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A twenty-year scientific cooperation has been discussed (1979-1998) between four clinics for laryngology at Medical Universities in Cracow, Poznań, Warsaw and Lublin. The results of research concerning the epidemiology, diagnostics and treatment of the carcinoma of the larynx are presented.

In patients suffering from several types of malignant tumours, changes in deoxyribonucleic acid (DNA) content are usually associated with poorer survival prognosis. In the present study, DNA content and clinical and histopathologic features were analyzed in patients suffering from laryngeal carcinoma, with a view to establishing the crucial prognostic factors. In the 5-year follow-up study, flow cytometry was used to analyze DNA content in the paraffin-embedded samples of laryngeal carcinoma tissue obtained from 90 patients who had undergone surgical treatment in the Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Cracow, Poland, in 1987 and 1988. The group consisted of 59 and 31 patients with T3 and T4 tumours, respectively. In each case, neck dissection was carried out either on one or both sides. Metastases in regional lymph nodes were found in 26 patients. The disease-free 5-year survival rate was 55.6%. Among the investigated cases, there were 14 aneuploid and 76 diploid tumours. The treatment yielded the worst results, when the S-phase fraction (SPF) and proliferative index (PI) were equal to or higher than 15.8% and 16.0%, respectively. The values of SPF and PI index did not correlate, however, with the frequency of regional metastases. Univariate analysis revealed that tumour size (T stage), presence of lymph node metastases, age of patients (< or = 60, > 60), tumour differentiation, tumour front grading (<15 points, > or = 15), mode of infiltration, SPF, and PI were positively correlated with the actual survival rate. Presence of lymph node metastases (p = .0001) and the PI (p = .0067) were found to be the only independent prognostic factors when the Cox multivariate analysis was applied. The assessment of the PI by flow cytometry may effectively facilitate the selection of patients recommended for a more aggressive treatment.

It has been shown the conception of partial surgery of the larynx due to cancer primary develops in the supraglottic. The evolution of this method which is a consequence of progress in anatomical and embryological knowledge as well as technical possibilities of surgeons has been introduced. The modern methods of partial removal of larynx let resume physiological function of larynx with oncological security.

Objective: The main objective of the present study was to assess the degree of voice signal impairment among patients who had undergone partial surgery of the larynx due to cancer of this organ. Such on evaluation may be helpful in the selection of the optimal surgical technique for the treatment of tumors displaying a varying degree of local advancement., Methods: A prospective examination was carried out among 128 patients. Additionally a comparative study of the control group consisting of 36 healthy males was carried out. Acoustic tests were carried out in an echo-free chamber. The temporal changes in the value of acoustic pressure of the uttered text were registered. The 'distance' between the normal speech signal and the pathological voice has been established., Results: The values of the fundamental frequency increase together with an increase of the range of resection of anatomical structures. The biggest differences in the value of results describing the distance from the standard were observed after hemilaryngectomy. The shortest distance from the acoustic standard was observed after chordectomy. No significant differences in the degree of voice signal impairment among patients who had undergone extended chordectomy and hemilaryngectomy were observed., Conclusion: The above findings can be of help in arriving at an optimum solution in cases of partial surgery of the larynx. The problem is particularly important in situations where there is the choice between different types of surgery.

We examined retrospectively whether the quantitative morphometric analysis of nuclear shapes in patients with advanced cancer of the larynx could be used as a prognostic factor. In all, specimens were taken from 90 patients treated by surgery in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The follow-up period was no shorter than 5 years. In the group examined there were 59 patients with T3 tumors and 31 with T4 tumors. A neck dissection was performed on one or both sides in each case. Metastases in regional lymph nodes were found in 26 patients. Histologic grading was assessed in all cases. Fourteen parameters of nuclear shape were studied using a computer-assisted system of image analysis. Morphometric data were compared with patients' survival rates. The worse survival rates were found to be linked with a nuclear area (NA) > or = 64.82 micron 2 and its standard deviation (SDNA) > or = 20.10 micron 2, a nuclear perimeter (NP) > or = 32.45 microns and its variation (SDNP) > or = 4.77 microns, nuclear density (ND) > or = 22,215.63 and its variation (SDND) > or = 6930.85 and nuclear roundness (NR) > or = 0.76. By using multivariate Cox regression analysis the SDND, presence of metastases in lymph nodes and low tumor differentiation were found to be independent prognostic factors. No statistically significant correlation was found between the parameters examined, lymph node status and tumor differentiation.

