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Purpose: To evaluate the functional and oncologic outcomes of adjuvant (chemo)radiation [(C)RT] after open partial horizontal laryngectomies (OPHLs)., Methods: Multicenter retrospective evaluation of 130 patients (116 males, 14 females) submitted between 1995 and 2017 to OPHL Types II and III for laryngeal cancer and receiving adjuvant (C)RT for one or more of the following risk factors at histopathologic examination of the surgical specimen: pT4a and/or > pN2a categories, close/positive resection margins, or presence of both perineural (PNI) and lympho-vascular invasion (LVI). The primary study endpoints were evaluation of the presence of tracheostomy and/or gastrostomy at last follow-up, and calculation of laryngo-esophageal dysfunction-free survival (LEDFS)., Results: Mean age of the study cohort was 60.8 ± 8.9 years (median, 62; interquartile range [IQR], 13). Mean follow-up was 50.7 ± 39.4 months (range 24-188; median, 38; IQR, 51). Adjuvant therapy consisted of CRT in 53 (41%) patients, and RT alone in 77 (59%). Five-year LEDFS was 85%. Overall survival was 71.5%, while 13% of patients remained tracheostomy- and 3% gastrostomy-dependent at the last follow-up. The only significant variable in predicting survival (p = 0.020) was tracheostomy dependence: it was maintained in 7.5% of subjects after OPHL Type II and in 34% of those submitted to OHPL Type III (p < 0.001)., Conclusions: In selected patients affected by advanced laryngeal cancer, OPHLs Type II and III have a relatively good laryngeal safety profile and provide favorable oncologic outcomes even in case of need for adjuvant (C)RT., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Objectives: The primary aim of the present study was to report our multi-institutional experience in surgical salvage with open partial horizontal laryngectomies (OPHL) after failed radiotherapy (RT) for laryngeal squamous cell carcinoma (LSCC). Secondary aims were to analyze the prognostic meaning of the main clinical and pathological parameters in relation to the oncologic outcome and to compare our results with the available literature., Study Design: A retrospective multicenter analysis of surgical oncological outcomes., Methods: We retrospectively review the clinical charts of 70 recurrent LSCC patients after primary RT failure undergone salvage OPHL., Results: At last follow-up, 46 patients (65%) were disease-free; six (9%) were alive with disease; nine (12%) died because of the disease; and nine (12%) died without evidence of disease. The final local control, overall survival, disease-specific survival, and laryngectomy-free survival were 87%, 75%, 87%, and 91%, respectively. Twelve patients (17%) experienced postoperative complications, whereas 18 patients (25%) experienced late sequelae. In five patients (7%), decannulation was not possible because of postoperative laryngeal stenosis., Conclusion: In selected patients, when proper selection criteria for conservation laryngeal surgery are adopted, OPHL can be considered for salvage after RT failure., Level of Evidence: 4 Laryngoscope, 130:431-436, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin., Objective: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis., Methods: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44±28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors., Results: 45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR=5.043; p=0.015) and recurrence (HR=11.586; p=0.012). Resection margin did not result an independent predictor (HR=0.757; p=0.653)., Conclusions: Our study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices., (Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Surgery is the treatment of choice in most head and neck cancers. Very often, the surgery is radical with high impact on the psychosocial, functional and aesthetic fields. The aim of this study is to gain a deeper understanding of the patient's, clinician's and key informant's point of view when surgery is proposed, to improve the quality of pathways in terms of patients' practical, psychological and relational needs. We followed a Grounded Theory approach with semi-structured interviews. Seventeen participants (six patients, nine healthcare professionals and two volunteers) were interviewed immediately before surgery. The study generated a process of "persuading the patient of an obligation" as the core category. The other principal categories that emerged highlighted the patients' doubts and fears regarding the surgery consequences and, in parallel, strategies employed by the healthcare professionals to rebut hindering issues impeding surgery. In particular, healthcare professionals involved patients in an affiliation process through simplified communication to sustain the choice of surgery; the family plays a supportive role in this process. The interplay between the organisational process and patients' experience results in "I will let you convince me" at the end of the decision-making process, where the main aim was to save and be saved., (© 2019 John Wiley & Sons Ltd.)

