It is generally believed that a reconstruction of the glottic region after a vertical partial laryngectomy (VPL) can improve the glottic and supraglottic function. However, there is a paucity of reports on secondary healing without a glottic reconstruction after a VPL. The aim of this study was to obtain objective phonatory data after a VPL without a glottic reconstruction. From 1993 to 2001, 13 patients, who had been treated with VPL without a glottic reconstruction, were enrolled in this study. Patients with a postoperative follow up of less than 12 months were excluded. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer- standard VPL (11 cases) and frontolateral VPL (2 cases). Acoustic ( (fundamental frequency, Fo), jitter, shimmer, the noise to harmonic ratio (NHR) ), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR) ) analysis and videostroboscopy were performed to evaluate the voice. There were significant differences in the Fo, jitter, shimmer, NHR, MPT and MFR between the VPL group and normal control group. In videostroboscopy, the following tendencies were observed in many cases: incomplete glottic closure, a decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Objective phonatory data after VPL without a glottic reconstruction was obtained. The voice quality after a VPL without a glottic reconstruction was somewhat unsatisfactory. A further comparison with other different surgical techniques of a VPL would help determine a better way of improving the voice quality in these patients.
Adult ; Aged ; Female ; *Glottis ; Human ; Laryngeal Neoplasms/*physiopathology/*surgery ; *Laryngectomy/methods ; Male ; Middle Aged ; Postoperative Period ; *Voice Quality

OBJECTIVE: To discuss the effect of reducing the cricopharyngeal dysfunction on the Groningen prosthesis voice restoration following total laryngectomy and the effect of different methods. METHOD: Fifty-six patients were implanted with Groningen voice prostheses to rebuild voice after total laryngectomy. The clinical data were analyzed retrospectively. RESULT: Of 56 patients, 412 patients successes in voice restoration. The success rate of amputating pharynx plexus nerves group was 60.0%, amputating cricopharyngeal muscle group was 62.5%, and the amputating pharynx plexus nerves and cricopharyngeal muscle group was 96.0%. CONCLUSION The combination of pharynx plexus nerves resection and cricopharyngeal myotomy can make higher success rate of voice restoration.
Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Larynx, Artificial ; Male ; Middle Aged ; Pharyngeal Muscles ; physiopathology ; Retrospective Studies

OBJECTIVETo explore the application of mesoesophagus suspension technique to improve the upper mediastinal lymph node dissection during thoracoscopic esophagectomy in the treatment of esophageal cancer.

METHODSClinical data of 164 thoracic esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy with two-field lymph node dissection in the Union Hospital of Fujian Medical University between October 2012 and June 2015 were retrospectively analyzed. Among 164 patients, 80 cases underwent upper mediastinal lymph node dissection by traditional method (traditional group), and the remaining 84 cases underwent upper mediastinal lymph node dissection by mesoesophagus suspension technique (suspension group). The operation time, estimated blood loss, number of excised lymph nodes and postoperative complications were compared between the two groups.

RESULTSThere were no significant differences in gender, age, location of tumor and pathology stage between the two groups. The operation time in the two groups was similar. The suspension group had significantly less thoracic blood loss than traditional group [(85±5) ml vs.(140±7) ml, P=0.000]. The number of dissected lymph nodes of bilateral recurrent laryngeal nerve was more in suspension group [median (interquartile range): left: 3 (2 to 4) vs. 2 (1 to 3), P=0.013; right: 3(2 to 6) vs. 2(1 to 3), P=0.007]. There was no significant difference in metastatic rate of lymph node in different sites between the two groups. The highest metastatic rate of suspension and traditional group was found at paracardia lymph nodes[22.6%(19/84) and 22.5%(18/80)], the next was at right laryngeal nerve lymph nodes [17.9%(15/84) and 15.0%(12/80)] and left laryngeal nerve lymph nodes [16.7%(14/84) and 12.5%(10/80)]. There were no significant differences with regard to the incidence of major postoperative complications between two groups, including respiratory complication, anastomotic leakage, vocal cord palsy.

CONCLUSIONSUpper mediastinal bilateral recurrent laryngeal nerve lymph node is the predilection site of lymphatic metastasis of thoracic esophageal cancer. Application of mesoesophagus suspension technique in thoracoscopic esophagectomy can improve the clearance quality of bilateral recurrent laryngeal nerve lymph nodes.

Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; adverse effects ; methods ; Lymph Nodes ; anatomy & histology ; pathology ; surgery ; Lymphatic Metastasis ; physiopathology ; Male ; Mediastinum ; surgery ; Operative Time ; Postoperative Complications ; Recurrent Laryngeal Nerve ; physiopathology ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the prognostic factors of 1018 patients with laryngeal cancer treated surgically.

METHODSAll patients were treated surgically for laryngeal cancer from 1984 to 1996. A total of 16 clinical factors was studied by univariate analysis and Cox multivariate model.

RESULTSThe follow-up rate was 93.5% over 5 years. The overall cumulative survival rate was 79.1% at 3 years, 70.2% at 5 years. The 5-year survival rate of T1N0 is the highest, followed by T1N+, T2N0, T3N0, T4N0, T2N+, T4N+, and T3N+. In univariate analysis, the survival was related to patient age, mobility of vocal cords, preoperative T status, preoperative N status, preoperative UICC stage, postoperative T status, postoperative N status, postoperative UICC stage, topographic location of the tumor and tumor size. In Cox multivariate modal, only postoperative N status, mobility of vocal cords and tumor size were independent prognostic factors.

CONCLUSIONIndependent prognostic factors for patients with laryngeal cancer after curative resection are postoperative N stage, mobility of vocal cords as well as tumor size. Postoperative follow-up and salvage surgery in time should be attached with importance to improve the survival of patients with laryngeal cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; mortality ; pathology ; surgery ; Laryngectomy ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Salvage Therapy ; Survival Rate ; Vocal Cords ; physiopathology