Ursula Schröder

Potential role of transoral laser surgery for larynx carcinoma.

Background and Objective: The treatment of larynx carcinoma is not settled to date. This prospective study evaluates the potential role of transoral laser surgery (TLS) for larynx carcinoma in a large series of unselected patients from a single institution.

Wertigkeit der Feinnadelpunktionszytologie bei Neoplasien der Glandula parotis

ZusammenfassungHintergrund: Die Punktionszytologie ist in nur wenigen Kliniken Deutschlands routinemäßiger Bestandteil der präoperativen Diagnostik von Speicheldrüsenerkrankungen. Als Hauptargument gegen die Punktionszytologie wird deren fehlende therapeutische Konsequenz angeführt. Zielsetzung: Im Hinblick auf eine genauere Planung der Art der operativen Therapie wurde die Feinnadelpunktionszytologie in der Dignitätsbeurteilung von neoplastischen Erkrankungen der Ohrspeicheldrüse überprüft. Patienten und Methode: In einer von 1/92–10/95 retrospektiv durchgeführten Untersuchung wurden 336 Patienten mit Ohrspeicheldrüsentumor punktionszytologisch und histologisch untersucht. Ergebnisse: Die Sensitivität der Punktionszytologie lag bei 93,1%, die Spezifität bei 99,22%, das positive bzw. negative Befundgewicht bei 93,1 bzw. 99,22% und die Testeffizienz bei 98,59%. Komplikationen traten in weniger als 1% auf. Schlußfolgerung: Bei seltenen und nicht gravierenden Komplikationen überwiegen die Vorteile der Punktionszytologie insbesondere hinsichtlich der in der Therapieplanung wichtigen Informationen über die Dignität der punktierten Raumforderung. Für die nicht selten klinisch symtomlosen Malignome der Kopfspeicheldrüsen stellt die Punktionszytologie eine hoch spezifische und damit bei positivem Nachweis sehr verläßliche Methode zur präoperativen Dignitätsbestimmung dar.AbstractBackground: In many parts of Germany fine-needle aspiration biopsy (FNAB) is still not part of the routine preoperative diagnostic evaluation of salivary gland neoplasms. Most opponents consider the study unnecessary and recommend that all salivary gland neoplasms should be excised. Objective: Because of this an evaluated the ability of FNAB to provide an accurate diagnosis of parotid gland neoplasms. Patients and method: Between January 1992 and October 1995, 336 patients referred for operative therapy of salivary gland neoplasms underwent retrospective analysis of preoperative FNAB compared with the excised tumor histology. Results: Results showed that the FNAB had a sensitivity of 93.1%, a specifity of 99.2%, a positive predictive value of 93.1%, a negative predictive value of 99.2% and an accuracy of 98.6%. Complications were observed in less than 1%. Discussion: Our findings demonstrated that the FNAB is a safe diagnostic tool that has a reliable sensitivity and high specificity for the assessment of salivary gland pathology. Since many malignant salivary gland neoplasms present with a virtual lack of symptoms indicating actual malignancy we believe that there is need for FNAB in routine preoperative diagnostic testing.

MR sialography : Initial experience using a T2-weighted fast SE sequence

PURPOSE The aim of this study was to evaluate an MR technique optimized for imaging of the parotid gland ductal system. METHOD The pulse sequence was optimized in 10 volunteers to depict static or nearly static fluid in the parotid ductal system. A heavily T2-weighted fast SE sequence (TR 3,600 ms/TE 800 ms) with a slice thickness of 30-40 mm using an 8 cm surface coil allowed depiction of the fluid-filled parotid duct. Thirteen patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 2), sialadenosis (n = 3), Heerfordt syndrome (n = 1), pleomorphic adenoma (n = 2), parotid carcinoma (n = 1), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 2), and non-Hodgkin lymphoma (n = 1). RESULTS The heavily T2-weighted projection image yielded good quality sialographic images. The main duct and primary branching ducts were clearly depicted in all normal cases. The main duct was visualized in all patients. Intra- and extraglandular duct widening and ductal strictures were well depicted. Sialolithiasis with a calculus in the main duct was correctly demonstrated in one case. CONCLUSION MR sialography is noninvasive and does not depend on duct cannulation or contrast agent injection. Initial experience with a thick slice projection technique indicates that MR sialography can be successfully applied to image the parotid gland ductal system.

