Abstract
Background
Tracheal autotransplantation is a reconstructive technique that allows for organ-sparing treatment of selected patients with advanced cricoid cartilage chondrosarcoma and T2 or T3 laryngeal squamous cell carcinoma (SCC) (unilateral T2 with impaired vocal fold mobility; T3 with subglottic extension and/or arytenoid cartilage fixation). This study evaluated the functional and oncologic outcomes of an optimized autotransplant technique that the authors have been using since 2003.
Methods
The study retrospectively reviewed the charts of all patients who underwent tracheal autotransplantation at the authors’ center between 2003 and 2015.
Results
The cohort included 30 patients: 7 with cricoid chondrosarcoma and 23 with laryngeal SCC. The median age of the patients was 60.5 years. The median follow-up period was 78 months. The 3- and 5-year overall survival rates were respectively 92 and 80 %, and the cause-specific survival rates were respectively 100 and 96 %. Only one patient experienced tumor recurrence. The temporary tracheostomy was closed in 22 patients (73 %). The laryngeal preservation rate was 90 %, with 25 patients (83 %) obtaining a functional voice and 25 patients (83 %) resuming normal oral feeding. The univariate analysis showed advanced age (>65 years) as a negative prognostic factor for functional outcome but exhibited no statistical influence of gender, tumor type or stage, or previous radiotherapy. Strikingly, all chondrosarcoma patients experienced optimal functional outcomes.
Conclusion
For this particular group of patients, the authors’ tracheal autotransplantation technique provides excellent functional results for respiration, speech, and swallowing without compromising the oncologic outcome. This is particularly true for patients younger than 65 years and for those with cricoid chondrosarcoma.
Similar content being viewed by others
References
Lagha A, Chraiet N, Labidi S, Rifi H, Ayadi M, Krimi S, et al. Larynx preservation: what is the best nonsurgical strategy? Crit Rev Oncol Hematol. 2013;88:447–58.
Ramakrishnan Y, Drinnan M, Kwong FNK, Grant DG, Mehanna H, Jones T, Paleri V. Oncologic outcomes of transoral laser microsurgery for radiorecurrent laryngeal carcinoma: a systematic review and meta-analysis of English-language literature. Head Neck. 2014;36:280–5.
Delaere PR, Hermans R. Tracheal autotransplantation as a new and reliable technique for the functional treatment of advanced laryngeal cancer. Laryngoscope. 2003;113:1244–51.
Delaere P, Vander Poorten V, Vranckx J, Hierner R. Laryngeal repair after resection of advanced cancer: an optimal reconstructive protocol. Eur Arch Otorhinolaryngol. 2005;262:910–6.
Delaere P, Goeleven A, Vander Poorten V, Hermans R, Hierner R, Vranckx J. Organ preservation surgery for advanced unilateral glottic and subglottic cancer. Laryngoscope. 2007;117:1764–9.
Delaere PR, Vranckx JJ, Dooms C, Meulemans J, Hermans R. Tracheal autotransplantation: guidelines for optimal functional outcome. Laryngoscope. 2011;121:1708–14.
Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.
Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31:845–52.
Hartl DM. Evidence-based practice: management of glottic cancer. Otolaryngol Clin North Am. 2012;45:1143–61.
Hartl DM, Brasnu DF, Shah JP, Hinni ML, Takes RP, Olsen KD, et al. Is open surgery for head and neck cancers truly declining? Eur Arch Otorhinolaryngol. 2013;270:2793–802.
Schultz P. Vocal fold cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:301–8.
Canis M, Ihler F, Martin A, Wolff H, Matthias C, Steiner W. Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery. Head Neck. 2014;36:652–9.
Baatenburg RJ, Jong D, Lent S Van, Hogendoorn PCW. Chondroma and chondrosarcoma of the larynx. Curr Opin Otolaryngol Head Neck Surg. 2004;12:98–105.
Sauter A, Bersch C, Lambert KL, Hörmann K, Naim R. Chondrosarcoma of the larynx and review of the literature. Anticancer Res. 2007;27:2925–30.
Rinaldo A, Howard DJ, Ferlito A, et al. Laryngeal chondrosarcoma: a 24-year experience at The Royal National Throat, Nose, and Ear Hospital. Acta Otolaryngol. 2000;120:680–8.
Maclean J, Cotton S, Perry A. Postlaryngectomy: it’s hard to swallow: an Australian study of prevalence and self-reports of swallowing function after a total laryngectomy. Dysphagia. 2009;24:172–9.
Sweeny L, Golden JB, White HN, Magnuson JS, Carroll WR, Rosenthal EL. Incidence and outcomes of stricture formation postlaryngectomy. Otolaryngol Head Neck Surg. 2012;146:395–402.
Maclean J, Szczesniak M, Cotton S, Cook I, Perry A. Impact of a laryngectomy and surgical closure technique on swallow biomechanics and dysphagia severity. Otolaryngol Head Neck Surg. 2011;144:21–8.
Ward EC, Bishop B, Frisby J, Stevens M. Swallowing outcomes following laryngectomy and pharyngolaryngectomy. Arch Otolaryngol Head Neck Surg. 2002;128:181–6.
Moon S, Raffa F, Ojo R, Landera Ma, Weed DT, Sargi Z, et al. Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study. Laryngoscope. 2014;124:2508–12.
Leong SC, Upile N, Lau A, Lancaster J, Praveen P, Rogers SN, et al. Extended vertical hemilaryngectomy and reconstruction with a neovascularised tracheal autograft for advanced unilateral laryngeal tumours: a learning curve. Eur Arch Otorhinolaryngol. 2014;271:1729–3522.
Delaere P, Vranckx J, Verleden G, De Leyn P, van Raemdonck D. Tracheal allotransplantation after withdrawal of immunosuppressive therapy. N Engl J Med. 2010;362:138–45.
Delaere PR, Vranckx JJ, Meulemans J, Vander Poorten V, Segers K, Van Raemdonck D, et al. Learning curve in tracheal allotransplantation. Am J Transplant. 2012;12:2538–45.
Conflict of interest
There are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Loos, E., Meulemans, J., Vranckx, J. et al. Tracheal Autotransplantation for Functional Reconstruction of Extended Hemilaryngectomy Defects: A Single-Center Experience in 30 Patients. Ann Surg Oncol 23, 1674–1683 (2016). https://doi.org/10.1245/s10434-015-5033-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-015-5033-y