Oncological and functional outcome of conservative surgery for primary supraglottic cancer

The aim of this study was to verify the oncological and functional outcome of conservative surgical treatment of primary supraglottic squamous cell ca rcinoma (SGSCC) and related neck disease in order to verify the effectivene ss of supraglottic laryngectomy (SL) and the validity of an "observation" p olicy in the control of clinically negative (NO) necks. Of a total of 252 c onsecutive patients affected by primary SGSCC seen between 1975 and 1990 at the Department of Otolaryngology of the University of Perugia (1975-1987) and the Catholic University of the Sacred Heart of Rome (1988-1990), a subs et of 132 patients treated with classical SL was evaluated after presenting sufficient clinicopathological data and a follow-up period of at least 5 y ears. Tumors were staged according to the 1992 UICC TNM classification and grouped into stages I-II (n = 94) and III-IV (n = 38). Comprehensive neck d issections were performed only in the clinically positive (N+) necks (25/13 2 cases), while in the clinically NO ones (107/132 cases) an "observation" policy under strict follow-up conditions was adopted. After primary surgery , the 5-year relapse-free survival (RFS) was 74%. The RFS was 80% for T1-2 disease and 65% for T3. The RFS was 80% for stages I-II tumors and 71% for stages III-IV. The actual 5-year overall survival (OS) was 89% for T1-T2 tu mors and 67% for T3 disease or 93% for stages I-II and 69% for stages III-I V. The OS was 89% for NO neck and 73% for N+. The 5-year-metastasis-free su rvival (MFS) was 83% for NO patients, 74% for N+, 84% for T1-T2 NO, 71% for T1-T2 N+, 81% for T3 NO and 68% for T3 N+. In all, SL was found to be high ly effective in the management of primary SGSCC. In the presence of clinica lly NO neck "observation" under strict follow-up with therapeutic comprehen sive neck dissection for delayed nodal recurrence, SL was suitable for cont rolling the neck cancer, as well as for salvaging recurrent disease. Bilate ral elective, selective or functional neck dissection in every instance of supraglottic cancer was best performed only in those SGSCC patients who wer e more likely to have occult nodal disease on the basis of biological facto rs and imaging data.