Magnetic Resonance Sialography

To evaluate a new noninvasive sialographic technique, we applied a new magnetic resonance technique to 10 healthy volunteers and 21 patients with lesions of the parotid gland. In addition to the usually performed T1 and T2 cross-sectional sequences, a heavily T2-weighted sequence (TR = 3600 msec, TE = 800 msec) was performed that allowed depiction of the fluid-filled parotid duct system. Twenty-one patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 6), sicca syndrome (n = 2), pleomorphic adenoma (n = 4), carcinoma of the parotid gland (n = 2), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 3), non-Hodgkins lymphoma (n = 2), and congenital duct dilatation (n = 1). Stensens duct was reliably depicted in all volunteers and patients. The primary branching ducts were reliably depicted in all normal cases. Intraglandular and extraglandular duct dilatations and duct strictures were well depicted in patients with chronic sialadenitis. Sialolithiasis with a calculus obstructing the duct was demonstrated in 2 cases. In conclusion, Initial experience indicates that magnetic resonance sialography can be applied successfully to investigate the duct system of the parotid gland. The usually performed cross-sectional MRI (T1- and T2-weighted images, gadolinium-DTPA) depicts the internal architecture of the parotid gland with high reliability. Magnetic resonance sialography with heavily T2-weighted images adds important information about the ductal system. Because it is completely noninvasive, the only contraindications are the ones generally accepted for MRI.

Successful adjuvant tamoxifen therapy for estrogen receptor-positive metastasizing sweat gland adenocarcinoma: need for a clinical trial?

We report on successful adjuvant tamoxifen therapy for a metastasizing sweat gland adenocarcinoma of the scalp in a 64-year-old woman. Before the antihormonal therapy, the patient had undergone repeated surgery for ipsilateral intraparotid, soft tissue, and lymph node metastases and had had disease-free intervals of less than 5 months. As the immunohistochemical analysis of the tumor tissue revealed a 100% nuclear reactivity to estrogen and progesterone receptors, we started empirical tamoxifen citrate therapy, which dramatically changed the course of the disease. The patient has been in complete remission for 3 years. This is the third report in the literature of substantial therapeutic benefit of antiestrogen therapy in metastasizing eccrine gland adenocarcinoma with positive hormone receptor immunohistochemistry. We suggest examining the hormone receptor expression in these neoplasms regularly. A prospective study should be commenced to assess the benefit of adjuvant antihormonal therapy in eccrine gland adenocarcinomas.

Indikation, Technik und Ergebnisse der rekonstruktiven Kehlkopfteilresektion nach Sedlacek-Kambic-Tucker

