• 대한두경부종양학회지
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• 제10권2호
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• pp.152-156
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• 1994

최근 10년간 후두전적출술을 시행하였던 159례 중 기공주변 재발이 발생하였던 12례에 대하여 후향적으로 분석함으로써 다음과 같은 결과를 얻었다. 1) 기공주변의 재발은 1차 치료종결후 평균 8.23개월에 발견되었으며, 발생빈도는 7.55%이었다. 2) 추정 원인은 광범위한 원발병소로 인한 부적절한 절재연, 기관절개술후 근치수술의 지연, 불완전한 림프전이절의 처리 순이었다. 3) 7례는 항암화학요법(국소 또는 전신적)과 고식적 방사선요법을 시행하였으며, 5례는 구제수술을 시행한 후 고식적 방사선요법 및 항암화학요법을 시행하였으나 구제수술을 받은 제 1형 1례를 제외하고는 모두 사망하였으며, 평균 생존기간은 $7.32{\pm}5.61$개월 이었다. 이상의 성적에서 기공주변의 재발 가능성이 높은 고위험군에 대하여는 광범위한 절제 후 적극적인 추적관찰과 더불어 과감한 구제수술로 생존기간을 연장할 수 있을 것으로 생각되었다.

• 대한기관식도과학회지
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• 제6권1호
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• pp.80-86
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• 2000

Background : Stomal recurrence that occasionally follows total laryngectomy is associated with very poor prognosis regardless of treatment modality, so it is very important to identify high risk patients to prevent stomal recurrence. Objectives : We attempted to select an optimal management method to prevent stomal recurrence by analyzing risk factors in each patient who was found to have stomal recurrence following total laryngectomy. Materials and Methods : Risk factors in each of eleven patients who had stomal recurrence out of 159 patients who underwent total laryngectomy in the last ten years were analyzed retrospectively. Data were gathered on risk factors such as the presence of subglottic extension, extralaryngeal extension, thyroid gland invasion, lymph node metastasis, timing of tracheotomy, tumor stage, postoperative radiotherapy, and inclusion of the stoma in the radiotherapy field. Results : There were eight cases of subglottic extension, six cases of extralaryngeal invasion, one case of pharyngocutaneous fistula that occurred as a postoperative complication, and one case who was taken completion laryngectomy following conservation surgery. With the exception of one case who was taken tracheotomy prior to total laryngectomy, all tracheotomies were performed intra-operatively after endotracheal intubation. There was no evidence of paratracheal lymph node or prelaryngeal lymph node metastasis on preoperative neck CT scan. There were six cases of T4 tumors, four cases of T3 tumors, and one case of T2 tumor. Salvage surgery was performed following radiotherapy in three cases, and aside from one case who was not taken post-operative radiotherapy, postoperative radiotherapy including the stoma was performed in the remaining seven cases within one month after surgery. Conclusion : Total laryngectomy with wide paratracheal lymph node dissection, thyroidectomy, and tracheotomy should be performed for patients who have high risk factors such as subglottic extension and advanced stage. We believe that tracheotomy should be precede endotracheal intubation. Efforts should be made to prevent stomal recurrence by utilizing postoperative radiotherapy and by minimizing postoperative complications such as infection and fistula.

• 대한기관식도과학회지
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• 제15권2호
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• pp.42-48
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• 2009

Background and Objectives : Obstructive laryngeal cancers have to be managed with tracheostomy, which has been reported with increased local or stomal recurrence. Stomal recurrence after treatment of laryngeal cancer is one of the most serious issues in the management of laryngeal cancer. Prognosis of locally advanced laryngeal cancer in patients with previous tracheostomy is evaluated. Materials and Methods : Between 1996 and 2007, 174 patients with previously untreated advanced laryngeal cancer(stage III, IV) were enrolled. Overall survival(OS) and disease specific survival(DSS) according to the presence of previous tracheostomy were compared. OS and DSS of the groups with different duration from tracheostomy to treatment were compared. Results : Among 174 patients with advanced laryngeal cancer, previous tracheostomy was performed in 24 patients. Of 24 patients, there were stomal recurrences in 5 patients. DSS of previous tracheostomy group and that of the other group were statistically different(p=0.001). There was statistical significant difference between OS of groups which start treatment more than 14 days after tracheostomy and within 14 days(p=0.03). Conclusions : If possible, Previous tracheostomy should be avoided and if it is inevitable, the elective treatment should be recommended at least within 2 weeks.

• 대한두경부종양학회지
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• 제27권1호
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• pp.92-95
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• 2011

The anterior mediastinal tracheotomy(AMT) facilitates resection of stomal recurrence after total laryngectomy and tumors involving the cervicothoracic trachea and esophagus. An 81-year-old-man came to our clinic due to the progressive dyspnea during three months. He received the total laryngectomy five years ago. We diagnosed as Sisson type I stomal recurrence and then performed the wide excision, both selective neck dissection, sternal manubrium resection and AMT. Before surgery, we planned the pectoralis major myocutaneous flap. Unluckily we could not fulfill this procedure because of patient's medical status during anesthesia. The tracheocutaneous fistula was observed in the second postoperative day. He expired due to the huge bleeding from the wound. When AMT is performed, exact manipulation of major vessels and adequate flap are mandatory these elevate the feasibility of AMT.

• 대한두경부종양학회지
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• 제3권1호
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• pp.55-63
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• 1987

A retrospective investigation of 52 cases of carcinoma of the larynx, who underwent total laryngectomy $\bar{c}\;or\;\bar{s}$ neck dissection at Pusan National University Hospital from 1978 to 1985, was performed. The results obtained were as follows: 1) There were 32 glottic(62.7%), 18 supraglottic(35.3%) and 1 subglottic(2.0%) carcinoma. 2) In stage grouping, stage ill was the most(64.7%) and then stage II, stage IV, stage I in order. 3) Overall rate of cervical metastasis was 29.4%. In glottic carcinoma, 0% of $T_1,\;40%\;of\;T_2,\;18%\;of\;T_3\;and\;25%\;of\;T_4$. In supraglottic carcinoma, there was 0% of $T_1,\;29%\;of\;T_2,\;56%\;of\;T_3\;and\;50%\;of\;T_4$. 4) The incidence of postoperative complication was 31.4% and stomal stenosis was the most(13.7%) 5) There were 8 cases of local recurrence and 3 cases of distant metastasis(2 cases in lung, 1 case in esophagus) among 40 cases which were able to follow up. 6) 3 year estimated survival rate for glottic and supraglottic carcinoma were 73.3 % and 85.7% respectively.