Partial Horizontal Laryngectomy and Epiglottiplasty

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat some patients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriform fossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4 % in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7 % after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.

SUPRAGLOTTIC LARYNGECTOMY WITH OR WITHOUT ONEARYTENOID IN EPIGLOTTIC CARCINOMA (40 CASES REPORT)

Objective: To investigate the indications of supraglottic laryngectomy. Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottis squamous carcinoma. This procedure consists of resection of the thyroid cartilage, epiglottis and the entire preepiglottic space. Methods: Between 1990 and 1996, we used supraglottic laryngectomy to treat 40 patients with supraglottic carcinoma. The data were collected by a review of patient records and follow-up. The cancers were stages T1 (17 cases), T2 (17 cases) and T4 (6 cases) according to the 1987 UICC on cancer staging criteria. Results: 12 ipsilateral and one bilateral functional neck dissection were operated simultaneously. Of which 7 patients had metastasis in lymph nodes. No patient died postoperatively. Only 8 (20%) had slight aspiration before the 20th day. All patients had decannulated. 29 cases received radiotherapy and chemotherapy. A follow-up analysis showed survived rate of 74% at 3 years. Conclusion: We propose supraglottic laryngectomy for the surgical treatment of early supraglottic carcinomas, which could acquire almost normal laryngeal function.

Reorganization characteristics of speech cortex during speech restoration following total laryngectomy A functional magnetic resonance imaging follow-up

During speech restoration following laryngectomy, language-related cortical areas develop connections with new primary motor neurons. The present study followed up 18 patients after total resection of laryngeal carcinoma. According to an evaluation of pronunciation, patients were assigned to three groups： poor, moderate and good pronunciation. Functional magnetic resonance imaging revealed significant increases in the number of activated voxels and the intensity of activation changes in the left middle frontal gyrus, left precentral gyrus, left postcentral gyrus, left supplementary motor area, left anterior cingulate gyrus and right fusiform gyrus between the moderate pronunciation group compared with the poor and good pronunciation groups. We propose that these brain regions play an important role in the progress of speech restoration, and improvements in pronunciation learning for patients following laryngectomy. However, during the later period of speech restoration, the number of activated voxels and intensity changes in these regions decreased to the level of healthy controls, indicating that the learning and instruction effects weakened once patients had mastered pronunciation techniques

Reconstruction of laryngeal function in subtotal laryngectomy with preservation of monoarytenoid cartilage

Objective: To evaluate subtotal laryngectomy with preservation of monoarytenoid cartilage to re-construct laryngeal function in the treatment of advanced laryngeal cancer. Methods: We retrospectively re-viewed 48 patients with advanced laryngeal cancer (T3 or T4 on the primary site) treated by subtotal laryngec-tomy with preservation of monoarytenoid cartilage to reconstruct laryngeal function. Eighteen of them under-went neck dissection. Ipsilateral recurrent laryngeal nerve was preserved during this surgery. The cricoid cartilage was anastomosed to hypopharynx accordingly. Results: The overall 3- and 5-year survival rates were 81.25% (39/45) and 66% 67% (32/48), respectively. All patients had good phonation and swallowing function after surgery. Decannulation rate was 93. 75%. Conclusion: Subtotal laryngectomy with preserva-tion of monoarytenoid cartilage is satisfactory for treatment of elected advanced laryngeal cancers. The effect of this surgery is more satisfactory than that of the near-total laryngectomy (Pearson''s technic).

