The Outcome Of Near-total Laryngectomy And Clinical Significance Of Fast-frozen Pathology In Diagnosing Surgical Margin

Objects: To explore the outcome of near-total laryngectomy with voicerehabilitation by mucosa tube and significance of fast-frozen pathology in diagnosing ofthe excision edge during operation for patients with laryngeal carcinoma.Methods: Forty-six patients with glottic laryngeal sqamous cell carcinoma wereperformed near-total laryngectomy between January 1999 and June 2001 in ourdepartment. All patients were males, their age ranged from 53 to 76 years with an averageof 62 years. The distribution of the patients according to UICC in 1997 was as follows:T₃N₀M₀ 32 cases(69.6%), T₃N₁M₀ 6 cases(13%), T₃N₂M₀ 2 cases(4.4%), T₄N₀M₀ 6cases(13%) and clinical stages;â…¢stages 38 cases(82.6%),â…£stages 8 cases(17.4%). During the operation large portion of larynx was resected, only the arytenoid of thehealthy side was preserved, a mucosa tube was sutured using healthy arytenoid and amucous membrane strip connecting to the trachea. There were 8 cases (17.4%) with necklymph node metastasis. The concurrent neck dissections were undergone for 8 cases(6unilateral side, 2 bilateral side). The surgical margins tissues which was 3mm, 5mm awayfrom cancer were 3×1mm size mucosa specimens. Three hundreds and eighty ninemucosa specimens were obtained from multi-spots and studied by fast-frozen pathologyintraoperatively in all patients. All patients undertook postoperative radiotherapy(DT55—65GY).Results: The postoperative follow-up was 5 years. All patients had near normalvoice and normal swallow function. The average 8.2samples is in every patient and sixwere positive in 181 samples 13 %(6/46) which was 3mm away from cancer. Largerresection(5mm) would made and frozen section again and no positive. Positive samplesdistributed in superior margin 2 cases, inferior margin 2 cases, healthy vocal cordfrontage 1 case, extralarynx tissue lcase. The samples which was 5mm away from cancer were negative in 192 samples.Wound infection were 3 cases and pharyngeal fistula in one case. Nasal feedingtube were removed 12-14 days after surgery and all patients had dining via mouth.Phonation-tube did not pronounce postoperation in 3cases(6.5%). Twelve patients diedduring the 5 years follow-up (neck lymph nod metastasis 8 eases, neck recurrence 3cases, lungs metastasis 1 case). The overall 5-year survival rate was 65.2% (30/46).Conclusion: Near-total laryngectomy performed in patients with advanced laryngealcancer obtained confirmation outcome. The surgical method will excise the tumorcompletely and preserve and reconstruct laryngeal function. It will obtain higher localcontrol rate and improve both survival rate and life quality. Fast-frozen pathology will behelpful in confirming safety boundary in surgery. The excision margin at 5 mm awayfrom the tumor can be regarded as a safe range for surgery of cancer of larynx.