Postoperative results and the effects of extended partial laryngectomy on the quality of life

Abstract

Background/Aim: Larynx cancers account for 2-5% of all malignancies worldwide. With early diagnosis, radiotherapy or a partial laryngectomy may help preserve voice and laryngeal functions and reduce morbidity. This study aimed to evaluate how laryngeal functions, voice, and life quality were affected in larynx cancer patients after partial and extended partial laryngectomy. Methods: The patients who were diagnosed with larynx cancer and underwent partial (supraglottic laryngectomy (SGL), supracricoid laryngectomy (SCL)) or extended partial laryngectomy (extended supraglottic laryngectomy (ESGL) and extended supracricoid laryngectomy (ESCL)) between May 2010 and December 2015 in the otorhinolaryngology clinic of a Training and Research Hospital were included in this study. A questionnaire comprising three forms was filled in by these patients. Voice quality, duration of hospitalization, time until removal of the nasogastric tube, location of the tumor, time of decannulation, swallowing, and cough were compared with regards to the types of laryngectomies. Results: Our study began with 102 patients who had a partial laryngectomy; however, twelve who eventually had to undergo a total laryngectomy were excluded. Of the remaining 90 patients, 67 filled out our questionnaire. Functional score (FS), social functional score (SFS), symptom score (SS), fatigue score (FAS), general health score (GHS), and swallowing symptoms score (HNSW) were calculated and compared. These scores did not differ with the types of laryngectomies. In terms of voice quality, there were significant differences between ESCL-SGL, SCL-SGL, ESGL-SGL groups (P=0.001, P=0.004, and P=0.004, respectively). Conclusion: Despite numerous changes in swallowing physiology and larynx anatomy after partial and extended partial laryngectomy, swallowing function is restored, and the patients can lead a healthy life.

Keywords

• Larynx cancer
• Life quality
• Voice

Genişletilmiş Parsiyel Larenjektomili Hastalarda Postoperatif Bulgular Ve Yaşam Kalitesi Üzerine Etkisi

Öz

Amaç: Larenks kanseri nedeniyle parsiyel larenjektomi ve genişletilmiş parsiyel larenjektomi olan hastaların larengeal fonksiyonların ne kadar etkilendiği, hastaların ses kalitesinin son durumu, hastaların larenjektomiden sonraki dönemdeki hayat kalitesi değerlendirildi. Yöntemler: Araştırma ve Uygulama Hastanesi Kulak Burun Boğaz Kliniği’nde Mayıs 2010 ile Aralık 2015 tarihleri arasında larenks kanseri tanısı almış parsiyel larenjektomi ve genişletilmiş parsiyel larenjektomi yapılmış hastalar dahil edildi. Bu hastalara 3 formdan oluşan anket formları doldurtuldu. Bulgular: Çalışmamıza 102 parsiyel larenjektomi yapılan hasta ile başlandı. Bu hastalardan 12’si takiplerde total larenjektomiye çevirildi ve bu hastalar listeden çıkarıldı. Kalan 90 hastadan 67’si anketimize katıldı. Hastaların ses kalitesi, hastanede kalış süresi, nasogastrik çekme süresi, tümörün yerleşim yeri, dekanülasyon süresi, gıdalarla öksürük ilişkisi larenjektomi tiplerine göre değerlendirildi. Sonuç: Larenjektomi tiplerine göre fonksiyonel skoru (FS), sosyal fonksiyon skoru (SFK), semptom skoru (SS), yorgunluk skoru (FAS), genel sağlık skoru (GHS) ve yutma semptom skoru (HNSW) hesaplanarak karşılaştırma yapıldı. Bu karşılaştırmalarda istatistiksel olarak anlamlı fark bulunamadı. Ses kalitesi açısından GSCL-SGL, SCL-SGL, GSGL-SGL grupları arasında anlamlı fark vardı (sırasıyla p=0,001, p=0,004, p=0,004).