ZusammenfassungHintergrund: Karzinome der vorderen Kommissur sind eine Schwachstelle der üblichen kehlkopferhaltenden Therapieverfahren. Die rekonstruktive Kehlkopfteilresektion nach Sedlacek-Kambic-Tucker erlaubt eine besonders weite Resektion des vorderen Schildknorpels und der anterioren Glottis. Indikationen, Technik und Ergebnisse werden am Krankengut der Kölner und Innsbrucker Klinik dargestellt. Methode: Es wurden die Akten aller Patienten retrospektiv ausgewertet, die zwischen 1991 und 1996 wegen eines Larynxkarzinoms operiert wurden. Ergebnisse: Bei 12 von 543 Patienten mit Larynxkarzinomen erfolgte eine rekonstruktive Kehlkopfteilresektion nach Sedlacek-Kambic-Tucker. Bis auf eine Fistelbildung traten keine Komplikationen auf. Bei einer mittleren, peroralen Ernährung ab dem 10. postoperativen Tag konnten alle Tracheostomien im Mittel am 17. postoperativen Tag verschlossen werden. Chronische Aspirationen oder Stenosen wurden nicht beobachtet. Die stimmlichen Ergebnisse sind aufgrund des ungenügenden Glottisschlusses und der unphysiologischen Konfiguration der rekonstruierten vorderen Kommissur schlecht. Schlußfolgerung: Die rekonstruktive Kehlkopfteilresektion nach Sedlacek-Kambic-Tucker hat eine sehr enge Indikationsstellung, ermöglicht aber eine chirurgisch sichere, radikale Resektion des vorderen Kehlkopfs, insbesondere auch bei Rezidivkarzinomen, mit onkologisch guten und funktionell zufriedenstellenden Ergebnissen.SummaryManagement of laryngeal carcinoma located at the anterior commissure remains controversial. Local control rates with radiotherapy or surgery are not as good as those seen after treatment of midcord lesions. The vertical partial laryngectomy with epiglottic reconstruction (VPLER) may be a more successful approach to such lesions. The charts of all patients treated for larynx carcinoma between 1991 and 1996 at the authors’ institutions were reviewed to identify those patients treated with VPLER as described by Sedlacek in 1965, Kambic in 1976 and Tucker in 1979. Indications for performing surgery and outcome data of patients were collected and analyzed according to the indications for surgery, surgical technique, perioperative complications, oncological outcomes and functional results. Twelve patients were identified that had been treated with VPLER. Indications for surgery included five patients with local recurrences following endoscopic laser partial laryngectomies, four cases with previously untreated primary tumors at the anterior commissure (T2 N0–2 M0), two with local recurrences following radiotherapy, and one with recurrence following frontolateral partial laryngectomy. There were no postoperative complications except for one laryngocutaneous fistula that required secondary repair. All patients were able to swallow at the tenth postoperative day. All had their tracheostomies closed after completion of wound healing, (a mean of 17 days after surgery). Phonatory results were usually poor. Two local recurrences occurred during the follow-up period. However, both patients were salvaged with total laryngectomies and have since been free from disease. All other patients are alive and well. Our findings show that VPLER is an effective surgical approach for carcinoma at the anterior commissure of the larynx that cannot be adequately managed with transoral laser surgery or simple frontolateral partial laryngectomy. This study demonstrates that the procedure can be successfully applied to the treatment of local recurrences following initial raditherapy or surgery. No major complications occurred in our study.

Die Kernspinsialographie : Ein neues diagnostisches Verfahren zur Speicheldrüsengangdarstellung

ZusammenfassungDie Kernspinsialographie wird als Modifikation einer MR-Pulsfolge vorgestellt und ihre Speichelgangdarstellung mit der digitalen Subtraktionssialographie als Standard verglichen. Bei 10 gesunden Probanden und 15 symptomatischen Patienten mit Erkrankungen der Glandula parotis wurde eine stark T2-gewichtete Kernspintomographie (TR 3600, TE 800) angefertigt, so daß lediglich der intraduktale, statische Speichel signalgebend zur Darstellung kam. Die untersuchten Patienten wiesen sowohl benigne als auch maligne Tumoren, Sialolithiasitiden, Sialadenitiden, ein Heerfordt-Syndrom oder kongenitale Ganganomalien auf. Der Stenon-Gang sowie Gänge 1. Ordnung ließen sich in der Kernspinsialographie gut darstellen. In der Darstellung von Gängen 2. und 3. Ordnung war die MR-Sialographie der Subtraktionssialographie als Standardmethode unterlegen. Die Kernspinsialographie erwies sich dagegen in der Diagnostik erweiterter Gänge proximal von kompletten Gangverschlüssen und der Darstellung von zystischen Speichelretentionen überlegen. Pathologische Befunde wie Gangektasien, Gangstrikturen, intraduktale Steine, tumorös bedingte Gangverlagerungen oder Gangabbrüche konnten sowohl in der Kernspin- als auch in der Subtraktionssialographie vergleichbar erhoben werden. Die Kernspinsialographie ist aufgrund der Darstellung pathologischer Befunde generell zur Beurteilung des Speichelgangsystems der Glandula parotis geeignet. Vorteile liegen in ihrer Nichtinvasivität, dem Fehlen einer Strahlenexposition und der funktionellen Darstellung des Speichelgangsystems. Des weiteren kann mit Hilfe der Kernspinsialographie die oft publizierte, kernspintomographische Darstellung des N. facialis differentialdiagnostisch zu den Speichelgängen verifiziert, bzw. falsifiziert werden.SummaryThe new technique of non-invasive magnetic resonance (MR) sialography was evaluated for normal and various pathologic conditions of the parotid gland. Ten volunteers and 15 patients with various symptomatic diseases of the parotid gland were tested in the present study. Diseases included pleomorphic adenoma, cystadenolymphoma, carcinoma ex pleomorphic adenoma, ductal carcinoma, adenoid cystic carcinoma, lymphoepithelial carcinoma, non-Hodgkin’s lymphoma, sialolithiasis, sialadenitis, Heerfordt’s syndrome and congenital duct ectasies. In addition to the usually performed T1 and T2 cross-sectional sequences a heavily weighted T2 sequence (TR 3600, TE 800) was performed and allowed depiction of a fluid-filled parotid duct. Results showed that the main parotid and primary branching ducts were depicted reliably in all normal cases and all patients, except one with sicca syndrome. Pathological conditions such as duct dilatations, duct strictures, obstructing duct calculus and irregular shapes and courses of the ductal system were demonstrable. While X-ray sialography obtained a higher resolution, only MR sialography was able to depict dilated ducts proximal from a complete obstruction, as well as all ductal cysts. Our findings show that MR sialography can be applied successfully to investigations of the parotid gland system. There have been no contraindications or complications to date because MR sialography is non-invasive. The technique will also allow the salivary ducts and lesions to be differentiated from the course of the facial nerve.

