Oncologic and Functional Outcomes of Supraglottic Partial Laryngectomy: 18 Years Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL), which provides the removal of selected tumors involving the upper structure of the glottis, shows equivalent oncologic outcome when compared to total laryngectomy with functional preservation. We report our 18-year experience of applying supraglottic partial laryngectomy in the Yonsei Head and Neck Cancer Clinic. SUBJECTS AND METHOD: We retrospectively reviewed the charts of 78 patients who underwent SPL. We divided the patients into two groups, the early and the recent, and performed Kaplan-Meier survival analysis and chi2-test on the groups. The post-operative functional outcome was assessed. RESULTS: The 3-year-disease-specific survival rate of the early and recent period was 87% and 84.6%, respectively. Decannulation and tolerability of an oral diet was possible in 93% and 95% of the earlier group, and 95% and 98% in the recent group, respectively. There was no statistically significant difference in survival rate, recurrence pattern, decannulation and tolerability of oral diet between the two groups. CONCLUSION: We achieved a satisfactory survival rate through SPL. In addition, almost all patients could be decannulated and eventually tolerated an oral diet. Our results confirm that SPL is an oncologically & functionally sound procedure for selected supraglottic tumors.

Gasless Transaxillary Robot-Assisted Neck Dissection: A Preclinical Feasibility Study in Four Cadavers

PURPOSE: We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers. MATERIALS AND METHODS: Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall. RESULTS: We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved. CONCLUSION: Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.

A Case of Liposarcoma Arising in Tracheoesophageal Groove / 대한이비인후과학회지

Liposarcoma is the second most common soft tissue sarcoma in adult, after malignant fibrous histiocytoma. But, the incidence of liposarcoma in the head and neck malignancies is approximately 1.8-6.3%. Primary liposarcoma of the thyroid gland is exceedingly rare with only six previous reports in the English literature. We report a case of liposarcoma in a 61-year-old male who had been misdiagnosed with thyroid nodule and follicular neoplasm suspected in fine needle aspiration cytology. Mass excision of the liposarcoma was performed. During the preoperative evaluation and operation, the author recognized that the tumor had origina-ted not from the thyroid gland, but from the tracheoesophageal groove. The histopathological examination revealed a combination type liposarcoma that was both well differentiated and myxoid. But a paramedian fixation was found in the left vocal cord palsy and injection la-ryngoplasty was performed. Postoperatively, radiotherapy was given to the neck region. Dur-ing the 36-month follow-up period, there was no evidence of the disease.