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The aim of this study was a retrospective analysis of the oncological results in a group of patients treated by frontolateral laryngectomy using clinical and histopathological correlations in order to review the indications for surgery. In all, 150 patients underwent frontolateral laryngectomy as described by Leroux-Robert. All were staged according to the 1992 UICC TNM classification. Factors examined were clinical T, histopathological T, tumor infiltration of the anterior commissure and the vocal cord muscle, survival without disease and the percentage of local relapses. Twenty-one patients had local relapses (14%), while four patients developed second primary tumors (2.7%). Among the different correlations examined, microscopic infiltration of the anterior commissure was related to a greater number of local relapses (25.5% vs 5%) and a 55% survival with with no evidence of disease (NED). The crude 5-year NED survival was 66% and was influenced by second primary tumors and metastases (7.4%) and non-oncological diseases (14.6%). These data show the need for a re-evaluation of the indications for frontolateral laryngectomy because subtotal reconstructive laryngectomy could be performed more safely in the more advanced cases. In contrast, cases with more limited tumors might be better treated by laser for a more functional and cost-beneficial result.

An a series of 1.053 treated surgically for laryngeal cancer, a noteworthy incidence of secondary tumors (S.T.) was observed. This occurrence was correlated to various oncological parameters of primitive laryngeal tumors in order to reveal any eventual predictive factors. A S.T. occurred in 80 patients (7.6%): in 22 cases (27.5%) in the upper aero-digestive tract; in 23 (28,8%) in the lungs; in 15 (18.7%) in the gastro-intestinal tract (stomach, intestines, liver, esophagus); in 9 (11.2%) in the genitourinary tract (bladder, prostate); in 4 (5%) on the skin; in 3 (3.8%) in the thyroid; in 2 (2.5%) in the skeletal system; in one case each in the nervous system and in the mediastinum (1.2% respectively). On slightly more than one half of the cases (56.3%) diagnosis was made in the first 5 years following laryngeal surgery; in 26.2% in the following 6-10 years; in 26.2% in the 17.5% after 10 years. Only in two cases (stomach and thyroid) a S.T. appear within 6 months (simultaneous S.T.). No predictive correlation was revealed with regard to site or laryngeal tumor extension; to the presence of lymph node metastases or capsular rupture. However, in patients that had undergone functional surgery, S.T. incidence was double that of those who had been treated with total laryngectomy. Furthermore, in comparing the incidence of pulmonary metastases with that of a pulmonary S.T., it appeared that these is a higher probability of occurrence of the former in cases of supraglottic carcinomas, of laterocervical lymph node metastases or of capsular rupture. This findings clearly demonstrate that during pre-operative staging and post-operative follow-up an extremely accurate clinical and instrumental examination, aimed furthermore at revealing any eventual second neoplasms which, on the basis of our observations, may strike anywhere in the body, is absolutely indispensable.

This paper reports a study of microscopic infiltration of the cartilage of the cricoid carried out in 335 patients with T2-T3 carcinomas of the larynx who had undergone total laryngectomy. The results of the investigation revealed microscopic infiltration of the cricoid cartilage in 12% (14/335) of the cases examined. The incidence, however, was much higher in those cases of extension to the hypoglottis (28% vs 5%, p0.0001) or in cases of an even greater extension of the tumor (13% vs 7%). In the 161 patients with neoplasias situated in the glottis, there was cricoid invasion in 30 cases regardless of the tumor class. However, with regard to cases with extension to the hypoglottis, a higher incidence of cricoid infiltration (20% vs 8%, p0.002) for all T classes was observed. As for as those cases with neoplasias in the supraglottis are concerned, there were no patients classified T2 (0/50) with cricoid infiltration against 8% in T3 subjects (10/124). In these subjects extension to the hypoglottis led to microscopic invasion of the cricoid cartilage in a greater number of patients (31% vs 3%, p0.0001). These observations confirm that microscopic infiltration of the cartilagenous skeleton of the larynx, especially of the cricoid, is relatively frequent. Factor of even higher risk are occurrence in the glottis and, in all the situations examined, extension to the hypoglottis. In addition, except in cases of vestibular T2, there is a 5 to 8% possibility of microscopic infiltration of cricoid cartilage even in the absence of clinical signs of hypoglottic invasion.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of microscopic infiltration of the laryngeal framework, with or without extra-laryngeal extension, was studied retrospectively in a series of 63 patients treated surgically for glottic T3 carcinomas in order to establish prognostic values. The results of histopathological examination revealed neoplastic invasion of the fibro-cartilaginous skeleton in 46 of the patients examined and in half of these microscopic diffusion in peri-laryngeal tissue. As far as prognosis is concerned, there was a clear-cut correlation between a decrease in survival rates and a contemporaneous increase in the real extension of the neoplasia, even if microscopic. In fact the NED survival rate of confirmed T3 patients was 85% while in cases reclassified as pT4, it was 64% and 47% on the basis on the absence or presence of extra-laryngeal extension. With these observations it is possible to affirm that the major staging is also attributable to cases with initial infiltration of the "laryngeal framework" without an extensive extension toward peri-laryngeal tissue. As far as T recurrences are concerned, a high incidence of relapse of the neoplasia was observed principally in the cases with extra-cartilaginous diffusion. This observation may have a predictive role and therefore direct post-surgery follow-up as well as eventual complementary treatment.

In laryngeal oncology histological evidence of neoplastic invasion of the latero-cervical lymph nodes (N+) is considered extremely serious in terms of prognosis. To find evidence of metastasis in more than one latero-cervical lymph node is, in fact, not unusual. The purpose of the present work has been to evaluate the clinical and prognostic aspects of multiple latero-cervical metastases in a group of 440 patients suffering from laryngeal carcinoma and who had undergone either total or partial laryngectomy with mono or bilateral lymph node dissection and who had been followed up for at least three years. Of the 440 patients examined 128 (29%) proved histologically N positive and of these 71 (71/128, 55%) showed multiple lymph node metastases, even in those cases of NO. On the average, from a prognostic point of view, the presence of multiple lymph node metastases halved the NED survival rate at three years (38% vs. 65%), clinical staging being equal. In conclusion, in agreement with the literature, the present observations indicate that the number of latero-cervical lymph nodes invaded must be taken into consideration along with the common prognostic factors used in cases of laryngeal carcinoma. In fact, the presence of multiple metastases has a broad, negative affect on survival. Nonetheless, it is not yet possible and is still risky to translate multiple metastases into a preoperative prognosis.

Invasion of the thyro-hyoid-epiglottic (TIE) space in supraglottic carcinoma is a frequent occurrence which, in most cases, only reveals itself upon post-surgical histology. In order to verify the current feeling that subclinical invasion does not in any way worsen prognosis the authors performed a retrospective study on the oncological results of 98 patients with T1-T2 supraglottic carcinoma. Of these 67 were treated by supraglottic laryngectomy while 31, taken as controls, had undergone total laryngectomy because of contraindications of a general nature. Histological examination of the surgical samples showed signs of space invasion in 60% of the cases. In these cases, there was a higher percentage of poor results (greater than 20%; mainly T recurrence) no matter what type of surgery had been performed. Therefore, subclinical invasion of the space must be considered as having an effect on prognosis and the authors feel that, whenever the pre-operative semiological criteria are insufficient to optimize surgical results, the patients presenting subclinical invasion of the space should be subjected to complementary radiotherapy.