Objectives:: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed., Methods:: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes., Results:: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05)., Conclusion:: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.

Purpose: The purpose of this study was to evaluate the oncological and functional results of patients affected by laryngeal squamous cell carcinoma (SCC) and surgically treated by supracricoid partial laryngectomy (SCPL) at the ENT Department of the University Hospital of Ferrara., Methods: In this retrospective study a total of 155 patients (149 males/l96.1% and 6 females/3.9%), have been included. All patients were treated between January 1st 1998 and December 31st 2010, by SCPL, including 126 cricohyoidopexies (CHP) and 29 cricohyoidoepiglottopexies (CHEP)., Results: The overall survival (OS) at 3 and 5 years was 88.77 and 83.24%, respectively and the disease-free survival (DFS) at 3 and 5 years was 84.4 and 81.55%, respectively.The recurrence rate was 17.5%, with local recurrences in 12.1% of the cases, regional in 4.7% and distant metastasis in 0.7% of the cases. Synchronous second primary tumors were 0.7% and metachronous second primary cancers (MSPCs) 5.4%. Removal of nasogastric feeding tube (NGT) or percutaneous endoscopic gastrostomy (PEG) was performed in 98.7% of the patients and lasted 22 days on average after SCPL (range 9-60), while decannulation was performed in all of patients at the 27th day on average after surgery., Conclusions: Oncological outcomes of this series are consistent with those of the literature, showing that SCPL is an effective and safe procedure in terms of survival rate and disease control. Functional outcomes confirmed that SCPL allows a good organ preservation and recovery of laryngeal functions.

Objectives/hypothesis: To demonstrate that endoscopic resection (ER), open partial laryngectomies, and cricotracheal resection and anastomosis (CTRA) achieve a good balance between oncologic radicality and organ preservation for laryngeal low-grade chondrosarcoma (LCS) and intermediate-grade chondrosarcoma (ICS)., Study Design: Retrospective series in an academic institution., Methods: Between 2001 and 2013, we treated 13 cricoid, two thyroid, and one arytenoid LCS and ICS. Two cricoid and the only arytenoid LCS were managed by ER. Two thyroid ala LCS were submitted to laminectomy. Five ICS and six LCS of the cricoid received CTRA., Results: Nine patients only required tracheotomy, removed after a maximum of 14 days. Three patients required a nasogastric feeding tube, removed after a maximum of 8 days. Immediate complications included one bleeding, one cervical emphysema, and one partial anastomotic dehiscence. The only late complication was anastomotic stenosis that was resolved by laser resection. All patients regained regular oral feeding and a voice ranging from normal to moderate dysphonia. At the last follow-up, two patients died of unrelated causes, seven are alive with asymptomatic and radiologically stable residual disease, and seven are alive without evidence of persistent disease. One patient received total laryngectomy 11 years after CTRA for recurrent symptomatic disease., Conclusions: Organ preservation surgery for laryngeal LCS and ICS represents a treatment option with low morbidity, good quality of life, and fair possibility to obtain oncologic radicality., Level of Evidence: 4., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To evaluate the oncologic results only in T3 glottic and supraglottic cancers regarding supracricoid partial laryngectomy (SCPL) not requiring total laryngectomy and to assess functional results by self-evaluation by the patient. Study Design Case series with medical record review., Setting: Single tertiary care center., Subjects and Methods: Thirty-two patients with laryngeal squamous cell carcinoma, previously untreated, who underwent SCPL with cricohyoidopexy or cricohyoidoepiglottopexy were reviewed., Results: At 1, 3, and 5 years, the disease-free survival rates were 96.9%, 89.4%, and 78.2%; overall survival rates were 96.9%, 93.2%, and 87.3%; local control and locoregional control rates were 100%, 96.2%, and 96.2%; and distant metastasis-free survival rates were 100%, 100%, and 88.2%, respectively. Aspiration pneumonia was the most common complication observed. The 3 laryngeal functions (speech, swallowing, and breathing) were spared in 83.9% of patients., Conclusion: Supracricoid partial laryngectomy for selected glottic and supraglottic T3 tumors has excellent oncologic and functional results.

