Partial laryngectomy constitutes one of the treatments for early stage glottic carcinoma (i.e. T1N0 and T2N0) in specialised centres. Over the years, several partial laryngectomy and reconstruction techniques have been described in the literature. The choice of technique depends on disease location and extension, as well as the individual surgeon’s preference. The most widely practised operations are vertical partial laryngectomy and horizontal supracricoid laryngectomy. Partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) has been shown to produce functional and oncological results analogous to supracricoid partial laryngectomy (cricohyoidoepiglottopexy) for T1b and T2 glottic carcinomas. The purpose of this study was to evaluate swallowing following PFLER using reproducible and objective tests and also identify preoperative factors that could influence swallowing outcomes. Twenty four patients that underwent PFLER in the period 2008-2012 were retrospectively evaluated. Locoregional control was achieved in all cases, but one after a median follow-up of 16.7 months. Swallowing was evaluated within 15 days (early score) and at two months (late score) post-operatively. In this series, 83% of patients had achieved at least partial oral feeding at time of hospital discharge (mean 18 days, range 10-39 days) and 87.5% achieved exclusive oral feeding at two months postoperatively. An objective swallowing assessment by videofluoroscopy showed that 50% had a good or excellent early score, 4.2% had an average early score and 41.8% had a poor early score. Regarding late scores, 63% were classified as good or excellent, 29% were classified as ‘middle result’ because their time to recover was longer (i.e. between one and two months postoperatively), and only two patients had a poor late score. Finally, only one patient was partially fed by gastrostomy (180 days after surgery). All patients tolerated decannulation and none experienced chronic pulmonary problems. With regards to pre-operative factors, T stage was the only factor shown to influence early swallowing outcomes (but not late outcomes), probably a direct result of the extent of surgical resection. The study’s main limitation relates to the small number of patients (n=24). This knowledge may prove of particular significance to head and neck surgeons when selecting and consenting patients for partial laryngeal surgery.
Swallowing outcomes following partial laryngectomy: objective assessment and pre-operative predictive factors
Reviewed by George Garas
Analysis of swallowing after partial frontolateral laryngectomy with epiglottic reconstruction for glottic cancer.
CONTRIBUTOR
George Garas
(Surgical Oncology) University Hospitals Birmingham NHS Foundation Trust
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