Investigation of QOL after Laryngectomy Using the UW-QOL Questionnaire with Chinese Patients

OBJECTIVE To assess the postoperative QOL(Quality of Life) of Chinese laryngeal cancer patients who have undergone a partial or total laryngec-tomy, and to analyze their prognostic factors, as well as to assess the feasibility of using the University of Washington Quality of Life (UW-QOL) questionnaire in QOL studies of laryngeal cancer patients, METHODS Using the UW-QOL questionnaire, a survey was conducted in patients treated by a partial or total laryngectomy for laryngeal cancer. RESULTS Questionnaires were sent to 142 patients who were disease-free for more than half a year after surgery. Replies were received from 130 patients (91% response rate) with 118 patients completing the questionnaire. These patients were divided into 2 groups: a partial-laryngectomy group (n=81; excluding cordectomy) and a total -laryngectomy group (n=37). The composite QOL scores of the partial-laryngectomy group (692.3±127.9) were higher than those of total-laryngectomy group (636.4±140.0), showing a statistically significant difference (P<0.05). The partial-laryngectomy group (74.3±23.8; 80.9±20.3) was better than the total-laryngectomy group (40.3±25.8; 69.6±27.1) in speech and appearance (P<0.001; P<0.05); but the total-laryngectomy group (92.6±13.0) was superior to the partial-laryngectomy group (83.0±20.5) in pain (P< 0.01). Six factors including cancer stage, operative modality, complications, postoperative radiotherapy or chemotherapy, living partners and chronic disease before or after operation were related to postlaryngecto-my QOL. CONCLUSION Partial laryngectomy is superior to total laryngectomy in speech, appearance and overall QOL. Besides operative modality, cancer stage, complications, postoperative radiotherapy or chemotherapy, living partners and chronic diseases before or after operation are factors influencing postlaryngectomy QOL. As a whole, the UW-QOL questionnaire is a good instrument for studying QOL of laryngeal cancer patients in China, and it can be used to explore the QOL outcomes obtained from different reconstructive techniques.

Comparison of the Clinical Outcomes of Early Enteral Nutrition Versus Convenience Diet by Tube Feeding Following Laryngectomy in Chinese Patients

The purpose of the present study was to evaluate the efficiency of early enteral nutritional support in patients undergoing laryngectomy. We retrospectively reviewed and analyzed 329 laryngeal cancer patients who underwent total or partial laryngectomy from November 2003 to July 2013 in our hospital. Of those patients, 278 were given enteral nutrition (EN group) with elemental formulations through a nasogastric tube beginning within 24 hours after the surgery, while 51 chose not to receive the elemental formulations and were on a homogenate diet (convenience diet group, CD group), which was also given through a nasogastric tube. The clinical outcomes were compared between the two groups. Thirteen patients in the EN group (13/278, 4.68%) and six patients in the CD group (6/51, 11.76%) developed fistulas. The difference was statistically significant (P < 0.046). The differences in the post-surgical infection rate, average length of hospitalization and other clinical indicators between the two groups were not statistically significant. In conclusion, early enteral nutrition should be recommended in patients undergoing laryngectomy, and convenience diet is not as effective as the commercial formulation in reducing the risk of fistula formation.

A Qualitative Study on Experiences of Patients with Esophageal Speech Training after Total Laryngectomy

Background: Patients who had total laryngectomy not only have a pressure from the possible diagnosis of laryngeal cancer, but also suffer from unspeakable misery. To relieve the suffering, some patients choose esophageal speech training. However, most of the current researches focus solely on the results of the training with the negligence of the patients’ mental health and their life experience during the training. A qualitative research is highly sensitive to patients’ subjective feelings, and thus able to capture their subtle emotional changes. Objective: To explore deeply patients’ real experiences of esophageal speech training after total laryngectomy and reveal the public their training experience of the unique and special group. Methods: In May 2018, researchers conducted a two-month field observation on and in-depth interviews with 15 patients who were on esophageal speech training after total laryngectomy in the esophageal speech training room of the Eye and ENT Hospital of Fudan University. The research applied phenomenological research method and Colaizzi Data Analysis. Results: The data analysis indicated four main themes: changes of mindset;showing positive attitudes and behaviors in training;shift in social relations;and arduous training process. Conclusion: The study has the finding that patients on esophageal speech training had negative emotions in the early stage of the training and dissatisfaction with its teaching. The repercussion of the surgery brought them changes of social relations, social bias and prejudice ensued. It is, therefore, urgent and crucial to give the speech trainees psychological counseling in the early stage to improve their qualities of life, to mobilize social support to incentivize their training, to optimize esophageal speech training teaching, and to regulate the management of the esophageal speech training environment.

