Clinical Application of Endoscopic Laser Assisted Supraglottic Partial Laryngectomy in Early Supraglottic Cancer

Korean Journal of Head & Neck Oncology 1998;14(2):164-168.
Published online November 30, 1998.

Jong Ouck Choi;Kee Hwan Kwon;Joon Hwan Oh;Seung Hoon Han;Seung Hoon Lee;Geon Choi

초기 상후두암종에서 레이저를 이용한 내시경하 상후두부분절제술의 적용

최종욱;권기환;오준환;한승훈;이승훈;최건

Abstract

Background: Supraglottis and glottis have a different embryologic origin. Supraglottic cancer is characterized by high incidence of cervical lymph node metastasis at initial diagnosis, and favored surgical management of the early supraglottic cancer was partial supraglottic laryngectomy, however the procedure resulted in frequent incidences of postsurgical aspiration and voice disabilities. Objectives: We retrospectively analyzed the problems and the advantages of the endoscopic laser assisted supraglottic partial laryngectomy as a part of surgical management for early supraglottic cancer. Materials and Methods: During the past nine years 25 cases of supraglottic cancer(Tl 10 cases, T2 15 cases) were treated by tracheotomy and laser assisted supraglottic partial laryngectomy(KTP532, 15 Watt, continuous type) and in 10 cases with cervical lymph node metastasis, they were additionally managed by neck dissection one week later, and all cases received postoperative irradiation therapy.
Results
At present, 19 cases are alive with no evidence of disease. During the follow up period total of six cases(primary failure: three cases, nodal failure: three cases) were recurred. In relation to tumor staging, One of the 10 Tl cases and two of the 15 T2 cases recurred showing 88% locoregional recurrence rate for early supraglottic cancer. Postoperative com-plication included bleeding in three cases who were controlled by electrocautery under general anesthsia, one case of longstanding aspiration and two cases of laryngeal stenosis as a delayed complication.
Conclusion
High control rate suggests that the endoscopic laser assisted supraglottic partial laryngectomy may be a good initial management method for early supraglottic cancer, however it is difficult to determine the resection margin, therefore, accurate tumor staging must be done prior to surgery. In order to prepare for postoperative bleeding, edema and aspiration, the tracheotomy must be performed prior to surgery.

Key Words: Supraglottic cancer, Endolaryngeal approach, Laser surgery(KTP532)