Clinicopathological Evaluation and Survival Rate of Advanced Laryngeal Malignancy (t3, T4) Managed with Widefield Total/near Total Laryngectomy with Neck Dissection

Address of Correspondence: Dr.Dipak Ranjan Nayak Professor Head of Unit-I Kasturba Medical College, Manipal E mail: [email protected] ABSTRACT: Objective: : This is a study of clincopathological features and outcome of surgical management with 3 years survival pattern following total/near total laryngectomy in advanced III,IV squamous cell carcinoma larynx. Methods: Retrospective observational study conducted between January 2000 to December 2013. with 87 patients of biopsy proved squamous cell carcinoma of larynx in advanced stage T3&T4. Radio residual cases were also included in the study. 79 patients were treated surgically with Wide field total laryngectomy and 8 with near total laryngectomy along with bilateral neck dissection. Average follow up period was 15 months postoperative. All cases received post op radiotherapy except the radio-residual cases which were managed with salvage surgery alone. Chemotherapy was added in 7 cases due to extra-capsular metastasis. . Data was analyzed using Kaplan Meier method of estimation to estimate the median survival time wherever applicable. Statistical analysis was carried out using STATA 13. Results: The age range was 40 years to 85 years .The maximum incidence was found in 6 and 7 decade. 84% of the total patients were male. About 69/87 (79.31%) were smokers. 51/87 (58.6%) were T3, 36/87(41.4%) were T4 lesions. 42/87(48.27%) were N0 , 30/87(34.48%) were N1 and 15/87(17.2%) were N2 lesions . Overall incidence of nodal metastasis was 51.7%. 71% of the supraglottic carcinomas had nodal metastasis at time of presentation and 44% of glottis tumors had nodal metastasis. There were no cases of distant metastasis. Topographical Distribution showed 46% were glottic lesions, 35.6% were supraglottic lesions and 18.4% were transglottic lesions. 22/87(25.28%) were cases of post RT recurrence and the mean duration of recurrence was 21 months. 65/87 cases who underwent the surgical intervention received radiotherapy3 to 4 weeks following surgery. 22/ 87 radio residual cases underwent salvage surgery. This study showed overall survival rate of 87.3% and disease specific survival rate at 3 years to be 86.7 % for all stage III, IV laryngeal carcinoma who underwent wide field total laryngectomy/near total laryngectomy. Conclusions: This study demonstrates the overall survival and 3 year specific disease free survival rates with Wide field total laryngectomy/ Near total laryngectomy in patients with stage III, IV laryngeal carcinoma.