It was retrospectively examined whether the tumor growth fraction determined by PCNA score in the advanced cancer of larynx could be used as a prognostic factor. There was used immunohistochemical method to evaluate the PCNA score of positive cells in paraffin embedded tissues of laryngeal carcinoma obtained from 90 patients. They were treated by surgery in the Department of Otolaryngology at the Medical University in Cracow, Poland in 1987 and 1988. The follow-up period was not shorter than 5 years. In the examined material there were 59 patients with tumor T3 and 31 with T4. Neck dissection on one or on both sides was performed on patients. The metastases in regional lymph nodes was found in 26 patients. Histologic grading (G1 = 18, G2 = 52 and G3 = 20 patients) and number of mitosis was assessed. The PCNA score was defined by counting positive cells and presented as percentage of a cells. It ranged from 2.1 to 73.0% with the average value of 34.5%. The PCNA score below this level was defined as a low PCNA score (49 patients) and above this level as a high PCNA score (41 patients). There was a correlation between PCNA score and survival of the patients. 35 patients (71.4%) with low PCNA score survived and 15 (36.6%) with high PCNA score (P < 0.05). Similarly the high PCNA score influenced the number of metastases in lymph nodes. They occurred in low and high PCNA score respectively at nine (18.4%) and 17 patients (41.5%) (P < 0.05). There was not found any correlation between PCNA score and tumor differentiation, its size and mitosis number. The PCNA may be a prognostic factor for the patients with advanced cancer of larynx.

From 1980 to 1992, 85 patients diagnosed with tumour of the glottis, localized exclusively in the vocal cord area, had undergone surgery. A 90% 5-year survival rate without recurrences had been obtained. Taking into account the cases of life-saving surgery, the percentage of the 5-year survivals amounted to 94%. Considerably better results were obtained by the excision of the entire vocal cord and not just one of its sections (1/2, 2/3 etc.). The degree of deformation of the voice following chordectomy was assessed by means of acoustic and laryngographic methods (Laryngograph Processor PCLX). A 13% rate of irregularity in the functioning of the neoglottis, following surgery, was observed. The Jitter-Shimmer co-efficients were established. The results of the deformation of the voice following chordectomy were presented on the J-S scale and compared with other partial surgeries performed on patients with tumours of the glottis. All of the acoustic and laryngographic findings were presented in the from of mean values most representative of chordectomy.

In a group of 579 patients with laryngeal carcinoma treated surgically in years 1988-1989 in four departments of otorhinolaryngology of the Medical Academies in Poznań, Warsaw, Cracow and Lublin, 72% survived 3 years without recurrence and 59% survived 5 years. Similar results were obtained in years 1986-1987. The authors discuss in detail the reasons for failures of the surgical treatment, i.e.: supraglottic localization of the cancer, its extensiveness in the larynx, the stage of clinical development, general condition of the patient, effectiveness of the operation, regularity of postsurgical examination, the degree of histological malignancy, blood transfusion during the operation, distant metastases, little efficiency of medical service in early diagnosis of laryngeal cancer, avoiding postsurgical radiation, subjective factors of the patients and the choice of the optimal method of the treatment. Few patients can be cured if the initial treatment fails.

In the group of 578 patients with larynx cancer that underwent surgical treatment in four clinics of Medical Academies between 1986-87 a comparable analysis of the efficiency of surgical treatment depending on age of the operated patients was carried out. It was found that the difference between age average and the general state of patients was statistically highly important: Statistically significant was also the dependence between the patients' age and the postoperative complications; close to importance was also the dependence between the age and the survival period of patients. 68% of operated patients up to 65 year of age had five-year survival period without any symptoms; but in the group of patients over 65 years of age the analogical survival value was 51%.

