A vote to save setting For advanced Laryngeal Cancer

Laryngeal cancer is the second joint Head and neck cancer in the United States, in spite of all measures in order to brake, we in India have also high incidence due to the habit of consumption of tobacco and alcohol. The ultimate goal for each clinician treating laryngeal cancer is to remove the disease with the conservation of voice and swallowing. Early glottic and supraglottic cancers are treated by surgery or radiation therapy without affecting the phonatory function, but it is difficult to achieve in greater transglottic lesions, because the preferred surgical treatment for advanced laryngeal tumors remains total laryngectomy (TL), a surgical technique as laryngeal speech is sacrificed. It is for this reason that the majority of our Indian patients refuse treatment.

The second alternative is radiation and chemotherapy, part of the so-called organ sparing protocols has also led to effective results but 30-40% may require salvage surgery for recurrent disease and post radiotherapy conservative procedures cannot be performed because of poor cure rate causes high Fistula and assessment of the Oncological safety margins are not sufficient. So these areas total Laryngectomy patients with high postoperative complications, so the primary surgery with voice conservation treatment modality is preferred. There is a report of Hoffmann too supraglottic cancers survival is poorer with simultaneous chemo radiotherapy compared with primary surgery followed by radiotherapy.

1980 Described Pearson and colleagues an alternative to the standard TL in patients with stage T3 glottic cancer forms. After pathological examination of a developing methods of larynx, they noted that in some units, pathology, total larynx often was not involved in the disease process. These researchers discovered that the column in the endolarynx could remain dispassionate and converted to a sphincteric pipes serves as a speech valve.

Studies have shown that near-total laryngectomy (NTL) in Select T3 and T4 laryngeal tumors allows a high VAT rate disease control compared with the total laryngectomy. NTL spare parts not tumor involved the larynx, which subsequently used for reconstruction. A patient undergoing NTL talk by means of an internal myomucosal healing, which is lung powered. The do not use, but a tracheostomy for breathing.

Near-total laryngectomy (NTL) is indicated in patients with advanced (T3, T4) laryngeal cancers when areas postcricoid and interarytenoid is free of the disease and value, transversal arytenoids are salvageable. Contra-indications for this procedure is a tumour in the interarytenoid, postcricoid region and bilateral arytenoids.

54 Year old male, also a chronic smoker, came to our hospital with the contested change in voice for the last six months and irritation in the throat while have foods for 3 months. Flexible direct laryngoscopy revealed ulceroproliferative lesion on the right supraglottic area (Aryepiglottic fold + Epiglottis) with fixed value of the right of the vocal cords. Interarytenoid postcricoid area and was free. Biopsy revealed moderate differentiated squamøs cell carcinoma. CT scan of the neck revealed right supraglottic mass with paraglottic extension with a few lymph nodes on the right level II, CXR had no evidence of disease. . It was staged as a clinical T3N1M0. The patient was discussed in the tumor Board and both settings of surgery and chemo radiotherapy were given to the patient. The patients selected for surgery provided he can be rehabilitated for voice production. The patient were given the option of NTL/TL + Provox voice prosthesis insertion and taken up for surgery. Intraoperative frozen section were sent from the interarytenoid area for inclusion, which were negative, so we continued with NTL and bilateral level II, III, IV neck dissection. Postoperative recovery was uneventful. He started oral feeding after 10 days, he had mild aspiration, which settled in days, his voice rehabilitation was started after 2 weeks. Definitive Histopathological examination revealed T3N2M0 squamøs cell carcinoma grade II, all margins were free.

The final result should be secure resection margins oncologically, with good voice production to communication; This will depend on the part of the surgeon skill and the extent of resection and subsequent reconstruction.

Posted in cancer

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