Objective: To evaluate the incidence of pharyngocutaneous fistula after pharyngolaryngectomy with and without a Montgomery salivary stent., Design: Retrospective analysis of patients with factors that predispose to the development of pharyngocutaneous fistula (i.e. disease extending to the supraglottic region, base of the tongue or pyriform sinuses, and/or radiochemotherapy)., Subjects: Between 2002 and 2008, 85 pharyngolaryngectomies were performed in our clinic. Of these patients, 31 were at increased risk of fistula development, of whom 45 per cent developed fistulas post-operatively. This subgroup of 31 patients was compared with a second subgroup of 22 patients at high risk of fistula development, treated between 2009 and 2011 with pharyngolaryngectomy and with a Montgomery salivary stent placed in advance during closure of the neopharynx., Results: Statistical analysis showed a significant reduction in the rate of fistula development, from 45 to 9 per cent (p < 0.01), with application of the salivary stent., Conclusion: These data confirm the preventive effect of a salivary stent placed during pharyngolaryngectomy, for patients at high risk of fistula development.

Long-term oncological and functional results from a retrospective study on 469 patients over a 10-year period of subtotal laryngectomies (SL), 399 supracricoid partial laryngectomies (SCL) and 70 supratracheal partial laryngectomies (STL) are presented. The mean follow-up time was 97 months (range 60–165 months). Acute complications, types and rates of late sequelae, functional results, 2-year post-operative scores of laryngeal function and quality of life are reported. The observed long-term results were: SCL, 5-year overall and disease-free survival: 95.6, and 90.9%, respectively; 2-year post-operative laryngeal function preservation: 95.7%; STL, 5-year overall and disease-free survival: 80 and 72.9%, respectively; 2-year post-operative laryngeal function preservation: 80%. The performance status scale for laryngeal function preservation showed very high 2-year scores, with no significant differences depending on the type and extent of surgery. The adopted type of function-sparing surgery provided overall and disease-free survival rates that were somewhat better than those reported in studies based on organ-sparing protocols with chemoradiotherapy. The rate of total laryngectomy of completion in this series was 4.4%. A new classification of the current horizontal partial laryngectomies is also proposed, namely “Horizontal Laryngectomy System” (HOLS), based on the extent of surgical removal of laryngeal structures.

Objectives/hypothesis: The aim of the study was to evaluate the oncologic outcome of our series of advanced laryngeal squamous cell carcinomas, primarily treated by supracricoid laryngectomy with cricohyoidopexy or total laryngectomy, to compare the two therapeutic modalities., Study Design: Retrospective controlled study., Methods: We retrospectively reviewed the medical files, operative charts, and pathology reports of 83 patients who underwent total laryngectomy or supracricoid laryngectomy with cricohyoidopexy between February 1999 and March 2009. We only included cases in which both surgical treatments were feasible. Endpoints included local control, locoregional control, overall survival, and disease-specific survival., Results: When we stratified the patients according to T stage, no statistically significant differences emerged in terms of overall and disease-specific survival. When we compared total laryngectomy to cricohyoidopexy in N1 patients, 3-year overall survival and disease-specific survival differences were statistically relevant (P = .022 and P = .030, respectively)., Conclusions: Total laryngectomy warranted better results in term of overall and disease-specific survival, although the differences were not statistically significant. Local and locoregional control in the two treatment groups were overlapping, showing that cricohyoidopexy (when technically feasible) could be a valid surgical option in selected advanced laryngeal squamous cell carcinoma., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