Krikohyoidopexie (CHP) und Krikohyoidoepiglottopexie (CHEP)

BACKGROUND Subtotal laryngectomy with Cricohyoido(epiglotto)pexy (CHEP and CHP) is a commonly used surgical procedure in France, Italy and North America, but it is rarely carried out in Germany,where most laryngeal carcinomas staged T1-T3 are resected endoscopically or with total laryngectomy. OBJECTIVE To identify indications for the CHEP and CHP in a setting that uses endolaryngeal procedures as a standard approach to organ preserving surgery in laryngeal cancer patients. PATIENTS Nineteen patients with primary (n=15) or recurrent (n=4), supra- or transglottic carcinoma or carcinoma of the anterior commissure staged (r)T1b-4N0-2cM0 were treated with subtotal laryngectomy with CHEP (with or without neck dissection/radiotherapy) between October 1997 and June 1999. RESULTS Undisturbed deglutition without aspiration and respiration without tracheotomy was achieved in 17/19 patients.Three patients showed temporary pneumonia from aspiration and two patients needed further treatment for endolaryngeal synechia. Three patients died of unrelated causes. Four patients were diagnosed with local recurrence: Two of them died from tumor, two patients had curative total laryngectomy as salvage surgery.Fourteen patients are living free of disease 24-40 months after therapy. CONCLUSION CHEP is a subtotal laryngectomy with increased postoperative morbidity, but good functional results.Assuming a scrupulous indication for the extended tumors the oncological results of the CHEP are satisfying, too.ZusammenfassungHintergrund. Während die CH(E)P in Frankreich, Italien und Nordamerika in der Therapie von T1–3-Larynxplattenepithelkarzinomen etabliert ist,werden in Deutschland T1–2-Larynxkarzinome größtenteils endoskopisch und T3–4-Larynxkarzinome überwiegend mittels totaler Laryngektomie therapiert.Wir wollen aufzeigen,welche Indikationen zur CH(E)P neben den ausgedehnten endolaryngealen Kehlkopfteilresektionen und der totalen Laryngektomie bestehen können. Patienten und Methode. Von 10/97 bis 6/99 erfolgte bei 19 Patienten mit (r)T1b-4N0-2cM0-Larynxkarzinomen eine CH(E)P mit oder ohne Neck dissection/Radiotherapie. Ergebnisse. 18 Patienten erlernten die aspirationsfreie perorale Nahrungsaufnahme.Bei 17 Patienten konnte das Tracheostoma verschlossen werden.Eine Aspirationspneumonie trat bei 3, eine ventrale Synechie bei 2 Patienten auf.3 Patienten verstarben interkurrent. Von den verbleibenden auszuwer tenden 16 Patienten zeigten 4 ein Residualkarzinom/Rezidiv; 2 dieser Patienten verstarben tumorbedingt,2 wurden mit einer totalen Laryngektomie kurativ behandelt. 14 Patienten leben tumorfrei 24–40 Monate nach CH(E)P,davon 12 mit erhaltenem und funktionierendem Kehlkopf. Schlussfolgerung. Die CH(E)P ist eine radikale Kehlkopfteilresektion mit erhöhter postoperativer Morbidität, aber akzeptablen funktionellen Ergebnissen. Neben ihrer Indikation beim Karzinom der vorderen Kommissur und ausgedehnt supraglottischen Karzinomen kann die CH(E)P für kritisch ausgewählte transglottische Karzinome eine Alternative zur totalen Laryngektomie darstellen.AbstractBackground. Subtotal laryngectomy with Cricohyoido(epiglotto)pexy (CHEP and CHP) is a commonly used surgical procedure in France, Italy and North America, but it is rarely carried out in Germany,where most laryngeal carcinomas staged T1–T3 are resected endoscopically or with total laryngectomy. Objective. To identify indications for the CHEP and CHP in a setting that uses endolaryngeal procedures as a standard approach to organ preserving surgery in laryngeal cancer patients. Patients. Nineteen patients with primary (n=15) or recurrent (n=4), supra- or transglottic carcinoma or carcinoma of the anterior commissure staged (r)T1b-4N0-2cM0 were treated with subtotal laryngectomy with CHEP (with or without neck dissection/radiotherapy) between October 1997 and June 1999. Results. Undisturbed deglutition without aspiration and respiration without tracheotomy was achieved in 17/19 patients.Three patients showed temporary pneumonia from aspiration and two patients needed further treatment for endolaryngeal synechia. Three patients died of unrelated causes. Four patients were diagnosed with local recurrence: Two of them died from tumor, two patients had curative total laryngectomy as salvage surgery.Fourteen patients are living free of disease 24–40 months after therapy. Conclusion. CHEP is a subtotal laryngectomy with increased postoperative morbidity, but good functional results.Assuming a scrupulous indication for the extended tumors the oncological results of the CHEP are satisfying, too.