Anahtar Kelimeler

• Larenks kanseri
• yaşam kalitesi
• ses

References

1. 1. Kaya S. Larenks Hastalıkları. Ankara: Bilimsel Tıp Yay; Ocak 2002;539–716.
2. 2. Özlügedik S, Ünal A. Bas boyun kanserlerinde epidemiyoloji ve risk faktörleri. KBB Bas Boyun Cerrahisi’nde Güncel Yaklaşım. 2005;1:51–6.
3. 3. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med. 1996 Mar 28;334(13):835-40. doi: 10.1056/NEJM199603283341306. PMID: 8596551.
4. 4. QL Coordinator Quality of Life Unit, EORTC Data Center, Avenue E. Mounier 83 - B11, 1200 Brussels, Belgium, Email: [e-mail]
5. 5. Long SA, D'Antonio LL, Robinson EB, Zimmerman G, Petti G, Chonkich G. Factors related to quality of life and functional status in 50 patients with head and neck cancer. Laryngoscope. 1996 Sep;106(9 Pt 1):1084-8. doi: 10.1097/00005537-199609000-00008. PMID: 8822710.
6. 6. Smith JC, Johnson JT, Cognetti DM, Landsittel DP, Gooding WE, Cano ER, et all. Quality of life, functional outcome, and costs of early glottic cancer. Laryngoscope. 2003 Jan;113(1):68-76. doi: 10.1097/00005537-200301000-00013. PMID: 12514385.
7. 7. Carr AJ, Higginson IJ. Are quality of life measures patient centred? BMJ. 2001 Jun 2;322(7298):1357-60. doi: 10.1136/bmj.322.7298.1357. PMID: 11387189; PMCID: PMC1120435.
8. 8. Jenney ME, Campbell S. Measuring quality of life. Arch Dis Child. 1997 Oct;77(4):347-50. doi: 10.1136/adc.77.4.347. PMID: 9389243; PMCID: PMC1717359.

