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Original Article
October 2000

Results of Larynx Preservation Surgery for Advanced Laryngeal Cancer Through Tracheal Autotransplantation

Author Affiliations

From the Departments of Oto-Rhino-Laryngology Head and Neck Surgery (Drs Delaere, Vander Poorten, and Vanclooster, and Ms Goeleven) and Radiology (Dr Hermans), Leuven University Hospitals, Leuven, Belgium.

Arch Otolaryngol Head Neck Surg. 2000;126(10):1207-1215. doi:10.1001/archotol.126.10.1207

Objective  To evaluate the use of tracheal autotransplantation for reconstruction of the hemilaryngectomy defect that includes the hemicricoid cartilage and results from resection of laryngeal or hypopharyngeal cancer.

Design  The clinical records of 28 patients undergoing primary or salvage hemicrico-hemilaryngectomy for laryngeal (26 patients) and pyriform sinus (2 patients) cancer were analyzed for function and local control.

Setting  Academic center.

Patients  Case series review of 28 consecutive patients treated during a 3½-year period who had an average follow-up period of 19 months.

Intervention  Twenty-five men and 3 women, aged from 28 to 79 years, underwent a hemilaryngectomy that included the hemicricoid cartilage, the ipsilateral thyroid lobe, and a unilateral or bilateral lymph node dissection. In 26 patients, these extensive defects were reconstructed with a tracheal autotransplantation that restored the larynx at the glottic and subglottic levels. In 2 patients, the defect was converted into a total laryngectomy because of tumor extension beyond the resection margins of a hemicrico-hemilaryngectomy.

Main Outcome Measures  The times to decannulation and retake of full oral feeding, the quality of speech, and the incidence and site of recurrent cancer were assessed.

Results  Of the 26 patients undergoing tracheal autotransplantation, 24 were decannulated and all regained the ability to maintain nutrition by mouth. Ultimate voice quality was "subnormal" to "moderately hoarse" in all patients. Five recurrences developed of which 2 were treated with total laryngectomy.

Conclusions  Functional reconstruction of extensive laryngeal defects can be achieved with an autotransplantation of cervical trachea, with favorable functional results and acceptable morbidity. This technique expands the limits of conservation surgery for selected laryngeal and hypopharyngeal tumors.