Linear Stapler in Total Laryngectomy

Introduction: Stapler application for pharyngeal closure after total laryngectomy allows rapid watertight closure. We intend to report the experience of the Portuguese Oncology Institute of Lisbon, Francisco Gentil (IPOLFG). Material and Methods: Retrospective study of patients submitted to total laryngectomy using linear stapler device treated in IPOLFG from 2005 to 2010. Results: 108 patients were studied. The majority of patients were male, aged from 60 to 69 years old, and had smoking and alcohol habits. The average length of hospital stay was 13.1 days. Post-operative complications occurred as follows: wound infection in 6.5%, cervical hematoma in 4.6% and pharyngocutaneous fistula in 11.1% of cases. Conclusions: The mechanical suture of the pharynx in total laryngectomy is a simple and quick method. It does not increase the incidence of post-operative complications. It seems to be a very safe method, as long as its limits regarding the location and extent of tumour are respected.

The use of Montgomery salivary bypass tubes and pharyngocutaneous fistula following salvage laryngectomy

Objectives:Pharyngocutaneous fistula(PCF)is the most common complication to follow total laryngectomy(TL)and is associated with increases in length of hospital stay and with a need for revision surgery or readmission,as well as with delays in return to oral diet.Patients who require salvageTL(STL)or primary(chemo)radiation therapy are at higher risk for developing PCF.Due to the quality‐of‐life burden of PCF on patients,limiting this occurrence is crucial.Methods:We conducted a retrospective cohort study of patients undergoing STL with placement of Montgomery salivary bypass tube(MSBT)^(TM)for at least 2 weeks duration between 2013 and 2017 at a single institution.Our patients all underwent free flap reconstruction.Our primary outcome of interest was development of PCF.Secondary outcomes included demographics,previous treatment,base of tongue(BOT)involvement,extent of defect,concurrent neck dissection(ND),and margin status.Univariateχ^(2) analysis was used to evaluate factors associated with PCF.Results:Forty‐four patients underwent STL with Montgomery tube placement and free flap reconstruction.Eight developed PCF(18.2%).The average age was 61.6 years;36 patients were male(81.8%),whereas eight patients were female(18.2%).There was no association between PCF and previous chemoradiation versus radiation(15.8%vs.33.3%,P<0.30),BOT involvement versus not(11.1 vs.22.2%,P<0.38),circumferential versus partial defect(18.8%vs.17.9%,P<0.94),ND versus none(10%vs.25%,P<0.20),or margin status.Conclusion:PCF complicated 18.2%of STL cases at our institution and was not associated with differences in primary treatment modality,presence of concomitant ND,extent of pharyngeal defect,BOT involvement,or positive frozen or permanent surgical margin.

Neck dissection does not add to morbidity or mortality of laryngectomy

Objectives:To examine the national rates of complications,readmission,reoperation,death and length of hospital stay after laryngectomy.To explore the risks of neck dissection with laryngectomy using outcomes.Methods:The American College of Surgeons National Quality Improvement Program(ACS-NSQIP)database was reviewed retrospectively.The database was analyzed for patients undergoing laryngectomy with and without neck dissection.Demographic,perioperative complication,reoperation,readmission,and death variables were analyzed.Results:754 patients who underwent total laryngectomy during this time were found.Demographic analysis showed average age was 63 years old,566(75.1%)were white,and 598(79.3%)were male.Of these patients,520(69.0%)included a neck dissection while 234(31.0%)did not.When comparing patients who received a neck dissection to those who did not,there were no significant differences in median length of hospital stay(12.5 days w/vs.13.3 days w/o,P=0.99),rates of complication(40%w/vs.35%w/o,P=0.23),reoperation(13.5%w/vs.14%w/o,P=0.81),readmission(14%w/vs.18%w/o,P=0.27),and death(1.3%w/vs.1.3%w/o,P>0.99).Furthermore,neck dissection did not increase the risk of complication(P=0.23),readmission(P=0.27),reoperation(P=0.81),death(P=0.94),or lengthened hospital stay(P=0.38).Conclusions:Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total laryngectomies.These results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.

