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Surgical Approach And Results Of The Treatment Twosubcategories Of Pt2 Glottic Carcinoma Of The Larynx

Jovic Rajko M., Canji K., Mitrovic S., Kljajic V., Dragicevic D.

Introduction: T2 glottic carcinoma presents non homogenous localization of laryngeal carcinoma with two subcategories: first (I)- carcinoma of the vocal cord with impaired mobility and second (II)- vocal cord carcinoma with spreading to supraglottic or subglottic part with good or impaired mobility. Aim: of the study is to retrospectivly analyze results of surgery of pT2 glottic carcinoma and to determine the importance of different subcategories (I and II) of glottic carcinoma on diagnostic procedures, applied surgical treatment and survival. Material and Method: During the period 1990-2000., 71/701 (10%) patients with pT2 glottic carcinoma were diagnosed. Squamous cell carcinoma was found in 68/71 (95.8%) of patients. In the first subcategory (I) there were 55/71 (77.5%) patients, and in second (II) 16/71 (22.5%) patients. All patients were treated surgically with great differences in percentual participation of different kinds of surgical techniques. Results: Total laryngectomy was performed in 14/71 (19.7%) patients, while other patients undergone functional reconstructive surgery. Involvement of anterior commisure in local spreading of the cancer was found in 24/71 (33.8%) patients. In I subcategory there were 15/55 (27.3%) and in II subcategory 9/16 (56.2%) of patients. Total laryngectomies were performed in 13/24 (54.2%) patients with anterior commisure involvement and in 11/24 (45.8%) patients reconstructive surgery was performed. Neck lymph node metastasis were found in 2/49 (4 %) patients. Positive marginal speciment was found in one of 57 patients (1.7%) with reconstructive laryngeal surgery. Local recidive occured in 8/55 (14.5%) patients with reconstructive laryngeal surgery, in I subcategory 6/55 (10.9%) patients and in II subcategory 2/16 (12.5%) patients. In all of them total laryngectomy was performed. Another primary carcinoma occured in 4/71 (5.6%) patients. Overall 5 -year survival rate was 90.1%, with small differences between subcategories (I subcategory 89.1%, II subcategory 93.7%) which was not statisticaly significant (p=0.596). Disease free 5 -year survival was 83.6% with differences between subcategories (I subcategory 81.1%, II subcategory 93.3%) which was not statisticaly significant (p=0.581). Although clinical significance persisted, statistical significance would be expected in larger subcategories. Conclusion: Spreading of glottic carcinoma toward supraglottic and subglottic structures complicates exact preoperative evaluation of tumor size, regardless to preoperative diagnostic procedures. Just owing to that, larger surgical resections performed, bring more radicality, with less percentage of local recidive and better effects on overall survival and disease free survival rate.

Türk Otolarengoloji Arşivi 07/45-3 Syf:158

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