9. 9. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365-76. doi: 10.1093/jnci/85.5.365. PMID: 8433390.
10. 10. Hinerman RW, Morris CG, Amdur RJ, Lansford CD, Werning JW, Villaret DB, et al. Surgery and Postoperative Radiotherapy for Squamous Cell Carcinoma of the Larynx and Pharynx. Am J Clin Oncol. 2006 Dec;29(6):613-21. doi: 10.1097/01.coc.0000242319.09994.78.
11. 11. Huang DT, Johnson CR, Schmidt-Ullrich R, Grimes M. Postoperative radiotherapy in head and neck carcinoma with extracapsular lymph node extension and/or positive resection margins: a comparative study. Int J Radiat Oncol Biol Phys. 1992;23(4):737-42. doi: 10.1016/0360-3016(92)90646-y. PMID: 1618666.
12. 12. Aslan I, Baserer N, Yazicioglu E, Oysu C, Tinaz M, Kıyak E, et al. Neartotal laryngectomy for laryngeal carcinomas with subglottic extension. Arch Otolaryngol Head Neck Surg. 2002;128:177-80.
13. 13. Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer. 2000 Sep;36(14):1796-807. doi: 10.1016/s0959-8049(00)00186-6. PMID: 10974628.
14. 14. Bjordal K, Ahlner EM, Tolleson E, Jensen AB, RAzavi D, Maher EJ et al. Development of a European Organization for research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer. Acta Oncol 1994;33:879–85.
15. 15. Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, et all. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999 Mar;17(3):1008-19. doi: 10.1200/JCO.1999.17.3.1008. PMID: 10071296.
16. 16. Erdamar B, Sütoglu Y, Kıyak E, Sunay T, Katırcıoğlu S, Güven M, et al. Cerrahi tedavi uygulanan larenks kanserli hastaların uzun dönemde yasam kalitelerinin degerlendirilmesi. KBB İhtisas Dergisi 2001;8:219–25.
17. 17. Inal E, Kemaloglu Y, Bayramoğlu I, Yeğin H. Larenks kanseri olgularımızın retrospektif analizi. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi, 1993;1:23-8.
18. 18. Müller R, Paneff J, Köllner V, Koch R. Quality of life of patients with laryngeal carcinoma: a post-treatment study. Eur Arch Otorhinolaryngol. 2001 Aug;258(6):276-80. doi: 10.1007/s004050100356. PMID: 11583465.
19. 19. Molina JM, Fernandez-Crehuet MJ, Caballero J, Gutierrez BM, Gomez GE, Fernandez-Crehuet NJ. Quality of life in patients treated for early laryngeal cancer, in healthy people and in those with other associated pathologies Acta Otorrinolaringol Esp. 2004;55:381–6.
20. 20. Gök Ü, Karlıdağ T, Kaygusuz İ, Yalçın Ş. Parsiyel Larenjektomi Sonrası fonksiyonel Sonuçlarımız. Türkiye Klinikleri KBB Dergisi 2003;3:4-8.
21. 21. Jun-Ook P, Young-Hoon J, Kwang-Jae C, Nam-Gyun K, Min-Sik K. Functional and Oncologic Results of Extended Supracricoid Partial Laryngectomy. Arch Otolaryngol Head Neck Surg. 2011;137:1124-29.
22. 22. Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas. Laryngoscope. 2000 Apr;110(4):627-34. doi: 10.1097/00005537-200004000-00017. PMID: 10764009.
23. 23. Akbas Y, Demireller A. Oncologic and functional results of supracricoid partial laryngectomy with cricohyoidopexy. Otolaryngol Head Neck Surg. 2005 May;132(5):783-7. doi: 10.1016/j.otohns.2005.01.030. PMID: 15886635.
24. 24. Yuce I, Cagli S, Bayram A, Karasu F, Satı I, Guney E. The effect of arytenoid resection on functional results of cricohyoidopexy. Otolaryngol Head Neck Surg. 2009;141:272-5.
25. 25. Sevilla MA, Rodrigo JP, Llorente JL, Cabanillas R, López F, Suárez C. Supraglottic laryngectomy: analysis of 267 cases. Eur Arch Otorhinolaryngol. 2008 Jan;265(1):11-6. doi: 10.1007/s00405-007-0415-9. Epub 2007 Aug 8. PMID: 17684753.
26. 26. Laccourreye O, Brasnu D, Merite-Drancy A, Cauchois R, Chabardes E, Ménard M, Laccourreye H. Cricohyoidopexy in selected infrahyoid epiglottic carcinomas presenting with pathological preepiglottic space invasion. Arch Otolaryngol Head Neck Surg. 1993 Aug;119(8):881-6. doi: 10.1001/archotol.1993.01880200087012. PMID: 8343251.
27. 27. Orús C, León X, Vega M, Quer M. Initial treatment of the early stages (I, II) of supraglottic squamous cell carcinoma: partial laryngectomy versus radiotherapy. Eur Arch Otorhinolaryngol. 2000 Nov;257(9):512-6. doi: 10.1007/s004050000276. PMID: 11131380.
28. 28. Baserer N, Kıyak E, Oysu Ç, Aslan I, Yazıcıoğlu E, Biliciler N et al. Larenks karsinomunda fonasyon teknikleri. Kulak Burun Bogaz Ihtis Der 1996;3:674-7.
29. 29. Öz F, Sekercioğlu N, Toprak M. T3 evresindeki transglottik kanserlerde genis parsiyel larenjektomi. CTF KBB Anabilim Dalı X Akademik Haftası Uluslararası Nöro-Otolojik Cerrahi Simpozyumu Tutanakları 1988:231-2.
30. 30. Ulusan M, Başaran B, Orhan KS, Comoğlu S, Yıldırmaz K, Kıyak OE. Oncologic and functional outcomes of open surgery in early supraglottic tumors: is it still a valid technique? Kulak Burun Bogaz Ihtis Der 2012;22:129-35.
31. 31. McConnel FM, Mendelsohn MS, Logemann JA. Manofluorography of deglutition after supraglottic laryngectomy. Head Neck Surg. 1987 Jan-Feb;9(3):142-50. doi: 10.1002/hed.2890090303. PMID: 3623944.
32. 32. Tuncay A, Titiz A, Özcan M. Parsiyel larenjektomi sonrası yutma fizyolojisindeki değişimler. Ankara Numune Eğitim ve Araştırma Hastanesi 1. KBB Kliniği Derleme
33. 33. Gallo O, Deganello A, Gitti G, Santoro R, Senesi M, Scala J, et al. Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies. Oral Oncology 2009;45, 30– 8.
34. 34. Woisard V, Puech M, Yardeni E, Serrano E, Pessey JJ. Deglutition after supracricoid laryngectomy: compensatory mechanisms and sequelae. Dysphagia. 1996 Fall;11(4):265-9. doi: 10.1007/BF00265213. PMID: 8870355.
35. 35. Woisard V, Serrano E, Yardeni E, Puech M, Pessey JJ. Deglutition after supra-glottic laryngectomy. J Otolaryngol. 1993 Aug;22(4):278-83. PMID: 8230379.
36. 36. Naudo P, Laccourreye O, Weinstein G, Jouffre V, Laccourreye H, Brasnu D. Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg. 1998 Jan;118(1):124-9. doi: 10.1016/S0194-5998(98)70388-2. PMID: 9450842.