Open Partial Resection for Malignant Glottic Tumors
The quality of primary treatment is crucial for the results of laryngeal tumor therapy and the patient’s life. Endoscopic resection was not able to replace open partial resection totally. Patient selection is based on the tumor’s extent, the surgeon’s exp
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13c
Christoph Arens
Core Messages
›› The quality of primary treatment is crucial for ›› ›› ››
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the results of laryngeal tumor therapy and the patient’s life. Endoscopic resection was not able to replace open partial resection totally. Patient selection is based on the tumor’s extent, the surgeon’s expertise, and patient’s expectations and/or demands. The main indication for open partial resection are glottic cancers with involvement of supraglottic or subglottic structures, one-sided slightly impaired mobility, or extension into the anterior commissure to the other vocal fold. Contraindications for oncological reasons include invasion of the thyroid cartilage, arytenoid fixation, interarytenoid invasion, subglottic extension with involvement of the cricoid cartilage, lesions that extend outside the larynx, and preepiglottic space invasion.
C. Arens Universitätsklinikum Magdeburg A.ö.R., Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Klinikdirektor, Leipziger Str. 44, 39120 Magdeburg, Germany e-mail: [email protected]
13c.1 Introduction Several surgical options for treating laryngeal carcinoma can be used that allow resecting the tumor with oncologically safe margins and preservation of laryngeal function. The quality of the primary treatment is crucial for the results of laryngeal tumor therapy and the patient’s life. Treatment includes addressing regional lymphatic drainage. The treatment strategy is based on the primary site of the tumor, its extension into the laryngeal structures, and the existence of regional and distant metastases. Transcervical open partial resection for glottic cancer found its earliest application in the treatment of glottic malignant tumors. As these tumors produce early symptoms, the patients often present with localized disease. The first transcervical cordectomy for a vocal fold carcinoma was carried out by Brauers in 1834 [1]. Around the turn of the 19th century, cordectomy was the most frequently practiced procedure, and it produced rather good results for certain indications [2]. Despite some trials on laryngeal preservation as an alternative to total laryngectomy, the era of partial resection started in the 50th of the last century. Among the pioneers of function-preserving laryngeal surgery was Leroux-Robert, who advocated frontolateral partial resection [3]. Several modifications of open partial resection were described over the following years by Lore, Conley, Ogura, Silver, Mayer, and Piquet. It was predominantly Italian and French head and neck surgeons who developed and advocated open partial resections as extensive as subtotal laryngectomy for more advanced glottic cancer.
M. Remacle, H. E. Eckel (eds.), Surgery of Larynx and Trachea, DOI: 10.1007/978-3-540-79136-2_13c, © Springer-Verlag Berlin Heidelberg 2010
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Conditions for the development of partial resection were the knowledge of tumor spread and laryngeal function as well as improved endoscopic diagnosis. This led to an exact pretherapeutic classification of tumor spread and
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