Abstract
Objective: A history of radiation therapy is known to be a major risk factor promoting postsurgical complications. By comparing the clinical outcomes of supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP) in radiated and nonradiated patients, we investigated the usefulness of salvage SCPL-CHEP.
Method: Among 61 patients who received SCPL-CHEP between 1997 and 2010, 25 (41%) had received radiation therapy preoperatively and 36 (59%) had not. Staging error, wound infection, accuracy of surgical margin determination, acquired laryngeal function, and prognosis were compared between the two groups.
Results: Staging error occurred in 5 out of 25 (20%) irradiated and 13 out of 36 (36%) nonirradiated patients. Wound infection developed in 11 out of 25 (44%) irradiated and 5 out of 36 (14%) nonirradiated patients. Delayed wound infection (eg, infection appearing more than 1 month after an uneventful postsurgical course) was identified in 4 patients with a radiation dose over 65 Gy. Intraoperative margin study demonstrated dysplastic or positive margin in 13 out of 25 (52%) irradiated and 9 out of 36 (25%) nonirradiated patients. Swallowing function (ability to eat out) was acquired in 23 out of 25 (92%) irradiated and 32 out of 36 (89%) nonirradiated patients. Five-year overall survival rates were 83% in both groups.
Conclusion: Risk of infection was significantly higher in irradiated patients; delayed infection should be appropriately managed. Functional and oncological results were stable regardless of radiation history. When salvage SCPL-CHEP is the only option to save a functioning larynx, head and neck surgeons are encouraged to take reasonable risks in performing SCPL-CHEP.
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