Experience of using horizontal access in laryngectomy. Evaluation of clinical results

Introduction. For now surgery is a key element in the treatment of advanced laryngeal cancer due to the most radical resection. Although, the incidence of complications in the form of pharyngocutaneous fistula is high, which leads to unsatisfactory functional and aesthetic results, increased treatment duration and cost.

The study objective is to improve the method for radical surgical treatment in patients with laryngeal cancer, to assess its impact on the frequency of postoperative complications.

Materials and methods. Our experience is based on the performed laryngectomy in 124 patients since 2009 to 2017. Laryngectomy was performed in 85 (68.5 %) patients, combined laryngectomy – in 17 (13.7 %) and extended combined laryngectomy – in 22 (17.8 %) patients.

Results. The developed approach method for surgical treatment of malignant laryngeal tumors allowed to avoid formation of pharyngocutaneous fistula and wound complications in postoperative period, and to achieve high functional and aesthetic results, decrease duration of inpatient care.

Conclusion. New treatment method provides favourable conditions for social, labor, medical rehabilitation of patients and allows to reduce treatment duration and cost.

1. Статистика злокачественных новообразований в России и странах СНГ в 2012 г. Под ред. М.И. Давыдова, Е.М. Аксель. М.: Издательская группа РОНЦ, 2014. 226 с. [Cancer statistics in Russia and CIS in 2012. Ed. by M.I. Davydov, E.M. Axel. Moscow: Izdatelskaya gruppa RONC, 2014. 226 p. (In Russ.)].

2. Пачес А.И. Опухоли головы и шеи: клиническое руководство. М.: Практическая медицина, 2013. С. 170. [Paches А.I. Head and neck tumors: сlinical guidelines. Мoscow: Prakticheskaya meditsina, 2013. P. 170. (In Russ.)].

3. Karatzanis A.D., Psychogios G., Waldfahrer F. et al. Management of locally advanced laryngeal cancer. J Otolaryngol Head Neck Surgery 2014;43:4. DOI: 10.1186/1916-0216-43-4. PMID: 24472173.

4. Состояние онкологической помощи населению России в 2016 г. Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ НМИРЦ Минздрава России, 2016. С. 157. [State of oncological care in Russia in 2016. Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertzena – filial FGBU NMIRC Minzdrava Rossii, 2016. Р. 157. (In Russ.)].

5. Кожанов А.Л. Современные аспекты лечения и реабилитации больных при раке гортани. Опухоли головы и шеи 2016;6(2):17–25. [Kozhanov A.L. Current aspects of treatment and rehabilitation of patients with pharyngeal cancer. Opukholi golovy i shei = Head and Neck Tumors 2016;6(2):17–25. (In Russ.)]. DOI: 10.17650/2222-1468-2016-6-2-17-25.

6. Акетова Т.А., Любаев В.Л., Бойков В.П. и др. Реабилитация больных раком гортани. Вестник РОНЦ им. Н.Н. Блохина 2003;14(2):42–5. [Aketova T.A., Lyubaev V.L., Boykov V.P. et al. Rehabilitation of patients with cancer of the larynx. Vestnik RONC im. N.N. Blokhina = Journal of N.N. Blokhin Russian Cancer Research Center 2003;14(2):42–5. (In Russ.)].

7. Weber R. S., Berkey B. A., Forastiere A. et al. Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91–11. Arch Otolaryngol Head Neck Surg 2003;129(1):44–9. DOI: 10.1001/archotol.129.1.44. PMID: 12525193.

8. Sassler A.M., Esclamado R.M., Wolf G.T. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121(2):162–5. DOI: 10.1001/archotol.1995.01890020024006. PMID: 7840923.

9. Stoeckli S.J., Pawlik A.B., Lipp M. et al. Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 2000;126(12):1473–7. DOI: 10.1001/archotol.126.12.1473. PMID: 11115285.

10. Leόn X., Quer M., Orús C.L. et al. Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy. Head Neck 2001;23(9):733–8. DOI: 10.1002/hed.1104. PMID: 11505482.

11. Tan H.K., Giger R., Auperin A. et al. Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas – stratification for postsalvage survival. Head Neck 2010;32(2):139–47. DOI: 10.1002/hed.21159. PMID: 19536855.

12. Esteller E., Vega M.C., Lόpez M. et al. Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy. Eur Arch Otorhinolaryngol 2011;268(2):295–301. DOI: 10.1007/s00405-010-1365-1. PMID: 20721572.

