Surgical Management of Supraglottic Laryngeal Carcinoma in Patients with Special Emphasis on Functional Preservation

OBJECTIVE To explore the surgical methods and evaluate the long-term results of laryngectomy in patients with supraglottic laryngeal cancer.

METHODS A total of 182 patients with supraglottic laryngeal carcinoma underwent an operation from 1979 to 1999. These cases comprised 11 in stage I, 45 in stage II, 49 in stage III and 77 in stage IV. The choice of surgical procedure was decided based on the condition of the diseased larynx. The surgical procedures proposed by TD Wang were adhered to as follows: minor partial laryngectomy 36, major partial laryngectomy 85, subtotal partial laryngectomy with laryngoplasty 22 and total larygectomy 39.

RESULTS The final rate of larynx preservation was 78.6% (143/182) and 69.8% (88/126) in patients with stage III and IV diseases. The extubation rate was 81.8% in cases with preservation of laryngeal function. The overall 3- and 5-year survival rates were 82.9% and 67.3%, with 76.88% and 57.4% in the advanced (stage III and IV) cases who survived with preserved laryngeal function, and 82.5% and 67.0% in similar advanced cases who were treated by total laryngectomy. The difference in the survival rates between these 2 groups was not statistically significant.

CONCLUSION It is suggested that preservation of the laryngeal function is possible for advanced supraglottic laryngeal carcinoma without compromising the long-term survival rate. To improve the rate of larynx preservation, one should follow the surgical methods suggested.