The vascular pattern of the injected with Mercox human fetal larynges, especially of the anterior commissure and surrounding it area, was analysed within the horizontal and frontal sections under a light microscope. The main result of our study was confirmation of existence of the avascular "plane zero" situated above the anterior commissure, which separates that structure from the supraglottic tier. That finding i.e. avascular separation between teh middle and upper laryngeal compartments, already present in the fetal period, has clinical implications as far as the spread of neoplastic process within the larynx is cancerued.

In 4 ENT Clinics of Medical Academies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: senility, other concomitant diseases (especially cardiac), prolonged diagnostic procedure, no up to date diagnostic methods, giving up the radiotherapy (38% of cases), upper laryngeal localization of tumors (87%), advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degrees and IV degrees 85%), lack of surgical radicality especially in neck dissection, unsuccessful neck dissection behind the accessory nerve, omittance of taking the specimens to the pathomorphologic examinations from the marginal part of the operational field in 25% of patients. The early recurrences in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.

We present historical review after treatment of laryngeal cancer. Complications after partial and total operations of laryngeal cancer was presented. Their results and complications were development of surgical treatment of laryngeal cancer.

The results of treatment by patients with I degree and II degree grade of glottic tumor was presented. As a method of treatment was chosen cordectomy and extended cordectomy. Five years survive rate was 91%.

In 4 ENT Clinics of Medical Akademies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: prolonged diagnostic procedure, upper laryngeal localization of tumors, advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degree and IV degree 85%), lack of surgical radicality especially in neck dissection. The early recurrencies in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.

A patient in age 68 years with malignant fibrohistiocytoma of the larynx was surgically treated in the department of Otolaryngology, Medical University in Cracow. Fibrohistiocytoma is very rare tumor of the larynx. The diagnosis was supported by immunohistochemical examination. In the course of treatment were observed local relapses and neck metastases.

A group of 578 patients with larynx cancer underwent surgical treatment in four Otolaryngological Clinics of Medical Universities in Poznań, Warsaw, Cracow and Lublin between 1986-1987. Within this group, 75% of operated patients had a three--year survival rate without symptoms, and 58% of patients had a five-year survival rate. A detailed evaluation of causes of failures in surgical treatment dealt with e.g. the initial placement of the cancer including entrance margins of larynx in a rich net of lymphatic vessels, extensiveness of organs, the degree of clinical progressions, general physical condition of a patient, radicality of treatment, regularity of check-ups after the operation, high degree of histological malignancy unfavourable configuration of TNM feature blood transfusions, the appearance of remote metastases low efficiency in the early diagnostics of larynx cancer, subjective conditions of patients, discontinuation of complementary irradiation.

Three and five years survival rates in a group of 3440 patients surgically treated for carcinoma of the larynx in four ENT Departments in the years 1977-86 were presented. 5 years survival rate was obtained in 70% of patients treated only surgically, and in 46% patients treated with surgery combined with radiotherapy.

Results are reported from a population study of 1700 patients of larynx cancer and 1206 cases controls without larynx cancer. If the patients have larynx cancer they won't have pollinosis and allergic asthma. The bloods groups AB0 all the cases were analysed. But we don't find interdependence.

During the years 1986--90 about 480 patients with tumors of the larynx were treated in Cracow Otolaryngological Clinic. In this group were two cases of neurofibroma of the larynx. These patients were treated upon by various types of surgically operations.

From September 1991 till January 1994 in ENT Clinic in Cracow 5 patients with far advanced laryngeal cancer involving hypopharynx were treated surgically. Total laryngectomy with partial or total hypopharyngectomy was performed and then the reconstruction of hypopharynx one stage procedure using lingual flap was done. In all patients functional results were acceptable. The main contraindications for using lingual flap is tumor infiltration of the base of tongue.

In the years 1973-1990, 48 children with laryngeal papillomatosis were treated in the Department of Otolaryngology, Medical University of Cracow. The data was obtained in 42 children. In 51% children the entire and long-lasting (from 4 to 8 years) remission of papillomatosis was ascertained. In 39% patients the considerably limited papillomatosis with distinctly prolonged remission time was obtained and in 9% of the patients the development of papillomatosis in low respiratory tract was noted.