The aim of the present investigation was to analyze the oncological results of a series of early stage glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery. We focused on prognosis factors with significant impact on local control and disease-free survival (DFS). This retrospective study was conducted on a series of 177 consecutive patients with pT1-T2 glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery in the period 2000-2007. All considered patients had at least a 24-month follow-up period (mean follow-up 49.1 ± 23.0 months). The overall survival and the disease-specific survival rates were respectively 90.8 and 98.8%. The rates of local control with primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 86.3, 94.3, and 97.7%, respectively. Arytenoids (p = 0.006) and limited subglottic involvements (p = 0.0002) have a significant impact on DFS. Endoscopic laser surgery is the gold standard in the treatment of early glottic carcinoma because of high local control rates with laser alone, day surgery modality, very low morbility, good post-operative voice quality in most of the cases, and low costs.

Background: The purpose of the present study was to report the oncological and functional results of our experience in open organ preservation surgery of the larynx., Methods: Between 1978 and 2006, 140 patients were treated with organ preservation surgery of the larynx. Feeding tube and tracheotomy duration, surgical infection, fistulae, and pneumonia were recorded., Results: Most patients were treated with supraglottic laryngectomies. Thirteen patients (9%) experienced a faringo-cutaneous fistula, 23 (16%) presented with a surgical site infection, and 6 (4%) developed pneumonia. Tracheotomy was maintained for a median period of 47 days in patients who did not receive postoperative radiotherapy (RT) and 140 days in patients who did. Eight (6%) total laryngectomies were performed because of oncological and functional reasons. Tube feeding continued for an average period of 34 days. Patients with squamous cell carcinoma (SCC) had 5-year disease-free survival (DFS) of 83.6%., Conclusion: Open organ preservation surgery proved oncologically effective with good functional outcome and acceptable complications., (Copyright © 2010 Wiley Periodicals, Inc.)

Objective/hypothesis: The purpose of the study was to assess the satisfaction and quality of life in laryngectomees after vocal rehabilitation using voice prostheses. We evaluated the impact on quality of life between laryngectomees with voice prostheses, laryngectomees without them and healthy controls., Methods: This was a prospective study on a sample of laryngectomees in an Italian university hospital. Our study population was composed of 42 patients who had previously undergone a total laryngectomy; in 24 of them, voice rehabilitation was obtained with a voice prosthesis device (group A), while 18 of them learned oesophageal voice (group B). The results were compared with a group of 25 healthy controls (group C). In order to investigate the quality of life, we administered the Short Form 36-Item Health Survey (SF-36) to the 3 groups. Moreover, self-satisfaction of the subjects in group A was assessed by single questions regarding their use of the voice prosthesis., Results: A statistical difference in the SF-36 was detected for social functioning (SF) between groups A and B. Role physical, SF and role emotional were significantly better in group C than in group A. Group A stated they were very satisfied with voice quality while there were still some problems regarding prosthesis lifetime and communication at the telephone or in noisy environments., Conclusions: Voice prosthesis implantation in laryngectomees showed positive effects on patients' quality of life; however, there are still some negative aspects. At present, an early diagnosis of larynx cancer with a partial laryngectomy in order to preserve phonatory function is the gold standard., (Copyright © 2011 S. Karger AG, Basel.)

