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Endoscopic Vertical Partial Laryngectomy
Author(s) -
Davis R Kim,
Hadley Kevin,
Smith Marshall E.
Publication year - 2004
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200402000-00012
Subject(s) - medicine , cordectomy , anterior commissure , laryngectomy , surgery , perioperative , cancer , larynx , basal cell , glottis
Objective: To explain the significant difference between microlaryngoscopy with cordectomy and endoscopic vertical partial laryngectomy (EVPL), to describe the efficacy of EVPL on T 1 b and T 2 glottic squamous cell carcinoma, and to evaluate EVPL with postoperative irradiation in T 2 glottic cancer with impaired true vocal cord mobility. Study Design: Retrospective review. Methods: Twenty‐six patients seen at the University of Utah Health Science Center between 1987 and 2000 with bilateral T 1 (T 1 b) or T 2 squamous cell carcinoma of the glottic larynx underwent EVPL. T 2 cancers were classified as follows: a = unilateral disease, b = bilateral disease; i = impaired mobility. T 1 b and T 2 a glottic cancer patients received surgery alone, whereas impaired mobility patients (T 2 ai + T 2 bi) patients received surgery followed by planned postoperative irradiation. Patients were assessed for primary site control, perioperative and long‐term complications, and ultimate cancer control. Results: Survival in the total group was 88.5%, with local control at 92.3%. The two recurrent patients were salvaged by total laryngectomy. For the whole group, anterior commissure involvement was present in 57.7% (15 of 26). Thirteen T 2 (5 T 2 ai + 8 T 2 bi) carcinoma patients underwent combined therapy, with 8 (61.5%) of these patients having anterior commissure involvement. Two of these patients were upstaged at surgery, one to T 3 and one to T 4 . Local control was 84.5%. Thirteen patients were treated by surgery only, with five of these patients having failed previous irradiation. Survival was 92.3% and local control 100%. This group included two T 2 bi patients, two patients upstaged to T 4 on the basis of extension beyond the subglottis to the anterior wall of the trachea, 3 T 2 b, and 6 T 2 a patients. Anterior commissure involvement was seen in 7 (53.8%) of these patients. Conclusions: EVPL alone controlled all T 1 b and T 2 a glottic cancer patients, even in the presence of greater than 50% anterior commissure involvement. The significant difference between EVPL and classical microlaryngoscopy with cordectomy was carefully described. EVPL with planned postoperative irradiation resulted in an 85% local control rate in clinically staged T 2 ai and T 2 bi cancer patients, including the three upstaged patients.