Jesús Herranz

Psychosocial Adjustment after Laryngeal Cancer Surgery

The objective of the study was to assess the psychosocial adjustment of 111 patients, and 87 partners, after laryngeal cancer surgery. Sixty-nine patients were grouped as having had radical surgery (total or near-total laryngectomy), and 30 as having had functional surgery (horizontal supraglottic laryngectomy or cordectomy). The Psychosocial Adjustment to Illness Scale Self Report questionnaire was used as the primary outcome. No significant differences were found between groups when global adjustment or domain adjustment was compared. Patient and partner responses were almost identical. Work and family relationships were the domains with poorest adjustment for both patients and partners. Information about treatment expectations was negatively rated by functional surgery patients, especially by those who underwent a cordectomy. We conclude that patient perspectives should be considered and consulted to 1) evaluate patient opinion about treatment results, 2) identify patients with special support needs, and 3) inform patients according to other patients priorities, based on their experience.

Complications after Total Laryngectomy in Nonradiated Laryngeal and Hypopharyngeal Carcinomas

To study the complications of total laryngectomy, we evaluated 471 previously untreated patients who underwent total laryngectomy between 1980 and 1997. This series consisted of 358 patients with primary carcinoma of the larynx and 113 with carcinoma of the hypopharynx. Concurrent neck dissection was performed in 85% of patients. Complications were studied in relation to age, T and N stage, previous tracheostomy, neck dissection, margins, reconstruction, tracheoesophageal puncture, and surgeon. Complication treatment and hospitalization were also evaluated. The overall complication rate was 30.7%, with 29.2% major and 6.5% minor complications. The mortality rate was 0.6% (3/471). Pharyngocutaneous fistula was the most frequent wound complication (21%), followed by wound infection (4.2%) and hemorrhage (2.3%). Pneumonia (1.4%) and embolism (0.4%) were the most frequent medical complications. Hypopharyngeal tumors, neck dissection, and extended procedures had a significantly higher rate of complications. Complication causes, prevention, and treatment are discussed.

Functional neck dissection: three decades of controversy.

Functional neck dissection (FND) is a neck-functional, tumor-radical approach for the management of the neck in patients with head and neck cancer. Based on the anatomic knowledge of the lymphatic compartments of the neck, FND is a different surgical technique rather than a modification of the classic procedure described by Crile. From an oncologic viewpoint, FND is a relatively safe operation to treat the cervical spread from head and neck cancer as long as the indications and technical details are carefully followed. In this report, based on our experience with more than 1,000 FNDs, we analyze the history and the philosophy of the operation.

Supraglottic Laryngectomy with or without Postoperative Radiotherapy in Supraglottic Carcinomas

A retrospective review of 193 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. All the patients received a supraglottic laryngectomy, and patients received a total of 284 elective or therapeutic neck dissections. Ninety-four (48.7%) of the patients received postoperative radiotherapy. The incidence of local recurrence was 8.2%, but the recurrence rate was unrelated to the use of postoperative radiotherapy. Neck recurrence was observed in 12.9% of patients, with no influence of postoperative radiotherapy in the dissected neck. The incidence of locoregional recurrences by stage in irradiated and nonirradiated patients did not reach significant difference. The 3-year survival was 74.3%. The overall survival of the whole series and by stage was not statistically altered in combined therapy compared to surgery.

Speech Results and Complications of Near-Total Laryngectomy

Near-total laryngectomy provides a functional alternative to total laryngectomy in selected cases of laryngeal and hypopharyngeal cancer. We report our experience with the first 49 patients treated with near-total laryngectomy over a 3-year period. Successful speech rehabilitation was obtained in 79.5% of the patients in a median time of 40 days. Speech was acquired in 89.6% of the patients with follow-up longer than 6 months. Hands-free conversation was possible in 51.4% of the speaking patients. Five patients had symptomatic aspiration and 23 developed postoperative pharyngocutaneous fistula. Four local recurrences occurred in the laryngeal remnant. These results confirm that near-total laryngectomy provides a relatively safe, simple, and reproducible speech rehabilitation method for patients in whom total laryngectomy otherwise would be required.

Laringuectomía supraglótica. Todavía en la brecha

Resumen Introduccion La laringuectomia horizontal supraglotica (LHS) permite conservar la funcion laringea evitando un traqueostoma permanente. Su empleo ha decrecido en favor de tecnicas endoscopicas y protocolos de preservacion de organo, condicionando su aprendizaje. Objetivo Presentar los resultados funcionales y oncologicos a largo plazo. Material y metodo Se revisan 110 pacientes, tratados con LHS, con seguimiento minimo de 5 anos. Resultados Control local de 89% en T1, 91% en T2, 80% en T3 y 91% en T4. Control regional del 80,9%. Supervivencia causa especifica de 77,6%, 72,6% y 67% a 3, 5 y 10 anos, influida significativamente por el estadio N. El 87% conserva una laringe funcional, de los que no se ha decanulado el 8,5%. Conclusion La LHS es una tecnica util y oncologicamente segura, con resultados funcionales y oncologicos similares a otras opciones terapeuticas. Su indicacion debe valorarse en funcion de los resultados y la experiencia propia.

Tracheal resection and anastomosis

Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. Decannulation is the primary treatment goal, and multiple options are available. These include dilations, endoscopic removal of the obstruction, and open surgicla techniques. No single procedure is appropriate for all situations, and the surgeon must choose the operation best suited for every particular case. This article describes the technical details and indications for tracheal resection and end-to-end anastomosis, emphasizing the releasing procedures that can be used in the management of extensive tracheal stenosis. The special problems created by subglottic stenosis and their open surgical management are also addressed.

Is radiotherapy recommended after supraglottic laryngectomy

ALFIO FERLITO, ASHOK R. SHAHA, JAVIER GAVILÁN, J. GRAHAM BUCKLEY, ALESSANDRA RINALDO, JESÚS HERRANZ and CARLOS SUÁREZ From the Department of Otolaryngology—Head and Neck Surgery, Uni×ersity of Udine, Udine, Italy, Head and Neck Ser×ice, Memorial Sloan–Kettering Cancer Center, New York, New York, USA, Department of Otorhinolaryngolog y, La Paz Hospital, Autonomous Uni×ersity, Madrid, Spain, Department of Otolaryngology—Head and Neck Surgery, Leeds General Inx8e rmary, Leeds, UK, Department of Otorhinolaryngolog y, Hospital Juan Canalejo, La Coruña, Spain, and Department of Otorhinolaryngolog y, Hospital Central de Asturias, O×iedo, Spain

Functional neck dissection: Surgical technique

Functional neck dissection (FND) is a safe surgical approach for the treatment of nonpalpable and palpable mobile nodes in patients with head and neck cancer. The operation is technically difficult and requires a thorough knowledge of cervical anatomy. FND is based on the fascial compartmentalization of the neck. The idea of fascial spaces and barriers holds the clue to the oncological safety of the procedure. In this article, a step-by-step description of the surgical technique is presented along with a review of the indications and rationale of FND. Some specific details that have been found to be helpful for the surgeon are also explained.

Horizontal supraglottic laryngectomy: Modifications to alonso's technique

Horizontal supraglottic laryngectomy (HSL) is an oncologically sound surgical procedure for selected cases of laryngeal cancer. It is based on the characteristic behavior of supraglottic carcinomas that do not invade the vocal cords. This constant finding, corroborated by clinical and anatomic studies, is attributable to the different embryological origin of the supraglottis from the glottis and subglottis. In this article we present a step-by-step description of the surgical technique described by Alonso, along with some technical modifications. The selection criteria and contraindications are briefly discussed.