Background: Transoral CO(2) laser surgery has been accepted as a valuable therapeutic option for glottic cancer., Methods: This was a retrospective analysis of 595 patients. Five-year overall and disease-specific survivals, local control with laser, locoregional, regional control, and organ preservation rates were calculated. The impact of different variables was calculated by univariate analysis., Results: Overall, disease-specific and disease-free survivals, local control with laser, locoregional, regional control, and organ preservation rates were 87.5%, 99%, 81.3%, 92.7%, 98.9%, 98.2%, and 97.1%, respectively. Univariate analysis showed a significant impact of pT category on local control with laser, organ preservation, locoregional and regional control, of endoscopic re-treatment for positive deep surgical margins on local control with laser and organ preservation, and recurrence after endoscopic re-treatment on local control with laser and organ preservation., Conclusion: This series confirms the good oncologic outcomes of endoscopic laser surgery for T(is), T(1), and selected T(2) and T(3) glottic tumors., (2009 Wiley Periodicals, Inc. Head Neck, 2010.)

Background: Selective neck dissection as a part of an elective or therapeutic treatment of the neck is a common practice during the surgical treatment of patients with head and neck cancer. Recently, the need for routine dissection of level IIb has been discussed. The aim of this study was to verify the incidence of metastases at level IIb in patients with clinically negative necks (N0) and clinically positive necks (N+) and discuss the need for its excision., Methods: A total of 114 patients with head and neck cancer undergoing neck dissection were prospectively analyzed. The total number of neck dissections analyzed was 148. The surgical specimens from each node level of the neck were pathologically diagnosed, with special attention to level IIb. Univariate associations between N classification and IIb positive cases were assessed using logistic regression and between IIa and IIb positive cases using Fisher exact test., Results: Of 148 neck dissections performed, level IIb resulted positive in 5 cases (3.3%): 1 patient with laryngeal cancer, 1 patient with oral cavity cancer, and 2 patients with oropharyngeal cancer, of which 1 underwent bilateral neck dissection. According to clinical N classification, for N0 and N+ the incidence of positive level IIb was 2% and 5%, respectively. All the cases with metastases at level IIb also showed metastases at level IIa. A statistically significant association between the presence of nodal metastases at level IIb and those at level IIa (p <.001) was found. The statistical association between N classification and IIb positive nodes only showed a trend toward significance (p = .06)., Conclusions: The incidence of metastases at level IIb is low, also in the N+ necks, therefore dissection of this level could be unnecessary in N0 necks. Furthermore, an interesting statistical association between the presence of metastases at level IIb and at level IIa was recorded., ((c) 2008 Wiley Periodicals, Inc. Head Neck, 2008.)

Objective: The aim of this study was to verify the efficacy and applicability of the Ultracision Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in pharyngolaryngectomy with radical neck dissection., Design: This work evaluated the use of the Harmonic Scalpel in otolaryngology as a new and alternative method to overcome some complications of traditional surgery., Setting: The study was conducted with 20 patients in the ENT Department of the University of Genoa (Italy) between January 1, 2005, and December 31, 2006., Methods: A prospective, randomized study was undertaken on 20 pharyngolaryngectomies with radical neck dissection performed using a Harmonic Scalpel (10 patients) or traditional surgery (10 patients)., Main Outcome Measures: The evaluation included operation time, intraoperative blood loss, postoperative seroma formation, and pattern of wound healing., Results: In patients treated with Harmonic Scalpel, the mean operation time was significantly shorter, the blood loss was less, laryngeal and neck drainage on the first and second postoperative days was significantly smaller, and no postoperative complications were noted., Conclusions: The use of the Harmonic Scalpel during pharyngolaryngectomy and radical neck dissection led to diminished bleeding, shorter operative time, less seroma formation, and better wound healing in the postoperative period.

Objective: To evaluate local control, organ preservation, and complications after endoscopic laser surgery for early recurrent glottic cancer after radiotherapy., Design: Retrospective study., Setting: European Institute of Oncology, Milan, Italy., Patients: The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent., Interventions: Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association., Main Outcome Measures: Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation., Results: The clinical classifications of the recurrences were rcTis (n = 4), rcT1a (n = 10), rcT1b (n = 11), and rcT2 (n = 12). The pathologic classifications of the recurrences were rpT0 (n = 2), rpTis (n = 5), rpT1a (n = 9), rpT1b (n = 3), rpT2 (n = 14), and rpT3 (n = 4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35%): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58% and 86%, respectively. The larynx was preserved in 26 patients (70%). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men)., Conclusions: Endoscopic laser surgery is a safe and effective salvage procedure in selected cases involving glottic recurrence after radiotherapy. Oncological results are satisfactory, and organ preservation can be achieved in a high proportion of cases; however, the risk of laryngeal stenosis is high in women.

