partial laryngectomy

1. EVALUATION OF THE OUTCOMES OF OPEN PARTIAL LARYNGECTOMY
IN THE TREATMENT OF EARLY GLOTTIC CANCER
PHAN VU THANH HAI
TRUONG NGOC HUNG

2. Introduction
Objectives
Methods
Results and Discussion

3. INTRODUCTION
Laryngeal cancers constitue approximately
25% of head and neck cancers. Most of
laryngeal cancers orginate in the glottic
region.
Surgical treatment for laryngeal cancers
can be divided into two main groups: open
and endoscopic surgery.
The frontolateral laryngectomy is a
surgical method applied for early stage
glottic cancers.

4. INTRODUCTION
SURGICAL TREATMENT IN LARYNGEAL CANCERS
OPEN SURGERY+/- NECK
DISSECTION
ENDOSCOPIC SURGERY
+/- NECK DISSECTION
Partial Laryngectomy
Total Laryngectomy
Transoral monopolar
surgery for laryngeal cancer
Transoral laser surgery
for laryngeal cancer
ROBOTIC
SURGERY
Microscopic laser
laryngoscopy

5. INTRODUCTION
Open partial laryngectomy has been conducted at Da Nang Hospital
for > 5 years.
The overall incidence of laryngeal cancer continues to rise.

6. • Open partial laryngectomy offers higher local control and vocal
preservation. However, posoperative problems such as granulation
tissue formation, laryngeal stenosis, poor voice and recurrence are
concerns.

7. OBJECTIVES
Describe clinical features and evaluate the results of the anterior
frontolateral vertical partial laryngectomy (AFVPL).

8. Time
From Oct/ 2019 to
Oct/2022
32 patients
Patients whom the FLL
operation was applied due
to early glottic carcinoma
(T1,T2) in the ENT
Department – Da Nang
Hospital
Documentation
Patient’s demographic
characteristics, tumor
stages, treatment, Ctscan
of the neck, Neck
ultrasound, esophageal
fiberoptic endoscopy
Histopathology diagnosis
Squamous cell Carcinoma
CRITERIA OF PATIENT
SELECTION
METHODS

9. Exclusion Criteria
Incomplete medical records
Participants decline to join in clinical trials.
The patient underwent a transoral endoscopic surgery for glottic cancer.
METHODS

10. MATERIRALS AND METHODS
The laryngeal framework was closed by suturing the mucoperichondrium, and
the region of resection was left to secondary healing. We did not use a
laryngeal keel for prevention of adhesion or stenosis. The negative pressure
wound drainage was used.
The patient was fed with a nasogastric tube for about 5 days. The
tracheotomy tube was usually removed on day 7.

11. Collecting patients who meet the inclusion
criteria into the study group
Collecting patient data (from 10/2019 to 10/2021)
Inviting patients to join study
group and check for recurrence
A retrospective study
MATERIALS AND METHODS

12. Collecting
patient data
Laryngeal
endoscopy
Evalutating
VHI
questionaire
MPT
(Maximum
phonation
time)
Data
analysis
Writting
1
2
3
4
5
6

13. OUTCOMES
Age
Mean
Range
60
45-70
Age >65 years (n) 12 (37,5%)
Tobaco intake (pack-years)
Meadn
Range
32
0-125
Alcohol Intake
Less than 1 glass of wine per
day
1 glass to 1 liter per day
1 to 2 liters per day
> 2 liters per day
10 (31,25%)
11 (34,75%)
7 (21,87%)
4 (12,22%)
30
93,7%)
2
6,25%)
The duration of hospitalization (days)
14 ± 2
CLINICAL PARAMETERS OF PATIENTS

14. S
L
I
D
E
O
C
E
A
N
6 patients
(19%)
T1a
7 patients
( 22%)
T1b
19 patients
(52%)
T2
T1a
Sharing Media
2 trường hợp (10%) tái phát
Follow-up: 6-18 months
Sharing Media
Không có trường hợp nào tái phát
Follow-up: 8-12 months
Sharing Media
Không có trường hợp nào tái phát.
Follow-up : 8-12 months
OUTCOMES
T2
T1b

15. S
L
I
D
E
O
C
E
A
N
Sharing Media
Sharing Media
OUTCOMES
True vocal cords motion Anterior commisure involvement Arytenoid cartilage involvement
Normal 27 84.4%
Reduced 5 15.6%
Fixed 0 0
Yes 4 12.5%
No 28 87.5
No 27 84.4%
Partial 5 15.6%
Complete 0 0
LARYNGEAL RIGID ENDOSCOPE

16. OUTCOMES
Radiologic Examination (Ctscan)
Characteristic of CTscan No of patient %
Maximum dimension
< 10mm
>10 mm
Tumor volume
<1000 mm3
>1000 mm3
Anterior commissure
Intact
Extent
Ventricle
Intact
Extent
Subglottic region
Intact
Extent
Thyroid Cartilage
Intact
Erosion
Arytenoid
Intact
Erosion

17. Cardiac
decompensation
1 patient (3,1%)
Asthma exacerbation
1 patient (3,1%)
Alcoho Withdrawal syndrome
(AWS)
1 patient (3,1%)
Diabetes exacerbation
2 patients (6,2%)
Posoperative
death
0
OUTCOMES
Medical-related complications

18. • No post-operative death
• Other complications: Cervical skin necrosis, laryngeal
chondritis with fistula formation, laryngocele were not
recorded in our study group.
9% 18.75% 12.5%
3.1% 3.1% 6.2% 3.1%
Wound infection
3 patients
Major subcutaneous
emphysema
6 patients
Hematoma
1 patient
Laryngeal stenosis
4 patients
Secondary Trach
1 patient
Bleeding
2 patients
Aspiration
1 patient
OUTCOMES
Surgical-related complications

19. Chức năng
(Functional)
Thực thể
(Physical)
Cảm xúc
(Physical)
10.77  2.70
11.67  2.90
6.06  2.14
Overall
28.50  7.74
OUTCOMES
VHI questionaire : 6 months
post operation
Maximum phonation time
(MPT): evaluated in all patients
6 months post-opt
11.65  2.12 s
93%
Airway
93.7%
Swallowing
93.7%
Speak
Functional outcomes
No breathing
problems
No difficult in
swallowing
Patients satisfied with
their voice

20. OUTCOMES
Patient
Age
(y)
Sex
Clinical T
classification
Pathologic T
classification
Management Outcomes
A 49 M II IV Radiotherapy Lost follow up
B 58 M I I Radiotherapy Free of disease for 1 year
C 45 M II III None
Recurred 4 months later,
successfully with total
laryngectomy
D 58 M II III None
Recurred 10 months later,
successfully with total
laryngectomy
E 56 M I I None
Free of disease after follow up for
5 months
Outcomes of patients with positive margins on histopathology diagnosis

21. CONCLUSIONS
1. Open partial laryngectomy is a safe option for early-stage glottic
cancer.
2. Common post-operation complications are subcutaneous
emphysema, and granulomatous glottis. Serious complications were
not recorded in our study group.
3. Patients had stabe condition after removing tracheostomy canula and
were satisfied with their voice.

22. RESEARCH LIMITATIONS
1. A small sample size
2. Follow-up time
3. Comparision of the survival rate with other surgical methods.

23. THANK YOU

24. Theo Giorgio Perretti
• 0 điểm: mức bình thường
• 1-30 điểm: mức nhẹ
• 31-60 điểm: mức vừa
• 61-90 điểm: mức nặng
• 91-120 điểm: mức rất nặng