LARYNGEAL RECONSTRUCTION AND SURVIVAL AFTER FUNCTION-SPARING LARYNGECTOMY FOR SELECTED T3 AND T4 LESIONS

Most patients lost their vocal ability after ablative surgery for the laryngeal cancer. Total laryngectomy has a history of over 100 years, hence many surgeons are accustomed to the en bloc organ resection and the loss of ability for communication after surgery. The recent advance of surgery introduces the concept and technique of radical cure and functional preservation of the cancer-afflicted-organ at same setting. For lesions of late T categories (T3, T4), the maintenance of normal function after wide resection to ensure radicality demands a special technique to repair the crippled larynx. For this purpose a local osteomuscular flap was designed to reconstruct a functioning larynx. The surgical manoeuvre was described and the result proved to be successful. The outcome of 138 patients with T3 and T4 laryngeal carcinomas following conservation laryngectomy was analyzed. The five-year survival rate was 69% for supraglottic type and 75% for glottic type. The quality of life was much improved.

Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

Aim:Lymph node(LN)metastases are associated with poor outcomes in patients with recurrent larynx squamous cell carcinoma(LSCC).Neck dissection(ND)is therefore commonly performed along with salvage total laryngectomy(STL).Here,we assess the rate of occult LN metastases and the diagnostic value of MRI and PET/CT for detecting them in recurrent LSCC.Methods:This retrospective study included patients with recurrent LSCC after primary(chemo)radiotherapy[(C)RT]who were re-staged by MRI and/or PET/CT and treated with STL and ND between 2004 and 2019.The histopathology of ND samples was used as the reference standard.Results:Forty-one patients were included.The prevalence of occult metastases in MRI-negative and PET/CT-negative neck nodes was between 3.2%and 6.1%.Negative predictive values of neck node re-staging were 93.9%for MRI,96.8%for PET/CT,and 96.2%for MRI and PET/CT combined.Conclusion:Both MRI and PET/CT afforded good negative predictive values for nodal staging in patients with recurrent LSCC after(C)RT prior to STL.In selected patients,these radiological modalities,particularly PET/CT,could help to avoid unnecessary surgery to the neck and its associated morbidity.

CO_2激光手术治疗早期喉声门型癌疗效分析

内镜下CO2激光显微外科手术对早期喉声门型癌疗效确切，对于某些放疗失败的病例亦可采用内镜TCO2激光行挽救性手术治疗。我们回顾性总结了内镜TCO2激光显微外科手术治疗Tis、T1及部分T2喉声门型癌的临床经验。

环状软骨舌骨会厌固定术治疗声门癌

1资料与方法 1.1一般资料。自2008年12月开展环状软骨舌骨会厌固定术（cricohyoidoepiglottopexy,CHEP）治声门型喉癌以来,对2012年6月前所完成的随访已超过2年的16例声门型喉癌患者进行分析,均为男性,平均年龄50.5岁,根据UICC（1997）分类标准,术前均行电子喉镜、喉部增强CT扫描、颈淋巴结彩超等检查,根据检查结果 ,其中T1b4例,T210例（单侧声带活动受限）,T31例（单侧声带固定）,T41例（增强CT显示甲状软骨板浸润）,

