Abdullah TAŞ, Ahmet Rıfat KARASALİHOĞLU, Elif ÇİFTÇİ, Mustafa Kemal ADALI, Cem UZUN, Muhsin KOTEN, Recep YAĞIZ

Frontal anterior laryngectomy with epiglottic reconstruction (Tucker's operation): Oncologic and functional results

Amaç: Epiglot rekonstrüksiyonlu frontal anterior larenjektomi (Tucker operasyonu) ile tedavi edilen hastaların fonksiyonel ve onkolojik sonuçlarını değerlendirmek. Hastalar ve Yöntemler: Eylül 1985-Kasım 2009 yılları arasında, erken glottik tümörü olan 58 hastaya Tucker operasyonu uygulandı. Dekanülasyon zamanı, nazogastrik sondanın çıkarılması, hastanede yatış ve onkolojik sonuçlar analiz edildi. Akustik analiz ve Ses Handikap Endeksi (SHE) vokal fonksiyon değerlendirmesi için kullanıldı. Bulgular: Ortalama dekanülasyon ve nazogastrik sonda çıkarılma süreleri sırasıyla 11,8 ve 15,4 gündü. Ortalama hastanede yatış süresi 19,3 gündü. Erken dekanülasyon uygulamasının hastaların dekanülasyon ve hastanede yatış sürelerini belirgin şekilde azalttığı bulundu. Beş yıllık genel sağ kalım oranı %81,5, primer hastalığa spesifik sağ kalım oranı %96,9 bulundu. On yıllık genel ve primer hastalığa spesifik sağ kalım oranları sırasıyla %67 ve %95,2 bulundu. Beş yıllık lokal kontrol oranı %95,4, nodal kontrol oranı %95,2 bulundu. Hastaların jitter, shimmer ve gürültü-harmonik oranı sırasıyla %8,1, %16,6 ve 0.51 bulundu. Bu değerler belirgin bir artışı gösteriyordu. Total SHE skoru ve alt grup skorlarından SHE-emosyonel hariç diğerleri hastaların hafif düzeyde ses sorunu yaşadığını gösterdi. Sonuç: Tucker operasyonu yüksek onkolojik ve tatminkar fonksiyonel sonuçlarıyla erken glottik karsinomların tedavisinde tercih edilebilecek tekniklerden biridir.

Epiglot rekonstrüksiyonlu frontal anterior Larenjektomi (Tucker Operasyonu): Onkolojik ve fonksiyonel sonuçlar

Objective: To evaluate functional and oncological results of patients who were treated with frontal anterior laryngectomy with epiglottic reconstruction (Tucker's operation). Material and Methods: From September 1985 to November 2009, 58 patients whose early glottic carcinomas were operated on with Tucker's operation. The time of decannulation, nasogastric tube removal, hospitalization and oncological results were analyzed. Acoustic analysis and Voice Handicap Index (VHI) were used to evaluate vocal function. Results: The mean time for decannulation and nasogastric tube removal were 11.8±7.6 and 15.4±4.4 days, respectively. The mean duration of hospital stay was 19.3±6.1 days. It was found that early decannulation significantly reduced patient decannulation and hospitalization time. The 5-year overall and cause-specific actuarial survival rates were 81.5% and 96.9%, respectively. The 10-year overall and cause-specific survival rates were 67% and 92.3%, respectively. The 5-year local and nodal control rates were 95.4% and 95.2%, respectively. The mean values for jitter, shimmer and noise-to-harmonic ratio were 8.10±5.59%, 16.60±5.81% and 0.51±0.23, respectively, and these scores showed a significant increase. Total VHI score and subscale scores except VHI-emotional noted that patients had a mild level of vocal disability. Conclusion: Tucker's operation is one of the preferred techniques in the treatment of early glottic carcinoma with its high oncologic success rate and satisfactory functional results.

