[Reconstructive sub-total laryngectomy according to Labayle. Clinical experience on 21 cases]

Abstract

In this paper the authors report the functional and oncological results regarding 21 patients suffering from laryngeal carcinoma, who underwent surgery at the University of Parma's ORL Clinic - between 1975 and 1984 - for sub-total reconstructive laryngectomy using the Labayle method. This process provides for not just the radical removal of the laryngeal tumor, but also for restoring basic functions such as respiration, phonation and swallowing. To this end, during the destructive phase, the cricoid cartilage (partially or wholly) and one or both of the arytenoids are retained. The application of this method is situated somewhere between the classic total laryngectomy and the conservative supraglottic, at times finding itself in natural opposition to the expanded supraglottic the lateral-front, the hemilaryngectomy, the crico-ioidopesia and the Serafini-type total laryngectomy. Since it doesn't concern a total laryngectomy in the strict sense of the word, the operation presents general counterindications that are relative - and which exist for that matter in all laryngeal surgery, functional or reconstructive - and local counterindications that are absolute. In addition to the, elective indications are dictated critically. The surgical act, illustrated in detail, consists in a period of approach or preparation, a period of destruction and a period of reconstruction. The results obtained from the series of cases followed are wholly satisfactory from both the functional and oncological point of view: the parameters evaluated - respiration, phonation and swallowing - were totally restored in the majority of cases. Swallowing in just two patients was insufficient, as was respiration in one. Concerning the oncological results, if we exclude 4 cases of the 21 considered which do not have a follow-up of more than three years, there have been no clinical signs of a recurrence of the tumoral disease in the remaining 17, of which 15 have been under observation for more than 5 years. The survival rate, up to the first months of 1985, is 70.5%.