RESULTS OF NEAR-TOTAL LARYNGECTOMY

The clinical records of 225 patients undergoing primary or salvage nea r-total laryngectomy (NTL) for laryngeal and pyriform cancer were anal yzed for local control and morbidity. If the primary cancer was laryng eal in origin, patients underwent a simple NTL; if it was pyriform, a minor modification called near-total laryngopharyngectomy (NTLP) was u sed. When NTLP was extended to include necessary portions of the tongu e base or posterior pharyngeal wall, pharyngeal reconstructions were a dded. The principal outcomes studied were 1) 5-year local control of t he primary cancer, 2) achievement of lung-powered shunt speech, and 3) incidence of aspiration. The local control of cancer was similar to t hat expected with total laryngectomy or laryngopharyngectomy. Conversa tional voice was achieved in 85% of patients surviving beyond 1 year. Some patients required additional surgery for voice - usually endoscop ic dilation. Aspiration was absent if primary healing was achieved. It was troublesome in wound breakdown if the shunt was directly affected . Secondary anti-aspiration procedures were required in 9% of our pati ents - usually preserving shunt speech.