RESUMO
La implementación en Cuba de técnicas quirúrgicas para el tratamiento del cáncer laríngeo con conservación del órgano ha ganado adeptos en los últimos años. La morbilidad por esta entidad en la provincia de Matanzas manifestó una incidencia ascendente en la quinta década de la vida, lo que justifica adoptar posiciones que permitan cambiar el curso de los acontecimientos y restaurar la salud, minimizando la mutilación, el sufrimiento y la sensación de amenaza vital. El objetivo de la presente investigación fue evaluar los resultados obtenidos con las técnicas de cirugía conservadora de laringe en el período comprendido de 2005 al 2012. Se realizó un estudio descriptivo de tipo transversal. El universo estuvo constituido por pacientes portadores de cáncer de laringe que cumplieron los criterios de inclusión, exclusión y salida. Treinta y cinco pacientes fueron sometidos a cirugía parcial de laringe. Se apreció un predominio de pacientes con cáncer de laringe del sexo masculino, blancos y con edades comprendidas entre 45 y 60 años. Se reiteró la estrecha relación entre el cáncer de laringe y los hábitos tóxicos. El sitio de más frecuente de localización del tumor fue la glotis. El carcinoma de células escamosas es el diagnóstico histopatológico más representado. La técnica quirúrgica más empleada en nuestro centro y la de mejores resultados oncológicos fue la cordectomía. La evolución postquirúrgica fue favorable en un 74,3 %.
The use of surgical techniques for the larynx cancer treatment with that organ conservation has got adepts in the last years in Cuba. Morbidity caused by this entity in the province of Matanzas showed an increasing incidence in the fifth decade of life. It validates the adoption of positions that allow changing the disease course and restoring health, minimizing mutilation, suffering and the sense of life threatening at the same time. The aim of the current research was assessing the results obtained with the larynx conservative technique in the period from 2005 till 2012. A cross-sectional, descriptive study was carried out. The universe was formed by patients with larynx cancer fulfilling the inclusion, exclusion and exit criteria. Thirty-five patients were object of larynx partial surgery. It was appreciated an increase of male, white patients, aged 45-60 years, with larynx cancer. It was stated again the tight relation between larynx cancer and toxic habits. The most common cancer location was the glottis. The squamous cell carcinoma was the most represented histopathologic diagnosis. Cordectomy was the most used surgical technique in our hospital and the one showing the best oncologic results. The postsurgical evolution was favorable in 74.3 % of the cases.
RESUMO
OBJETIVOS: Com a intenção de se avaliar os resultados funcionais e terapêuticos da laringectomia supracricóide com crico-hióide-epiglote-pexia (CHEP) foram estudados 50 casos de pacientes com carcinoma epidermóide da glote classificados como T2/T3 submetidos a esta técnica em nossa instituição. MÉTODOS: Foi realizada uma análise retrospectiva entre 1996 e 1999. Classificamos 18 pacientes como T2N0M0 e 32 pacientes como T3N0M0. Quarenta e um pacientes foram submetidos a esvaziamento cervical seletivo lateral bilateralmente, quatro foram submetidos ao mesmo esvaziamento unilateralmente, e cinco não foram esvaziados. Analisamos as complicações e a sobrevida livre de doença pelo método de Kaplan-Meyer. RESULTADOS: Dez pacientes tiveram complicações pós-operatórias, dois foram tratados com complementação da laringectomia. Os 48 pacientes restantes mantiveram a via aérea normal, deglutição e a voz. Três pacientes no grupo submetido a esvaziamento cervical apresentaram linfonodo metastático. Quatro pacientes tiveram recidiva da doença, três com recidiva local, sendo dois tratados com laringectomia total e estão vivos e sem doença, o outro com doença avançada alcançou o óbito pela doença. O paciente que teve recidiva no pescoço foi tratado com esvaziamento cervical mais radioterapia e morreu com doença. Dois pacientes tiveram um segundo tumor primário em orofaringe, sendo um tratado com radioterapia paliativa e morreu com doença e o outro tratado com cirurgia está vivo e sem doença. A sobrevida livre de doença em três anos foi de 88 por cento para pacientes T2 e 72 por cento para pacientes T3. CONCLUSÕES: Esta técnica é útil no tratamento de casos selecionados de carcinoma epidermóide da glote T2/T3 sempre se considerando a extensão da doença. A incidência de complicações necessitando laringectomia total de resgate não compromete a funcionalidade desta técnica. A sobrevivência é comparável aos pacientes submetidos a laringectomia total e laringectomia ...
BACKGROUND: Our objective was to assess whether Supracricoid Laryngectomy with CricoHiodoEpiglottoPexy (CHEP) could successfully achive cure preserving voice in the treatment of glottic laryngeal cancer. METHODS: A retrospective analysis has been carried out between 1996 through 1999. We classified 18 patients as T2N0M0 and 32 patients as T3N0M0. Fourty one patients underwent selective bilateral lateral neck dissection, four had unilateral neck dissection and five patients had the neck undissected. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Ten patients had postoperative complications, two treated with total laryngectomy. The remained 48 patients maintained normal airway, swallowing and speech. Three patients in the neck dissection group presented occult neck metastasis. Four patients had recurrences, three of them were local. Two patients treated with total laryngectomy are alive without disease, and another had advanced recurrence and died. One patient had neck recurrence and was treated with radical neck dissection plus radiotherapy and died from the disease. Two patients presented a second tumor in the oropharynx. One of them was treated with palliative radiotherapy and died and the other had surgical resection and is alive without disease. Three years disease free survival was 88 percent for T2 and 72 percent for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer, regarding the extension of the disease. The incidence of complications required completion laryngectomy which did not compromise the functionality of this technique. Survival is comparable to patients submitted to total laryngectomy and near-total laryngectomy, regarding the extension of the lesion.