Resultados na cirurgia conservadora do carcinoma espinocelular de laringe

Introducao: a partir da nocao de compartimentalizacao da laringe, surgiram as tecnicas de laringectomias parciais, com a finalidade de proporcionar radicalidade oncologica e a preservacao funcional do orgao. Objetivo: avaliar resultado oncologico e complicacoes de pacientes submetidos a essas tecnicas. Metodos: uma serie consecutiva de 71 pacientes foi submetida a laringectomia parcial no periodo de 1996 a 2003, conforme o estadiamento local (T). As margens cirurgicas foram avaliadas por exame de congelacao no intra-operatorio. O seguimento variou de 24 a 85 meses (mediana de 48). Radioterapia adjuvante foi realizada conforme o estadio do pescoco (pN+). As complicacoes edema de aritenoide, fistula faringo-cutânea ou laringo-cutânea, pneumonia, hemorragia, disfagia, infeccao de parede, estenose laringea e insuficiencia glotica foram avaliadas. Resultados: a sobrevida livre de doenca foi: 85,4% para T1; 81,2% para T2; e 42,8% para T3. Apos o resgate cirurgico, a sobrevida final foi 97,9% para T1; 87,5% para T2; e 42,8% para T3. Houve edema de aritenoide em cinco pacientes, fistula laringo-cutânea em dois; infeccao de parede em um; pneumonia em tres; disfagia em um; e estenose laringea em quatro. Conclusoes: o indice global final de cura em pacientes portadores de tumores T1-T3 de laringe e de 91,6%, sendo melhor nos estadios mais precoces. O indice de complicacoes e aceitavel e estas podem ser abordadas conservadoramente com sucesso. Introduction: the techniques of partial laryngectomy are based on the compartimentalization of the larynx, and their aims are provide the oncologically radical excision and preserve the laryngeal function. Objective: to evaluate the oncological results and the complications in patients undergone these techniques. Methods: a consecutive series of 71 patients underwent partial laryngectomy from 1996 to 2003, according to the local clinical staging (T). The surgical margins were evaluated for frozen section examination during the surgery. The follow up varied from 24 to 85 months (median, 48). Adjuvant radiation therapy was indicated according to the lymph node staging (pN+). The following complications were evaluated: edema of the arytenoid, pharyngocutaneous or laryngocutaneous fistula, pneumonia, haemorrhage, dysphagia, wound infection, laryngeal stenosis and glottic insufficience. Results: the free of disease survival was: 85.4% for T1 tumors; 81.2% for T2; and 42.8% for T3. After the surgical salvage, the ultimate survival was: 97.9% for T1; 87.5% for T2; and 42.8% for T3. There was edema of the arytenoid in 5 patients, laryngocutaneous fistula in 2; wound infection in 1; pneumonia in 3; dysphagia in 1; and laryngeal stenosis in 4. Conclusions: the global ultimate cure rate in patients with T1-T3 laryngeal cancer is 91.6%, and this rate is higher in the early clinical staging. The complication rate is acceptable and its management is conservative with success.