POTENTIAL SUCCESS OF NEAR-TOTAL LARYNGECTOMY DESPITE POSTOPERATIVE RADIATION-THERAPY

Advanced laryngeal cancers frequently require total laryngectomy (TL). Some of these cancers, however, are suitable for near-total laryngect omy (NTL). We review our experience with NTL over a 14-year period and compare the functional results with those obtained over the same peri od using TL followed by tracheoesophageal puncture (TEP). One particul ar interest was the results achieved when surgery was preceded or foll owed by radiation therapy. From January 1980 through December 1994, 22 patients underwent NTL. The mean age of the 19 men (86.4%) and 3 wome n (13.6%) was 61.1+/-9.9 years. Follow-up ranged from 4 to 109 months, with a mean of 26.5 months. The local control rate was 90.9% (i.e., 2 0 of the 22 patients). Over the same time period, 11 TEPs were perform ed in 7 men (63.6%) and 4 women (36.4%) who had a mean age of 60.4+/-7 .2 years. Compared with the TEP group, the patients in the NTL group h ad higher mean scores for swallowing, aspiration, and voice quality ev aluations, although the differences were not statistically significant . Notably, 21 of 22 patients (95.5%) received preoperative or postoper ative radiotherapy. Complications in the NTL group included aspiration , dilated shunt appendix, and inadequate tracheopharyngeal shunt funct ion. Slight modifications of the NTL technique, including routine entr ance into the vallecula in uninvolved larynges, the use of contralater al pyriform mucosa naps, and the performance of an H-nap tracheostomy are described. The NTL is a sound oncologic procedure for tumors causi ng vocal cord fixation, and it can be successful even when post-operat ive radiotherapy is administered The quality of speech, the ease of sw allowing, and the incidence of aspiration are similar to those in pati ents who have had a TEP following TL.