Surgical treatment options in laryngeal and hypopharyngeal cancer

In Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses. Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options: Local tumour, no systemic metastasis Tumour has to be resectable in healthy margins mortality/morbidity Surgery must not lead to unreasonable mutilation Lack of other therapeutic alternatives having an equal or lesser impact In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.SummaryIn Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses.Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options: Local tumour, no systemic metastasisTumour has to be resectable in healthy marginsmortality/morbiditySurgery must not lead to unreasonable mutilationLack of other therapeutic alternatives having an equal or lesser impact In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.ZusammenfassungIn Österreich ist bei Kehlkopfkarzinomen derzeit jährlich mit etwa zehn Neuerkrankungen pro 100.000 Einwohner und bei Hypopharynxkarzinomen mit etwa drei Neuerkrankungen bei Männern zu rechnen. Bei Frauen sind die Inzidenzen etwa um den Faktor 5 geringer. Insgesamt scheint die Rate der Neuerkrankungen den letzten Jahren konstant oder leicht rückläufig zu sein. Etwa 70 % aller Kehlkopfkarzinome sind glottische, also von den Stimmlippen ausgehende Neoplasien. Etwa 30 % sind supraglottische Tumoren, echte subglottische Karzinome sind sehr selten. Die Mehrzahl der Hypopharynxkarzinome geht von den Sinus piriformes aus. Stimmlippentumore führen zu einem typischen und klinisch erkennbaren Frühsymptom: Heiserkeit. Über Wochen hinweg persistierende Stimmstörungen bei Erwachsenen müssen daher stets laryngoskopisch abgeklärt werden. Hierdurch eröffnet sich eine echte Möglichkeit der Früherkennung von Kehlkopfkarzinomen, so dass heute etwa 60 % aller Larynxkarzinome in den klinischen Frühstadien I und II nach UICC bzw. als intraepitheliale Neoplasie (früher so genanntes Karzinoma in situ) diagnostiziert werden können. Bei glottischen Karzinomen werden sogar etwa 75 % in diesen Frühstadien diagnostiziert, bei supraglottischen Tumoren dagegen nur etwa 30 %, bei Hypopharynxkarzinomen unter 15 %. Prinzipiell stehen Chirurgie, Strahlentherapie und medikamentöse Therapie als onkologische Ansätze zur Verfügung. Voraussetzung für den sinnvollen kurativen Einsatz chirurgischer Therapieoptionen ist in der Regel die Erfüllung folgender Bedingungen: Lokal begrenzte Tumorkrankheit, keine systemische MetastasierungTumor muss operationstechnisch in gesunden Grenzen resezierbar seinVertretbare perioperative Mortalität/MorbiditätOperation darf nicht zu unzumutbaren Verstümmelungen führenFehlen gleichwertiger und weniger beeinträchtigender therapeutischer Alternativen Im Folgenden sollen die Indikationen zur chirurgischen Behandlung von Larynx- und Hypopharynxkarzinomen diskutiert und die Ergebnisse der chirurgischen Therapie kurz zusammengefasst werden.