Purpose: To retrospectively evaluate local control rates, late damage incidence, functional results, and second-tumor occurrence according to the different patient, tumor, and treatment features in a large bi-institutional series of T2 glottic cancer., Methods and Materials: A total of 256 T2 glottic cancer cases treated consecutively with radical intent at the Florence University Radiation Oncology Department (FLO) and at the Radiation Oncology Department of the University of Brescia, Istituto del Radio "O. Alberti" (BS) were studied. Cumulative probability of local control (LC), disease-specific survival (DSS), and overall survival (OS) rates were calculated and compared in the different clinical and therapeutic subgroups by both univariate and multivariate analysis. Types of relapse and their surgical salvage were evaluated, along with the functional results of treatment. Late-damage incidence and second-tumor cumulative probability (STP) were also calculated., Results: In the entire series, 3-year, 5-year, and 10-year OS rates were, respectively, 73%, 59%, and 37%. Corresponding values for cumulative LC probability were 73%, 73%, and 70% and for DSS, 89%, 86%, and 85%, taking into account surgical salvage of relapsed cases. Seventy-three percent of the patients were cured with function preserved. Main determinants of a worse LC at univariate analysis were larger tumor extent and impaired cord mobility. At multivariate analysis, the same factors retained statistical significance. Twenty-year STP was 23%, with second-tumor deaths less frequent than larynx cancer deaths (20 of 256 vs. 30 of 256). Incidence of late damage was higher in the first decade of accrual (22%) than in the last decade (10%, p = 0.03); the same was true for severe late damage (9% vs. 1.8%)., Conclusion: Present-day radical radiotherapy can be considered a standard treatment for T2 glottic cancer. Better results are obtained in patients with less extended disease. Late damage is relatively infrequent, but a careful follow-up is warranted for early detection not only of relapses (because salvage surgery is feasible) but also of second malignant tumors, which constitute a relevant but not the leading cause of death in these patients and are potentially curable.

Objective: The pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy, and its etiology is not well understood yet. The aim of our study was to evaluate predisposing factors, incidence, and management of this complication., Study Design and Setting: This was a retrospective study of 268 patients who underwent total laryngectomy in our clinic (January 1990-December 2001). A number of factors potentially predisposing to PCF formation were evaluated., Results: A PCF was observed in 16% of patients. Systemic diseases, previous radiotherapy, supraglottic origin of tumor, and concurrent radical neck dissection were significantly associated with PCF. Spontaneous closure was noted in 28 patients, whereas a surgical closure was necessary in 15 patients., Conclusions: In presence of a specific risk factor, PCF can be expected; nevertheless, its prevention remains very difficult. Moreover, given the high percentage of spontaneous closure, we suggest the "wait and see" approach for 28 days before proceeding with a surgical approach., Ebm Rating: C.

The aim of this study was to test the validity and reliability of the European organization for research and treatment of cancer (EORTC) quality of life questionnaire (QLQ)-head and neck (H&N) 35 in Italian laryngeal cancer patients. The original questionnaire was developed by the EORTC quality of life (QoL) study group and tested in H&N cancer patients from Norway, Sweden, and the Netherlands. The Italian translation of the questionnaire used in this study was made by a team of the CRO, National Cancer Institute, using a double-back translation method between independent translators. The translated EORTC QLQ-H&N35 was given to 99 patients with H&N cancer who had undergone total laryngectomy 1-26 years before and had been then treated with radiotherapy and, in some cases, chemotherapy. The questionnaire was re-administrated to 33 patients after 1 month to test its stability over time. It was structurally made up of seven scales (pain, swallowing, sense, speech, social eating, social contact, and sexuality) and 11 single items that considered the most important clinical aspects characterizing the QoL in H&N cancer patients. The statistical analysis of the indexes of validity and reliability confirmed the results obtained with other linguistic versions of the questionnaire. Our Italian version of the EORTC QLQ-H&N35 proved to be a statistically valid instrument to assess QoL in laryngectomized patients.

