Results of larynx preservation surgery for advanced laryngeal cancer through tracheal autotransplantation

Objective: To evaluate the use of tracheal autotransplantation for reconstr uction of the hemilaryngectomy defect that includes the hemicricoid cartila ge and results from resection of laryngeal or hypopharyngeal cancer. Design: The clinical records of 28 patients undergoing primary or salvage h emicrico-hemilaryngectomy for laryngeal (26 patients) and pyriform sinus (2 patients) cancer were analyzed for function and local control. Setting: Academic center. Patients: Case series review of 28 consecutive patients treated during a 31 /2-year period who had an average follow-up period of 19 months. Intervention: Twenty-five men and 3 women, aged from 28 to 79 years, underw ent a hemilaryngectomy that included the hemicricoid cartilage, the ipsilat eral thyroid lobe, and a unilateral or bilateral lymph node dissection. In 26 patients, these extensive defects were reconstructed with a tracheal aut otransplantation that restored the larynx at the glottic and subglottic lev els. In 2 patients, the defect was converted into a total laryngectomy beca use of tumor extension beyond the resection margins of a hemicrico-hemilary ngectomy. Main Outcome Measures: The times to decannulation and retake of full oral f eeding, the quality of speech, and the incidence and site of recurrent canc er were assessed. Results: Of the 26 patients undergoing tracheal autotransplantation, 24 wer e decannulated and all regained the ability to maintain nutrition by mouth. Ultimate voice quality was "subnormal" to "moderately hoarse" in all patie nts. Five recurrences developed of which 2 were treated with total laryngec tomy. Conclusions: Functional reconstruction of extensive laryngeal defects can b e achieved with an autotransplantation of cervical trachea, with favorable functional results and acceptable morbidity. This technique expands the lim its of conservation surgery for selected laryngeal and hypopharyngeal tumor s.