抄録
This study involved 424 patients with laryngeal cancer who underwent primary treatment during the 21-years period from 1978 to 1998. This group of patients comprised 401 males and 23 females, and ranged in age from 37 to 89 years with a mean age of 64.7 years. Among the 424 patients, 285 had glottic cancer. The subglottic region was defined as the area from 10 mm inferior to the free border of the vocal cords to the inferior border of the cricoid cartilage. Subglottic extension was noted in 23 of 81 cases (28.4%) at stage T2, 15 of 30 cases (50%) at stage T3, and 2 of 2 cases at the T4 stage. At T2, in the presence of subglottic extension, a total laryngectomy was performed in only 13 of 58 cases (22.4%), along with conservative treatment, especially radiotherapy, being frequently employed. At T3, total laryngectomy was frequently performed irrespective of the presence or absence of subglottic extension, and a partial resection was performed in 1 patient with subglottic extension, and in 4 cases without subglottic extension. Of the cases that were operated on, lymphatic metastasis was detected in 4 of 15 patients with subglottic extension at stage T2, and paratracheal lymphatic metastasis was recognized in 2 of the 4. Lymphatic metastasis was observed in 5 of 13 patients at stage T3, and paratracheal lymphatic metastasis in one. A laryngectomy was performed in patients with no subglottic extension, with whom lymphatic metastasis was occasionally observed but without paratracheal lymphatic involvement.
The difficulty with larynx-trachea resection is problematic tracheal stoma construction after resection. This is associated with impeded blood flow resulting from peritracheal detachment, tension of suture due to unnatural raising of trachea, and anastomotic dehiscence at the tracheal stoma.
Countermeasures against these problems accordingly include extensive tracheal resection with the addition of sternum resection, reduction of suture tension by constructing tracheal stoma at a lower position, and tracheal stoma construction with reconstructive material such as a musculocutaneous flap to prevent blood flow.
