection and high percentage of decannulated cases (93%). In the glottic resection the respiratory tract protection was satisfactory in 9/11 patients and in 7/8 satisfactory speech quality was noticed. Following the extended laryngeal structures resection (extended supraglotic and supracricoid laryngectomies) worse protection of respiratory tract, higher percentage of not decannulated cases and worse quality of speech were observed than in operation previously discussed. It was proved that the one-stage reconstruction of the laryngeal structures (arytenoid cartilage and/or vocal cord) or base of the tongue improves the result considerably, in particular the deglutition and phonation. The oncologic and functional results after the discussed types of operation should stimulate their more frequent application in larynx cancer treatment.