Subtotal laryngectomy with cricohyoidopexy as first treatment procedure for supraglottic carcinoma: Institut Gustave-Roussy experience (146 cases, 1974-1997)

Patients and methods: Between 1974 and 1997, 297 patients underwent a subto tal laryngectomy at the Institut Gustave-Roussy; 146 of these patients unde rwent cricohyoidopexy (CHP) for a supraglottic primary as their first treat ment. The majority of patients were men (137) aged from 33 to 78 years (med ian 54 years). The tumour ag stage at presentation was T1 in 2, T2 in 87, T 3 in 53 (preepiglottic space involvement), and T4 (minimal thyroid cartilag e invasion) in 4 patients. One hundred and twenty-five patients were NO (86 %) and 21 patients were Np (palpable); 98% had homolateral and 55% had bila teral neck dissections. Results: One patient died postoperatively of a myoc ardial infarction and 68% patients had an uneventful course. Aspiration was the commonest complication (23 patients, 19%). The median time to removal of the tracheotomy cannula. was 10 days and for the nasogastric tube 21 day s during the past 10 years. Completion of subtotal laryngectomy into total laryngectomy was done in 21 cases (15%): eight times because of oncological events [five local failures, two second primary (hypopharynx), one positiv e margin] and 13 times because of aspiration (9%). There were six local fai lures (4%) and eight nodal failures (5%). The rates of distant metastases a nd second primaries were 6% and 16% respectively. Half of the local and nod al failures were subsequently sterilized. Findings at death were two local recurrences, four nodal recurrences, eight distant metastases, and 11 secon d primaries. The 3- and 5-year overall survival rates were 92% and 88% resp ectively, with an overall laryngeal preservation rate of 86%. Conclusion: W hen supraglottic laryngectomy is not feasible for supraglottic cancer, subt otal laryngectomy with CHP is a safe and effective oncological procedure, w ith preservation of satisfactory laryngeal function.