ABSTRACT
OBJECTIVE: To report the oncologic and functional outcome of patients undergoing near-total laryngectomy. STUDY DESIGN AND SETTING: A retrospective analysis was carried out from 1991 through 1998. RESULTS: Eighty-seven patients underwent near-total laryngectomy. The Kaplan-Meier overall survival, cause-specific survival, and relapse-free survival estimates at 5 years were 48.2%, 75.8%, and 72.4%, respectively. Univariate analysis revealed prognosis significance for location, stage, and pathologic cervical lymph node status. Five percent of the patients developed local recurrence, 16% recurrence in cervical lymph nodes, and 10% distant metastasis. Pharyngocutaneous fistula was the most frequent complication (48%). Seventy-seven percent of cases achieved voice preservation. Symptomatic aspiration was noted in 12.3% of cases. CONCLUSION: Near-total laryngectomy can be a successful surgical procedure for selected patients; it does not replace total laryngectomy but reduces its indications. Voice preservation can be achieved in most cases. SIGNIFICANCE: Near-total laryngectomy enhances the speech rehabilitation options for the laryngectomy patient by adding a physiologic, nonprosthetic tissue technique.
Subject(s)
Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Pharyngeal Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Female , Humans , Laryngeal Neoplasms/pathology , Laryngectomy/adverse effects , Male , Neoplasm Staging , Pharyngeal Neoplasms/pathology , Prognosis , Retrospective Studies , Survival Analysis , Treatment Outcome , Voice Disorders/etiology , Voice Disorders/prevention & controlABSTRACT
This study was performed to evaluate the effectiveness of functional neck dissection in controlling metastasis to the clinically negative (cN0) neck, focusing on recurrences in the pathologically negative (pN0) neck and the role of extracapsular spread in the cN0 neck. A series of 172 patients (253 dissected fields) treated for cN0 laryngeal or hypopharyngeal cancer with a 5-year minimum follow-up is presented. Occult metastasis was observed in 30% of the patients. Extracapsular spread was present in 39% of the positive nodes. The neck recurrence rate was 5.2%. Surgical specimens from cases of neck recurrence in pN0 necks were reevaluated for micrometastasis by immunostaining with antibody for cytokeratins. The immunohistochemical findings were positive in 1 of 4 cases. Functional neck dissection provides good neck control and survival rates for the cN0 neck. The accurate prognostic significance of extracapsular spread in cN0 necks is still unknown. Micrometastasis alone may be insufficient to explain recurrences in pN0 necks.
Subject(s)
Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/surgery , Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/surgery , Lymph Node Excision , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Female , Humans , Hypopharyngeal Neoplasms/mortality , Hypopharyngeal Neoplasms/pathology , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Lymphatic Metastasis , Male , Middle Aged , Neck , Neoplasm Recurrence, Local , Retrospective Studies , Survival RateABSTRACT
Parathyroid cysts are rare lesions of uncertain embryological origin, usually presenting as a painless mass in the lower part of the neck. Clinical presentation usually mimics a thyroid nodule, and fine needle aspiration with demonstration of high parathyroid hormone levels in fluid is often required to establish the diagnosis. In addition to difficulty in diagnosis, the best treatment for these uncommon lesions remains controversial. We present a case of recurrent parathyroid cyst after several fine needle aspirations managed by surgery, and discuss the relevant associated literature.
