Extending the Inferior Limits of Supracricoid Partial Laryngectomy: A Clinicopathological Correlation
Version of Record online: 3 JAN 2009
Copyright © 2005 The Triological Society
Volume 115, Issue 2, pages 297–300, February 2005
How to Cite
Sparano, A., Chernock, R., Feldman, M., Laccourreye, O., Brasnu, D. and Weinstein, G. (2005), Extending the Inferior Limits of Supracricoid Partial Laryngectomy: A Clinicopathological Correlation. The Laryngoscope, 115: 297–300. doi: 10.1097/01.mlg.0000154737.46528.82
- Issue online: 3 JAN 2009
- Version of Record online: 3 JAN 2009
- Manuscript Accepted: 30 JUL 2004
- organ preservation;
- subglottic extension;
Objectives/Hypothesis: The study examined preoperative clinical characteristics that can be used to predict secure inferior margins of glottic squamous cell carcinoma extending toward the cricoid cartilage when performing organ preservation surgery of the larynx.
Study Design: The study was retrospectively performed using 31 serially sectioned whole-organ total laryngectomy specimens with associated preoperative clinical data.
Methods: Histopathologic and clinical variables including true vocal cord (TVC) fixation, cricoarytenoid joint invasion, subglottic extension (SGE) of tumor, and prior radiation were examined as independent and multivariate correlates of cricoid cartilage invasion.
Results: All tumors with subglottic extension of 15 mm or less and without arytenoid fixation were free of cricoid invasion. Of tumors invading cricoid with subglottic extension of 15 mm or less, all had a fixed arytenoid cartilage and local cricoid invasion type only. Correcting for subglottic extension using multivariate analysis, cricoarytenoid joint invasion and fixed true vocal cord independently predicted cricoid invasion. However, in a multivariate model together, true vocal cord mobility adds no predictive power to cricoarytenoid joint invasion. Prior radiation of the larynx did not significantly change the predictive capacity of these variables.
Conclusion: Preoperative assessment of arytenoid mobility and extent of subglottic extension are reliable predictors of cricoid invasion by glottic squamous cell carcinoma. Organ preservation surgery is oncologically safe in the setting of glottic squamous cell carcinoma with subglottic extension of 15 mm or less and without arytenoid fixation.