We report 77 cases of associated primary cancers of the larynx and lung that were managed at the Department of Otolaryngology, University of Padua, between 1980 and 1994. To our knowledge, this is the largest series reported in the literature to date. This association is not a chance finding, but presumably the result of common pathogenetic factors.

Incidence of microscopic infiltration of the laryngeal framework, with or without extra-laryngeal extension, was studied retrospectively in a series of 63 patients treated surgically for glottic T3 carcinomas in order to establish prognostic values. The results of histopathological examination revealed neoplastic invasion of the fibro-cartilaginous skeleton in 46 of the patients examined and in half of these microscopic diffusion in peri-laryngeal tissue. As far as prognosis is concerned, there was a clear-cut correlation between a decrease in survival rates and a contemporaneous increase in the real extension of the neoplasia, even if microscopic. In fact the NED survival rate of confirmed T3 patients was 85% while in cases reclassified as pT4, it was 64% and 47% on the basis on the absence or presence of extra-laryngeal extension. With these observations it is possible to affirm that the major staging is also attributable to cases with initial infiltration of the "laryngeal framework" without an extensive extension toward peri-laryngeal tissue. As far as T recurrences are concerned, a high incidence of relapse of the neoplasia was observed principally in the cases with extra-cartilaginous diffusion. This observation may have a predictive role and therefore direct post-surgery follow-up as well as eventual complementary treatment.

Supraglottic laryngectomy combined with functional elective or curative neck dissection is a priceless contribution toward treatment of supraglottic cancer and its lymph node metastases. The history and background of this conservative approach is reviewed. Results related to staging are presented. Irradiation as a combined or alternative therapy is considered.

Chondrosarcoma is the most common mesenchymal tumor of the larynx and approximately 200 cases have been collected in the world medical literature. It is less aggressive in the larynx than elsewhere: cervical or distant metastases are rare (8.5%), and although local recurrences are not uncommon, they are not catastrophic. A retrospective study was made on eight cases of laryngeal chondrosarcoma. Three cases had originally been diagnosed as idiopathic vocal cord paralysis, possibly because of early involvement of the cricoarytenoid joint or the distal portion of the recurrent nerve. This fact emphasizes the need for accurate laryngeal computed tomography in cases of vocal cord paralysis of unknown origin. Surgical excision is the treatment of choice for laryngeal chondrosarcoma, and conservative techniques may sometimes be appropriate. Supraglottic laryngectomy may be the technique of choice in the rare cases of epiglottic involvement.

The effect of various patient and tumor characteristics were evaluated in 378 laryngeal carcinomas treated only surgically between November 1974 and December 1987 at the Ear, Nose and Throat Clinic of Cagliari Medical University in South Sardinia. The overall three-year survival rate was 68%, the five-year survival rate was 61% (approximate 95% confidence interval (CI), 54-68%), and then a plateau seemed to emerge, with the ten-year survival rate being 51%. Tumor ulceration exerted a strong influence on survival: patients with ulcerated tumors had a twofold (95% CI, 1.4-2.9%) higher death rates. Conversely, the influence of tumor site and type of operation was not statistically significant in the multivariate analysis. A median delay in diagnosis of 4 months was found, with 30% of patients reporting an interval longer than 6 months between first symptoms and referral to a physician; overall, however, the influence of delay in diagnosis on survival rate was not significant. Dysphonia seemed to be the symptom less promptly recognized by the patient.