Xavier León1,2, Montserrat López3, Jacinto García3, Maria Casasayas3, Carlota Rovira3, Miquel Quer3. 1. Otorhinolaryngology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041, Barcelona, Spain. xleon@santpau.cat. 2. Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain. xleon@santpau.cat. 3. Otorhinolaryngology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041, Barcelona, Spain.
Abstract
PURPOSE: Extended total laryngectomy with en-bloc resection of overlying cervical skin (ETL) is indicated in cases with infiltration of the pre-laryngeal soft tissues. The present study analyses the surgical indications and the results of ETL in our hospital. METHODS: Retrospective review of 38 patients treated with an ETL during the period 1988-2016. RESULTS: The indications for ETL were the initial treatment of tumors with extralaryngeal extension (n = 16), salvage treatment after failure of partial surgery or radiotherapy (n = 17), and total laryngectomy in patients with infection or fibrosis of the skin over the larynx (n = 5). The surgical defect was reconstructed with local flaps in 3 cases, with pectoralis major flaps in 34 cases, and with an internal mammary artery perforator flap in one case. The rate of pharyngocutaneous fistula in the postoperative period was 16%. 5-year cancer-specific survival for patients treated with an ETL was 67.1%. The patients with positive margins and those operated as a salvage treatment after failure of previous treatments showed worse survival. CONCLUSIONS: ETL offers acceptable oncological results for patients with tumors with extralaryngeal extension. Myocutaneous or myofascial pectoralis major flaps allow for adequate reconstruction of the surgical defect with a low rate of complications.
PURPOSE: Extended total laryngectomy with en-bloc resection of overlying cervical skin (ETL) is indicated in cases with infiltration of the pre-laryngeal soft tissues. The present study analyses the surgical indications and the results of ETL in our hospital. METHODS: Retrospective review of 38 patients treated with an ETL during the period 1988-2016. RESULTS: The indications for ETL were the initial treatment of tumors with extralaryngeal extension (n = 16), salvage treatment after failure of partial surgery or radiotherapy (n = 17), and total laryngectomy in patients with infection or fibrosis of the skin over the larynx (n = 5). The surgical defect was reconstructed with local flaps in 3 cases, with pectoralis major flaps in 34 cases, and with an internal mammary artery perforator flap in one case. The rate of pharyngocutaneous fistula in the postoperative period was 16%. 5-year cancer-specific survival for patients treated with an ETL was 67.1%. The patients with positive margins and those operated as a salvage treatment after failure of previous treatments showed worse survival. CONCLUSIONS:ETL offers acceptable oncological results for patients with tumors with extralaryngeal extension. Myocutaneous or myofascial pectoralis major flaps allow for adequate reconstruction of the surgical defect with a low rate of complications.
Entities:
Keywords:
Extended total laryngectomy; Extralaryngeal extension; Salvage surgery; Total laryngectomy
Authors: Pascal P A Schellekens; Emma C Paes; Joris J Hage; Martijn B A van der Wal; Ronald L A W Bleys; Moshe Kon Journal: J Plast Reconstr Aesthet Surg Date: 2010-05-15 Impact factor: 2.740
Authors: A Gallo; R Moi; M Simonelli; D Vitolo; M L Fiorella; V Marvaso; V Manciocco; M de Vincentiis Journal: Arch Otolaryngol Head Neck Surg Date: 2001-07
Authors: Ivan Marcelo Gonçalves Agra; Alfio Ferlito; Robert P Takes; Carl E Silver; Kerry D Olsen; Sandro J Stoeckli; Primož Strojan; Juan P Rodrigo; João Gonçalves Filho; Eric M Genden; Missak Haigentz; Avi Khafif; Randal S Weber; Peter Zbären; Carlos Suárez; Dana M Hartl; Alessandra Rinaldo; Kwang Hyun Kim; Luiz P Kowalski Journal: Head Neck Date: 2011-04-11 Impact factor: 3.147
Authors: Carlos Miguel Chiesa Estomba; Jose Angel González García; Jon Alexander Sistiaga Suarez; Izaskun Thomas Arrizabalaga; Ekhiñe Larruscain Sarasola; Xabier Altuna Mariezcurrena Journal: Acta Otorrinolaringol Esp (Engl Ed) Date: 2017-09-01
Authors: Federico L Ampil; Cherie Ann O Nathan; Gloria Caldito; Timothy F Lian; Robert F Aarstad; R Murty Krishnamsetty Journal: Am J Otolaryngol Date: 2004 Mar-Apr Impact factor: 1.808