重视喉全切除术后言语康复

随着人们生活水平和对生存质量要求的提高,喉全切除术后若不能进行有效的言语康复,患者往往难以接受。不同个体的喉癌喉咽癌由于肿瘤侵及范围不同,喉全切除术后修复方法不同,同时由于放射等综合治疗,修复后的喉咽和颈段食管可能有不同程度的狭窄以及颈部不同程度的瘢痕，因此术后言语康复的方法和效果不尽相同，目前，有多种发音重建术用于喉全切除术患者的言语康复。喉全切除术后患者失去了发音器官，也就是说失去了能够发出基音的声带，

喉全切除术后喉咽闭锁

1 临床资料 患者,男,60岁,因喉癌喉全切除术后1年,喉咽闭锁不能进食6个月为主诉入院。患者1年前因喉癌于外院行喉全切除术及颈淋巴结清扫术,术后出现感染咽瘘并行局部清创、换药及颈部局部皮瓣转移喉咽修复、颏下皮瓣转移颈部缺损修复术治疗,咽瘘愈合后行根治性放疗,8个月前放疗结束，出现喉咽狭窄，仅能进水，于外院行胃造瘘术进行营养，逐渐加重，6个月前喉咽完全闭锁不能进食，于我院就诊，以喉癌术后喉咽闭锁收入院。患者一般状态良好，

Tracheoesophageal Voice Prosthesis Outcomes:Success or Insucess?

Introduction: Total laryngectomy/pharingo-laryngectomy is a potentially aggressive surgery for advanced laryngeal/hypopharyngeal carcinomas, which results in important physical and functional changes that compromise some of the most vital functions, including speech communication. For these patients, tracheoesophageal speech is considered to be the gold standard for voice rehabilitation. Objectives: The purpose of the present study was to determinate the success rate of voice prosthesis rehabilitation, voice prosthesis lifetime and the rate of complications, and its related clinicopathologic factors. Material and Methods: Retrospective review of 92 patients who undergone tracheoesophageal puncture (TEP) performed between January 2007 and December 2012 at the Francisco Gentil Portuguese Institute of Oncology of Oporto. Age, primary disease, staging, the extent of surgical resection, radiotherapy treatment, timing of TEP, surgical and prosthesis-related complications were noted. The impact of these clinicpathological factors on functional outcome, complications of TEP and lifetime of prosthetic valves was assessed in univariate analysis. Vocal rehabilitation efficacy with voice prosthesis was assessed with the multidimensional Harrison-Robillard Shultz (HRS) Rating Scale. Lifetime of voice prosthesis and early and late complications were recorded. Results: A total of 83 patients met the study criteria, predominantly males (94%) with a mean age of 63.7 years. 77% of the patients underwent primary and 23% secondary TEP. 68.7% of patients achieved functional tracheoesophageal speech (HRS score ≥ 10), 67.2% had performed primary TEP and 73.7% had performed secondary TEP. The mean device lifetime was 9.8 months for voice prosthesis. Prosthesis-related complications occurred in 81% of the patients and the most common issues were prosthesis leakage (76%) and displacement (22%). The most common surgical-related problem was a large and deep tracheostoma. Conclusions: Our success rate of voice rehabilitation was comparable to that reported in published literature with a satisfactory median device lifetime. Because of its safety and simplicity, tracheoesophageal puncture is considered to be an effective method for voice rehabilitation after total laryngectomy.

喉癌术后发声和吞咽功能评价

喉癌术后对发音和吞咽功能的评价，是评价不同功能性喉保留手术效果的有效方法。国际上对喉癌术后功能评价方法的研究越来越深入，各种新的评价方法不断涌现。本文就近年来国内外在该领域的研究进展做一综述。

喉癌功能保全性手术对嗓音的影响

喉癌的功能保全性手术方式有多种,不同的手术方式对嗓音会产生不同的影响,因此,了解不同的手术方式对嗓音的影响有利于术后嗓音的恢复,提高生活质量,进一步探索更佳的手术方式。