The evaluation of surgical treatment results was done to 308 oncological patients to whom metastases were formed in lymph nodes between 1980-1984, following the previous surgical treatment of the laryngeal cancer. The evaluation included among others the following: cancer initial localization: T and N traits; the degree of malignancy; surgical radical intervention ; assertion of neoplastic cell plugs in vessels; the time of recurrent lymphatic metastases, etc. The efficiency of surgical treatment of metastases being formed following the previous surgical treatment of laryngeal cancer, measured by the time of 5 years asymptomatic life, equalled 33.4% in the discussed material. Moreover, it was stated that in the studied group of 308 patients the percentage of deaths was increasing in the subsequent years of taking observations (from 1980 to 1984) and depended also on patients overall condition, initial cancer localization, the degree of neoplastic advancement and on the degree of cancer histologic malignancy.

In the years 1985-1990 within the group of 2769 patients operated upon for laryngeal cancer in four medical centres (Kraków, Poznań, Warszawa, Lublin), a clinical analysis on surgical treatment failures was performed. The most significant reasons of failures were: the highly advanced age of patients, coexistent diseases, in particular the cardiopulmonary disease; poor information of neoplastic diseases (carcinomas) and delayed referral to the doctor; lack of consent for surgical treatment; old fashioned diagnostic methods; prolonged period of making diagnosis; increasing number of patients with supra-glottic localization including the hypo-pharynx and piriform recess; a considerable degree of organ ++cancer advancement and substantial clinical advancement; not radical excision of neck glands; intra-surgical blood transfusion; micrometastases to lymphatic glands; immunity collapse; discontinuance of post-surgical radiation on affected parts; lack of lymphadenectomy backward from accessory nerve ; massive cancer metastases to lymph nodes; high histologic malignancy with characteristic carcinous invasiveness; and finally, surgical and post-surgical early and late complications ranginy within our material from 25% to 29% of surgical patients. Basing on the above mentioned analysis, the authors developed indications for surgical treatment of laryngeal cancer.

Among total number of 1399 patients with laryngeal malignant tumors treated in Cracow Otolaryngological Clinic in the years 1966-1985 there were only six (4%) patients with non-epithelial neoplasms. These patients were operated upon by various types of laryngectomy.

During the years 1980-1988 2458 laryngeal cancer patients were operated upon in 4 ENT AM Clinics in Kraków, Poznań, Lublin and Warszawa. 300 (12%) out of them have had the cervical node metastases in 18 months after the surgery. The cause analysis was performed. The primary localizations were in the epiglottic and ++post-cricoid areas. The causes of metastases to the ++lymph nodes were analyzed; the primary epiglottic and ++post-cricoid localization of the tumor, its extensiveness and advanced clinical stage. Twice more often were the nodal metastases stated before the primary treatment, a high degree of histological malignancy, probably insufficient radicality of the surgery and insufficient immunological resistance of the organism were taken in consideration. This group of patients presented a rather high percentage of early unsuccessful results of surgical treatment of the laryngeal cancer; this problem needs further analysis and observations.

A case of surgically treated amyloidosis of the larynx is presented. Current opinions on the structure of amyloid are given.

The surgical complications in a group of 1712 laryngeal cancer patients treated during the years 1981-87 in ENT Clinics of Cracow, Poznań, Warsaw and Lublin were described. The most dangerous were bleedings and the most frequent wound and tracheo-+-bronchial infections and pharyngo-cutaneous fistulas++, after radical neck dissection however the paralysis of sublingual and accessory nerves and of brachial plexus. The predisposing factors were: diabetes, lung and heart diseases, late stage of cancer, extent of surgery and tumor infections.