Indikationen zur chirurgischen Therapie von Larynx- und Hypopharynxkarzinomen

In Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses. Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options: Local tumour, no systemic metastasis Tumour has to be resectable in healthy margins mortality/morbidity Surgery must not lead to unreasonable mutilation Lack of other therapeutic alternatives having an equal or lesser impact In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.SummaryIn Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses.Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options: Local tumour, no systemic metastasisTumour has to be resectable in healthy marginsmortality/morbiditySurgery must not lead to unreasonable mutilationLack of other therapeutic alternatives having an equal or lesser impact In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.ZusammenfassungIn Österreich ist bei Kehlkopfkarzinomen derzeit jährlich mit etwa zehn Neuerkrankungen pro 100.000 Einwohner und bei Hypopharynxkarzinomen mit etwa drei Neuerkrankungen bei Männern zu rechnen. Bei Frauen sind die Inzidenzen etwa um den Faktor 5 geringer. Insgesamt scheint die Rate der Neuerkrankungen den letzten Jahren konstant oder leicht rückläufig zu sein. Etwa 70 % aller Kehlkopfkarzinome sind glottische, also von den Stimmlippen ausgehende Neoplasien. Etwa 30 % sind supraglottische Tumoren, echte subglottische Karzinome sind sehr selten. Die Mehrzahl der Hypopharynxkarzinome geht von den Sinus piriformes aus. Stimmlippentumore führen zu einem typischen und klinisch erkennbaren Frühsymptom: Heiserkeit. Über Wochen hinweg persistierende Stimmstörungen bei Erwachsenen müssen daher stets laryngoskopisch abgeklärt werden. Hierdurch eröffnet sich eine echte Möglichkeit der Früherkennung von Kehlkopfkarzinomen, so dass heute etwa 60 % aller Larynxkarzinome in den klinischen Frühstadien I und II nach UICC bzw. als intraepitheliale Neoplasie (früher so genanntes Karzinoma in situ) diagnostiziert werden können. Bei glottischen Karzinomen werden sogar etwa 75 % in diesen Frühstadien diagnostiziert, bei supraglottischen Tumoren dagegen nur etwa 30 %, bei Hypopharynxkarzinomen unter 15 %. Prinzipiell stehen Chirurgie, Strahlentherapie und medikamentöse Therapie als onkologische Ansätze zur Verfügung. Voraussetzung für den sinnvollen kurativen Einsatz chirurgischer Therapieoptionen ist in der Regel die Erfüllung folgender Bedingungen: Lokal begrenzte Tumorkrankheit, keine systemische MetastasierungTumor muss operationstechnisch in gesunden Grenzen resezierbar seinVertretbare perioperative Mortalität/MorbiditätOperation darf nicht zu unzumutbaren Verstümmelungen führenFehlen gleichwertiger und weniger beeinträchtigender therapeutischer Alternativen Im Folgenden sollen die Indikationen zur chirurgischen Behandlung von Larynx- und Hypopharynxkarzinomen diskutiert und die Ergebnisse der chirurgischen Therapie kurz zusammengefasst werden.