Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy

Objwectives/Hypotheses Study 1: To assess the oncologic outcome following s upracricoid partial laryngectomy (SCPL), Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophagea l puncture (TEP), Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL, Study Design: Study 1: A retros pective review of patients who underwent SCPL. Study 2: A non-randomized, p rospective study using QOL instruments to compare patients who underwent ei ther SCPL or TL, Study 3: A retrospective histopathologic study of TL speci mens assessed for the possibility of performing an SCPL. Methods: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between Ju ne 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This: incl uded the SF-36 general health status measure, the University of Michigan He ad and Neck Quality of Life (HNQOL) instrument, and the University of Michi gan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgi cal, specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma. A computer program was written to classify whether the patient was amenable to SCPL. Results: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglott opexy (CHEP) was 95% (20/21). The local control rate following SCPL with cr icohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly hig her domain scores than TL and TEP in the following categories for the SF-36 : physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The signi ficantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assesse d with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be re sectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEF and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have u ndergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). Conclusions 1) A review of the literature and an analysis o f the data in this study indicate that excellent local control may be expec ted following SCPL. 2) The QOL following SCPL, as measured by three validat ed QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who ha ve been subjected to TL may have been candidates for SCPL. 4) If the indica tions and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.