13. Ganly I., Patel S., Matsuo J. et al. Postoperative complications of salvage total laryngectomy. Cancer 2005;103(10):2073–81. DOI: 10.1002/cncr.20974. PMID: 15816049.

14. Lavertu P., Bonafede J.P., Adelstein D.J. et al. Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer. Arch Otolaryngol Head Neck Surg 1998;124(4):401–6. DOI: 10.1001/archotol.124.4.401. PMID: 9559686.

15. Schwartz S. R., Yueh B., Maynard C. et al. Predictors of wound complications after laryngectomy: a study of over 2000 patients. Otolaryngol Head Neck Surg 2004;131(1):61–8. DOI: 10.1016/j.otohns.2003.08.028. PMID: 15243559.

16. Nichols R. D., Mickelson S. A. Partial laryngectomy after irradiation failure. Ann Otol Rhinol Laryngol 1991;100(3):176–80. DOI: 10.1177/000348949110000302. PMID: 2006814.

17. Dedivitis R. A., Aires F. T., Cernea C. R., Brandão L. G. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck 2015;37(11):1691–7. DOI: 10.1002/hed.23804. PMID: 24958209.

18. Hasan Z., Dwivedi R.C., Gunaratne D.A. et al. Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 2017;43(1):42–51. DOI: 10.1016/j.ejso.2016.05.017. PMID: 27265037.

19. Patel U.A., Moore B.A., Wax M. et al. Impact of pharyngeal closure technique on fistula after salvage laryngectomy. JAMA Otolaryngol Head Neck Surg 2013;139(11):1156–62. DOI: 10.1001/jamaoto.2013.2761. PMID: 23576219.

20. Stoeckli S.J., Pawlik A.B., Lipp M. et al. Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 2000;126(12):1473–7. DOI: 10.1001/archotol.126.12.1473. PMID: 11115285.

21. Holsinger F.C., Funk E., Roberts D.B., Diaz E.M. Jr. Conservation laryngeal surgery versus total laryngectomy for radiation failure in laryngeal cancer. Head Neck 2006;28(9):779–84. DOI: 10.1002/hed.20415. PMID: 16637055.

22. Jorgensen K., Godballe C., Hansen O., Bastholt L. Cancer of the larynx – treatment results after primary radiotherapy with salvage surgery in a series of 1005 patients. Acta Oncol 2002;41(1):69–76. DOI: 10.1080/028418602317314091. PMID: 11990522.

23. Клочихин А.Л., Марков Г.И., Ашерова И.К. Состояние функции внешнего дыхания после резекции гортани по поводу рака 3 стадии с использованием различных полимерных материалов. Вестник оториноларингологии 1997;(5):37–9. [Klochikhin A.L., Markov G.I., Asherova I.K. The state of external respiration function after larynx resection for stage 3 cancer with the use of various polymeric materials. Vestnik otorinolaringologii = Bulletin of Otorhinolaryngology 1997;(5):37–9. (In Russ.)].

24. Русина Н.А., Моисеева К.С. Клинико-психологическое исследование пациентов, страдающих раком гортани. Вестник Южно-Уральского государственного университета. Серия: Психология 2013;6(1):82–9. [Rusina N.A., Moiseeva K.S. Clinical and psychological study of patients with the oncologic diseases of larynx. Vestnik Yuzhno-Ural’skogo gosudarstvennogo universiteta. Seriya: Psikhologiya = Bulletin of the South Ural State University. Series: Psychology 2013;6(1):82–9. (In Russ.)].

25. Балацкая Л.Н. Речевая реабилитация и качество жизни после лечения больных опухолями головы и шеи: дис. … д-ра биол. наук. Томск, 2001. [Balatskaya L.N. Speech rehabilitation and quality of life of patients after treatment of head and neck tumors: dis. … of cand. of med. sciences. Tomsk, 2001. (In Russ.)].

26. Балацкая Л.Н. Речевая реабилитация и качество жизни после хирургического лечения больных раком гортани. Сибирский онкологический журнал 2003;(2):54–7. [Balatskaya L.N. Speech rehabilitation and quality of life after treatment of patients with the oncologic diseases of larynx. Sibirskiy onkologicheskiy zhurnal = Siberian Journal of Oncology 2003;(2):54–7. (In Russ.)].

27. Herranz J., Sarandeses A., Fernández M.F. et al. Complications after total laryngectomy in nonradiated laryngeal and hypopharyngeal carcinomas. Otolaryngol Head Neck Surg 2000;122(6):892–8. DOI: 10.1016/S0194-59980070020-9. PMID: 10828805.