Surgery and function reconstruction of laryngeal cancer involved supraglottic and glottis area

Objective To investigate the surgery preserving epiglottis, the repair and the postoperative functions in laryngeal carcinoma involving supraglottic and glottic areas. Methods A total of 97 cases with laryngeal cancer involving both supraglottic and glottic areas with normal epiglottis underwent surgery between June 2005 and December 2010 was reviewed. Of them 37 cases were stage H, 41 cases were stage m, and 19 cases were stage IV. Vertical partial laryngeetomy（VPL） or extended VPL with the repair and functional reconstruction was carried out in 86 cases and cricohyoidoepiglottopexy （CHEP） in 11 cases. Postoperative survival rate, laryngeal functions and quality of life were evaluated. Results The 3-year and 5-year total cumulative survival rate （Kaplan-Meire survival analysis） were 87.1% and 69.6% in the 97 eases; 86.6% and 68. 3% in VPL/EVPL group; 90.0% and 78.8% in CHEP group, respectively, with no significant difference between VPL/EVPL and CHEP groups （P > 0.05）. Of 97 cases, 86（88.7%） cases were decannulated postoperatively. The rates of decannulation were 87.2% （75/86） in VPL/EVPL group and 100%（11/11） in CHEP group, with no significant difference （P >0.05）. Average oral diet recovery time of VPL/EVPL group and CHEP group was （5.2±1.3 ） and （ 15.7±5.2） days, respectively,with a significant difference （P 0.05）. Voice handicap index-10 （VHI-10） scores of VPL/EVPL and CHEP groups were 29.5±4.7 and 31.6±6.3, respectively, no significant difference （P > 0.05 ）. Conclusions For patients with the laryngeal carcinoma involving both supraglottic and glottic areas, VPL has better anatomical and functional outcomes than CHEP. The preservation of at least 2/3 of the lamina of thyroid cartilage on one side and shift-down of epiglottis were key to successful VPL and postoperative decannulation. Key words: Laryngeal neoplasm; Carcinoma, squamous cell; Laryngectomy; Voice quality; Deglutition disorders; Quality of life