[Therapeutic management of glottic tumours: about a series of 41 cases of subtotal laryngectomy with cricohyoidoepiglottopexy (CHEP)]

Abstract

Objectives: 1) To analyse the oncological and early functional results of partial supra-cricoid laryngectomy with crico-hyoido-pexy performed as a primary treatment modality on patients diagnosed with glottic squamous cell carcinoma involving the anterior commissure; 2) To propose a therapeutic management.

Patients and methods: This is a retrospective study conducted over a period of 10 years (1995-2005). Inclusion criteria included: 1) Squamous cell carcinoma of the vocal cords reaching the anterior commissure; 2) Absence of previous treatment for the glottic lesion; 3) Minimum follow-up period of 24 months. The functional results were evaluated according to duration of hospitalization, and the time elapsed before decanulation and realimentation. Statistical analysis was performed using the stat-view software.

Results: Forty-one patients underwent partial supra-cricoid laryngectomy. All patients had a tumour stage I or II. Mean follow-up was of 88 months. Tumour resection was complete in 95% of cases. The rate of lymph node involvement was 7.3%. Four patients (9.8%) developed local recurrence 13 months, on average, postoperatively. Three patients (7.3%) developed a metachronous lesion 14 months, on average, postoperatively. Three patients (7.3%) died during the follow-up period (2 cases related to the cancer). The specific survival and recurrence-free survival rates were 95% and 84.7% respectively. There was no statistically significant difference in survival rates between patients with stage I and stage II tumours. The mean duration of hospitalization was 24 days. The mean time intervals to decanulation and realimentation were 21 and 15 days respectively.

Conclusion: Partial supra-cricoid laryngectomy with crico-hyoido-pexy is one surgical option in laryngeal conservative surgery. This surgical procedure allows for adequate oncological control and good functional results as long as the indications are well respected and the surgical techniques are well mastered.