Morphology of blood vessels in cancer of the larynx, which as other solid tumors has great neoangiogenic abilities, was studied on microcorrosion casts in SEM. Most evident changes of the endothelial patterns were seen on the casts of capillaries, venules, and veins. Capillaries, especially the newly formed, are the most numerous constituent of the vascular bed in all zones of cancer of the larynx. These vessels exhibit great morphological differentiation varying from the single, blind-ended pipes via relatively long hairpin loops spirally twisted in the long axis, to strongly spiralled and convoluted loops, resembling pseudoglomeruli. The newly formed capillaries deriving predominantly from the host's capillaries, venules, and veins have a embryonal character. It seems reasonable to presume that the neoangiogenesis process triggered by active influence of the tumor angiogenesis factor, is in principle, a repetition of the mechanism of the embryonal angiogenesis.

The results of laryngeal cancer surgery were assessed in a group of 832 patients treated in four major ENT centers in Poland. Five-year survival rates were as follows: stage I, 86%; stage II, 71%; stage III, 54%; and stage IV, 42%. In experienced hands and for properly selected cases, cure rates after partial (conservation) laryngeal surgery were similar to those after total laryngectomy. For early stages (I and II), the survival after partial surgery was better than that found after radiotherapy.

Injection methods were used for the study of the blood vascular system in 50 specimens from total or subtotal laryngectomy in patients with extensive cancer of the larynx, and in 24 normal postmortem larynges. All specimens were injected via the superior laryngeal arteries. A silicone rubber technique was found to be the most suitable for the aims of this study. A chaotic distribution of abnormal vessels that differ in shape, a rich neovascular network within the tumor, and capillary hypertrophy in its vicinity are the main features of the blood vascular system in laryngeal cancer. The results obtained indicate great tumor-angiogenic ability that can be indirectly explained by action of an angiogenesis factor diffusing from cancer cells. This may open new possibilities for the treatment of carcinoma of the larynx based on anti-angiogenesis.

Observations that certain primary tumors (solid ones) are infiltrated by cells which participate in immune responses tend us to examine this problem in spontaneously growing larynx carcinoma (ca. planoepitheliale). Our observations in SEM revealed within but also in surrounding of cancer infiltrations the presence of cellular elements belonging to the immune system like: lymphocytes, monocytes and macrophages. The most numerous of them, lymphocytes, are brought to the surrounding and tumor's territory by very rich vascular network (angiogenesis phenomenon). Bidirectional transmigration of the lymphocytes, observed mainly within the postcapillary venules, takes place through the cytoplasm of endothelial cells. It is most probably that they are lymphocytes of T-type which are involved in a cell mediated mechanisms of the immune response against a tumor. The lymphocytes are responsible also for the presence of monocytes and especially macrophages within a tumor's territory. These facts suggest that the human organism, in certain degree, is able to fight against malignant tissue by similar mechanisms which are involved in the rejection of the graft.

Twenty specimens for laryngectomy in extensive cancer of the larynx were examined after injecting the blood vessels with silicone rubber. The behavior of the vessels during the process of destruction of the laryngeal cartilages by the neoplasm were evaluated, as was the part played by the vascular system in spreading cancer in the larynx and its passage beyond the anatomical borders of this organ. Cartilages are damaged by cancer mainly in ossified and vascularized sites. The nonossified and avascular cartilages, on the contrary, are maintained in an almost unchanged condition amid the extensive tumorous masses surrounding them.

Human larynges, removed surgically for advanced planoepithelial carcinoma were used for study. After employing appropriate preparation procedure the obtained material was examined in scanning electron microscope (SEM). The predominant findings were: the human cancer cells transmigrate through the venule lining at/or near the sites of the endothelial intercellular junction, capillaries and postcapillary venules constitute a territory within the transmigration of lymphocytes, piercing the body of the endothelial cell, occur in both directions, the cellular elements of the immune system are relatively more numerous gathered in the peripheral areas of the primary tumor, the obtained results are consistent with in vivo and in vitro experimental data.

The injection replication method was used in a study of the vascular system in cancer of the larynx. Following maceration, clean microcorrosion casts of the blood vessels of larynx cancer were examined in a scanning electron microscope (SEM). The effective filling of the whole vasculature, including its finest capillaries, makes it possible to obtain really three-dimensional pictures of the tumor blood vessels in the SEM. These SEM pictures allow a more detailed and profound analysis of the behavior and arrangement of blood vessels in three basic, angioarchitectonically differentiated zones of the tumor.