Pignat’s vertical partial laryngectomy with crico-hyoido-epiglotto-plasty

• Published in: European archives of oto-rhino-laryngology 2022-02, Vol.279 (2), p.979-986
• Main Authors: Pecorari, Giancarlo, Perottino, Flavio, Riva, Giuseppe, Nora, Valsecchi, Poupart, Marc, Zrounba, Philippe
• Format: Article
• Language: English
• Subjects: Carcinoma, Squamous Cell - surgery; Cricoid Cartilage - surgery; Epiglottis - surgery; Head and Neck; Head and Neck Neoplasms; Head and Neck Surgery; Humans; Laryngeal Neoplasms - surgery; Laryngectomy; Medicine; Medicine & Public Health; Neurosurgery; Otorhinolaryngology; Retrospective Studies; Survival Rate; Treatment Outcome
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-021-06858-7

Purpose Pignat’s partial laryngectomy with crico-hyoido-epiglotto-plasty (CHEPL) is a vertical laryngectomy with resection of the anterior portion of the thyroid cartilage and reconstruction with a wires net and the subhyoid muscles. The aim of this retrospective study was to evaluate and analyze oncologic and functional outcomes in patients affected by laryngeal squamous cell carcinoma and treated with Pignat’s partial laryngectomy. Methods Seventy patients with cT1–cT3 glottic cancer were surgically treated with Pignat’s technique. Exclusion criteria: invasion of posterior cricoid arch, more than 3 mm under glottis, of more than one arytenoid, of posterior portion of thyroid cartilage, of the suprahyoid epiglottis. Overall survival, disease free survival, rates of decannulation and enteral feeding were analyzed. Results 23 (32.9%) pT1, 37 (52.9%) pT2, 5 (7.1%) pT3, 5 (7.1%) pT4a, 64 (91.5%) pN0, 5 (7.1%) pN1, 1 (1.4%) pN2. Adjuvant treatment was administered to 13 patients (18.6%). All patients had tracheotomy. Five year OS and DFS were 81.66 and 77.95%, respectively. A statistically significant DFS difference was observed between early and late stages. Five year local control was 81.16%. Five year larynx preservation rate was 89.16%. Median decannulation time was 12 days. Median duration of enteral nutrition was 16 days. All patients achieved efficient phonation. Conclusion Pignat’s partial laryngectomy with CHEPL can represent an alternative to horizontal supracricoid laryngectomy to achieve laryngeal preservation. Good oncologic and functional outcomes are possible as long as indications are followed.