Patient selection for near-total laryngectomy and oncologic results

Yıl 2002, Cilt: 9 Sayı: 2, 121 - 125, 12.03.2002

Erkan Özüdoğru Emre Cingi Hamdi Çaklı Cem Keçik Cemal Cingi M. Kezban Gürbüz

Öz

Objectives: We reviewed preoperative, perioperative, and postoperative findings and the survival data to determine which patients may be appropriate for near-total laryngectomy.Patients and Methods: We reviewed hospital records of 20 patients ali males; mean age 56.6 years; range 35 to 73 years who underwent near- total laryngectomy. Indications for patient selection for near-total laryngectomy and survival data were evaluated in comparison with literatüre reports.Results: The site of the tumor was the sinüs pyriformis in two, and the larynx in 18 patients. Thirteen patients had T3, seven patients had T2 tumors. The lesions were localized in the sinüs pyriformis in two patients with T2 tumors. The locoregional control rate at the end of two years was 75%; two- and three-year survival rates were 81.2% and 64.2%, respectively.Conclusion: Following a detailed and meticulous investigation in the preoperative period, near-total laryn­ gectomy seems to be appropriate in selected patients with advanced laryngeal and hypopharyngeal tumors in which partial laryngectomy procedures are not consid- ered. İt may both provide cure and preserve phonation.İt may also be considered for functional purposes in patients whose pulmonary functions are insufficient for partial laryngectomy, in those in whom food aspiration is inevitable after partial laryngectomy, and in those suffering from lifelong food aspiration due to neurologic causes, and for oncologic reasons in patients who develop local recurrences after partial laryngectomy.

Anahtar Kelimeler

Laryngeal neoplasms/surgery, laryngectomy/ methods, larynx/surgery, neoplasm recurrence, local, patient selection, survival rate

Near-total larenjektomi için hasta seçimi ve onkolojik sonuçlar

Öz

Amaç: Ameliyat öncesi, ameliyat sırasında ve ameliyat sonrası dönemdeki bulgular ve elde edilen sağkalım oranlarına göre near-total larenjektominin hangi hastalarda uygulanabileceği incelendi.Hastalar ve Yöntemler: Near-total larenjektomi uygulanan 20 hastanın tümör kontrol kartları ve hastane dosyaları retrospektif olarak incelendi. Literatürde near-total larenjektomi uygulanan olgular arafltırılarak, bizim serimizlehasta seçimi ve sağkalım açısından karflılafltırıldı.Bulgular: Yirmi olgunun ikisinde tümör sinüs piriformis, 18’inde ise larenjeal yerleflimli idi. Tanı konduğunda 13 olgu T3, yedi olgu T2 evresinde idi. T2 evresinde olan olguların ikisinde, tümör sinüs piriformisyerleflimli idi. İki yıllık lökorejyonel kontrol oranı %75,iki yıllık sağkalım oranı %81.2, üç yıllık sağkalımoranı %64.2 bulundu.Sonu ç : Parsiyel larenjektomi tekniklerinin uygulanamayacağı ileri evreli larenjeal ve hipofarenjeal tümörlühastaların bazılarında ameliyat öncesi titiz ve detaylıbir incelemeden sonra uygulanacak near-total larenjektomi bir yandan iyileflme sağlarken, diğer yandanfonasyonu korumaktadır. Near-total larenjektomi ayrıca, bozulmufl akciğer fonksiyonları nedeniyle parsiyellarenjektomi yapılamayan olgularda, parsiyel larenjektomi sonrası önlenemeyen gıda aspirasyonu olan olgularda ve nörolojik nedenlerle ömür boyu sürebilecekgıda aspirasyonu olan olgularda fonksiyonel nedenlerle; parsiyel larenjektomiden sonra nüks geliflen olgularda ise onkolojik nedenlerle uygulanabilir

Anahtar Kelimeler

Larenjeal neoplazmlar/cerrahi, larenjektomi/yöntem, larenks/cerrahi, neoplazm rekürensi, lokal, hasta seçimi, sağkalım oranı

Kaynakça

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