Retrospective chart review.
METHODS: Twenty-four consecutive patients who underwent SCL for
laryngeal cancer in our institution from December 2000 to March 2006 have been reviewed. Reports of the site and extent of
tumor, type of reconstruction, preoperative or postoperative
radiotherapy, and the final histopathologic examination were reviewed. In addition, the reports of the preoperative examination, inpatient course, and postoperative follow-up were reviewed.
RESULTS: A total of 24 patients were involved in the study; 19 had
tumors involving the glottic region, and 5 patients had
tumors involving both the glottic and supraglottic regions (transglottic). Ten patients had their SCL for postradiotherapy recurrence/persistence of disease. Eighteen patients underwent reconstruction through cricohyoidoepiglottopexy (CHEP), whereas six patients had cricohyoidopexy (CHP). Eleven patients had an arytenoid cartilage resected; 8 of 11 had CHEP, and 3 of 11 had CHP. All patients had a
tracheostomy and percutaneous endoscopic
gastrostomy (PEG) tube placement performed at the same time as the SCL. The median
hospital stay period was 6 days. Twenty-three of 24 had successful
tracheostomy tube decannulation, with a median time to decannulation of 37 days. The median time to removal of the PEG tube was 70 days. The complications with SCL were
postoperative wound infection in two patients (SCL/CHP) and the need for completion total
laryngectomy secondary to intractable aspiration in one patient with SCL/CHP. One patient with SCL/CHEP had a ruptured pexy and subsequently underwent a second reconstruction with successful
tracheostomy and PEG tube removal. One of 24 patients is still PEG tube dependant, and he had postoperative
radiotherapy. Fifteen patients underwent concurrent
neck dissection. None of the patients had any local or regional recurrence, with a median follow-up period of 3 years. All final
surgical margins were negative for
tumor invasion. Three patients had postoperative
radiotherapy, two patients because of nodal
metastases in the excised lymph nodes and one because of perineural invasion on final histopathologic examination of the SCL specimen. There were no perioperative deaths.
CONCLUSION: SCL with CHEP or CHP represents an effective technique that can be taught and effectively used to avoid a total
laryngectomy while maintaining physiologic speech and swallowing in selected patients with advanced stage primary
laryngeal cancer or recurrent/persistent
laryngeal cancer after
radiotherapy. There is a good functional recovery with acceptable morbidity and an excellent oncologic outcome when strict selection criteria are applied and a formal swallowing rehabilitation program is followed.