Results of conservation surgery for cancers of the supraglottis and pyriform sinus.

A retrospective review of patients treated by surgery and/or radiation for carcinoma of the supraglottic larynx and the pyriform sinus was accomplished for the period 1964-1974. This patient population reflects the 10-year period following earlier experience with conservation surgery at this institution, and, thus, updates the current status of treatment for these cancers. Endpoints examined included survival, control, pattern of failure, the influence of nodal metastasis, and voice preservation. Of 160 patients treated for supraglottic laryngeal carcinoma, 119 received conservation surgery (subtotal supraglottic laryngectomy, SSL, or partial laryngopharyngectomy, PLP); 21 patients received total laryngectomy; and 20 others received palliative radiation. The 3-year actuarial survivals for these groups were 67%, 43% and 30%, respectively. Voice was preserved in 85% of the patients treated by conservation surgery, in 70% of those treated by radiation alone, and, of course, in none of the patients receiving total laryngectomy. There were 175 patients treated for carcinoma of the pyriform sinus; 85 received PLP; 57, total laryngopharyngectomy (TLP); and 33, palliative radiation. Acturial 3-year survival was 59% for the PLP-treated group, 36% for the TLP-treated group and 11% for the palliation group. Voice was preserved in 52% of the patients treated by conservation surgery, in 6% of those treated by radiation alone, and in none of those patients treated by total laryngectomy. Comparison of this data with that in other published reports indicates that, for selected patients, conservation surgery is as effective in controlling disease as is radical surgery. Furthermore, it is possible to preserve speaking ability in a significant number of patients having carcinoma of the supraglottic larynx or pyriform sinus.