Surgical Laryngeal Preservation in Early-Staged Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hypopharyngeal cancer is aggressive, grows rapidly and often tends to spread through the submucosa combined with multiple "skip lesions" or tumor satellites. Therefore, even in the early stages, most patients require wide resection, usually including total laryngectomy followed by radiotherapy. However, it is obvious that, with consideration of quality of life, the laryngeal function and cancer control are equally important. The purpose of this study is to evaluate the oncologic and functional results of laryngeal conservation surgery for early-staged hypopharyngeal cancer. SUBJECTS AND METHOD: Fourteen patients with T1 or T2 carcinoma of the various subsites of the hypopharynx, including the medial wall of pyriform sinus (four patients), lateral wall of pyriform sinus (four patients), and posterior pharyngeal wall (six patients), who were treated surgically between 1992 and 2000, were studied. All except one patient who had skin graft underwent surgical resection of the primary tumor with laryngeal preservation and immediate reconstruction with forearm free flap transfer or primary closure. Follow-up period was 6-54 months. RESULTS: One patient died in the immediate postoperative period due to myocardial infarction. However, other postoperative complications were minimal. There was no evidence of disease for at least 1 postoperative year in 7of 13 patients (53.8%) with hypopharyngeal cancer who have been performed the conservation surgery. All patients except one who died of myocardial infarction, were decannulated. All but 2 patients achieved oral intake without continuous aspiration. Of these 2 patients, one patient had severe dysphagia due to the bulkiness of the reconstructed flap and he was fed through a gastrostomy tube. The other patient died of myocardial infarction before the trial of oral diet. CONCLUSION: Our data suggest that if the precise evaluation of the extent of the tumor and a careful selection of the well adjustable patients are done preoperatively, the laryngeal conservation surgery in early hypopharyngeal cancer may be valuable in terms of oncologic and functional aspect.

Supraglottic Partial Laryngectomy: Oncologic and Functional Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy allows the removal of selected supraglottic tumors, preserving a functioning larynx and avoiding a permanent tracheotomy. The purpose of this study was to evaluate our experience with supraglottic partial laryngectomy and to review the functional and oncologic results of the operation. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 40 patients with squamous cell carcinoma of the supraglottis and 1 patient with sarcomatoid cancer ; they were either treated with supraglottic laryngectomy (n=31) or extended supraglottic laryngectomy (n= 10) from May 1991 and December 2001. Fifteen patients had tumors in T1, 25 patients in T2, and 1 patient in T3. The primary lesion of the tumors were as follows: suprahyoid epiglottis (n=12), infrahyoid epiglottis (n=13), aryepiglottic fold (n=10), false vocal cord (n=4), and pyriform sinus (n=2). A Kaplan-Meier, Willcoxon and Fisher's exact test was performed to obtain the survival rate and the prognostic factors. The evaluations of postoperative function were performed with regard to decannulation, oral diet, and average time taken to decannulate and to initiate oral intake. RESULTS: The disease-specific 3-year survival rate was 87%. Pathologic lymph node metastasis and the invasion of tumor to the preepiglottic space were significant clinical prognostic factors affecting survival. Local recurrence was developed in only one case (2.6%). Decanulation was possible in 93% of our patients. Ninety-five percent of our patients could ultimately take oral diet. The average decannulation time was postoperative 28.3 days and the average time taken to begin oral feeding time was 23.2days. CONCLUSION: This study suggests that supraglottic partial laryngectomy may be used with acceptable oncologic and functional results for supraglottic cancers.

A Case of Solitary Fibrous Tumor of the Nasal Cavity

Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, first described as a primary spindle cell tumor of the pleura in 1931. Recently, SFT has been reported in various locations with no relation to serosal surface, such as the mediastinum, head and neck, orbit and urogenital system. Histopathologically, the tumors have a disorganized or "patternless" arrangement of spindle cells in a collagenous background and prominent vascular channels of varing size. To date, only 22 cases of SFT arising from the nasal cavity and paranasal sinuses have been reported in the world literature. We report a case of SFT localized in the right nasal cavity with extension to the right ethmoid sinus with a review of literature.