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1. Back G, Sood S. The management of early laryngeal cancer: options for patients and therapists. Curr Opin Otolaryngol Head Neck Surg 2005;13:85-91. [CrossRef]
2. Karasalihoglu AR, Yagiz R, Tas A, Uzun C, Adali MK, Koten M. Supracricoid partial laryngectomy with cricohyoidopexy and cricohyoidoepiglottopexy: functional and oncological results. J Laryngol Otol 2004;118:671-5. [CrossRef]
3. Tucker HM, Wood BG, Levine H, Katz R. Glottic reconstruction after near total laryngectomy. Laryngoscope 1979;89:609-18. [CrossRef]
4. Tucker HM, Benninger MS, Roberts JK, Wood BG, Levine HL. Near-total laryngectomy with epiglottic reconstruction. Long-term results. Arch Otolaryngol Head Neck Surg 1989;115:1341-4. [CrossRef]
5. Mallet Y, Chevalier D, Darras JA, Wiel E, Desaulty A. Near total laryngectomy with epiglottic reconstruction. Our experience of 65 cases. Eur Arch Otorhinolaryngol 2001;258:488-91. [CrossRef]
6. Lawson G, Jamart J, Remacle M. Improving the functional outcome of Tucker’s reconstructive laryngectomy. Head Neck 2001;23:871-8. [CrossRef]
7. Oysu C, Aslan I. Cricohyoidoepiglottopexy vs near-total laryngectomy with epiglottic reconstruction in the treatment of early glottic carcinoma. Arch Otolaryngol Head Neck Surg 2006;132:1065-8. [CrossRef]
8. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. The Voice Handicap Index (VHI) development and validation. Am J Speech Lang Pathol 1997;6:66-70.
9. Kiliç MA, Okur E, Yildirim I, Oğüt F, Denizoğlu I, Kizilay A, et al. Reliability and validity of the Turkish version of the Voice Handicap Index . Kulak Burun Bogaz Ihtis Derg 2008;18:139-47.
10. Núñez Batalla F, Caminero Cueva MJ, Señaris González B, Llorente Pendás JL, Gorriz Gil C, López Llames A, et al. Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the Voice Handicap Index. Eur Arch Otorhinolaryngol 2008;265:543-8. [CrossRef]
11. Ciftci E. Late functional evaluation after supracricoid partial laryngectomy [master’s thesis]. Edirne, Medical Faculty, Trakya University; 2009.
12. Leipzig B. Neoglottic reconstruction following total laryngectomy. A reappraisal. Ann Otol Rhinol Laryngol 1980;89:534-7.
13. Pearson BW. Subtotal laryngectomy. Laryngoscope 1981;91: 1904-12. [CrossRef]
14. Zanaret M, Giovanni A, Gras R, Bonnefille E, Robert D, Cannoni M. Reconstructive anterior frontal laryngectomy. Long-term results in T2 glottic cancers. Ann Otolaryngol Chir Cervicofac 1995;112:205-10.
15. Bakhos D, Lescanne E, Beutter P, Morinière S. Indications of cricohyoidoepiglottopexy versus anterior frontal laryngectomy: the role of contralateral vocal fold spread. Head Neck 2008;30: 1408-14. [CrossRef]
16. Chevalier D, Laccourreye O, Brasnu D, Laccourreye H, Piquet JJ. Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients. Ann Otol Rhinol Laryngol 1997;106:364-9.
17. Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas. Laryngoscope 2000;110:627-34. [CrossRef]
18. Nomiya T, Nemoto K, Wada H, Takai Y, Yamada S. Long-term results of radiotherapy for T1a and T1bN0M0 glottic carcinoma. Laryngoscope 2008;118:1417-21. [CrossRef]
19. Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009;266: 1333-52. [CrossRef]
20. Rödel RM, Steiner W, Müller RM, Kron M, Matthias C. Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure. Head Neck 2009;31:583-92. [CrossRef]
21. Lelièvre G, Laccourreye O, Strunski V, Juvanon JM, Bedbeder P, Peynegre R. Critical study and role of partial vertical reconstructive laryngectomies with epiglottoplasty by the Tucker method. Apropos of 18 cases. Ann Otolaryngol Chir Cervicofac 1987;104:323-8. [CrossRef]
22. Laccourreye O, Brasnu D, Merite-Drancy A, Cauchois R, Chabardes E, Ménard M, et al. Cricohyoidopexy in selected infrahyoid epiglottic carcinomas presenting with pathological preepiglottic space invasion. Arch Otolaryngol Head Neck Surg 1993;119:881-6.
23. Giovanni A, Guelfucci B, Gras R, Yu P, Zanaret M. Partial frontolateral laryngectomy with epiglottic reconstruction for management of early-stage glottic carcinoma. Laryngoscope 2001;111:663-8. [CrossRef]
24. Haddad L, Abrahão M, Cervantes O, Ceccon FP, Gielow I, Carvalho JR, et al. Vocal assessment in patients submited to CO2 laser cordectomy. Braz J Otorhinolaryngol 2006;72:295-301.
25. Modrzejewski M, Olszewski E, Wszołek W, Reroń E, Strek P. Acoustic assessment of voice signal deformation after partial surgery of the larynx. Auris Nasus Larynx 1999;26:183-90. [CrossRef]
26. Olthoff A, Mrugalla S, Laskawi R, Fröhlich M, Stuermer I, Kruse E, et al. Assessment of irregular voices after total and laser surgical partial laryngectomy. Arch Otolaryngol Head Neck Surg 2003;129:994-9. [CrossRef]