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Otorhinolaryngology 2021 June;71(2):51-6

DOI: 10.23736/S2724-6302.21.02337-7


language: English

Pignat’s anterior vertical partial laryngectomy in the elderly and frail patients

Mauro MAGNANO 1, Giulia ELIA 1 , Giacomo MACHETTA 1, Francesca REVELLO 1, Isabella POLLICINA 2, Marco ANDREIS 1

1 Unit of Otorhinolaryngology, Department of Surgical Sciences, Ospedali Riuniti of Pinerolo and Rivoli, ASL TO3, Pinerolo, Turin, Italy; 2 Unit of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy

BACKGROUND: Frailty, defined as a clinical state in which there is an increase in an individual’s vulnerability, is present in 10% of persons aged 65 years or more to between 25% and 50% for those aged 85 years and over. It is estimated that frailty has a prevalence of 42% in patients with malignancy. Laryngeal cancer is particularly challenging to treat; it has a great risk of damaging at least one of the distinctive functions of the organ between protective, respiratory and phonatory, depending on the involved subsite, the tumor size, the therapy and the pre-existence of a disfunction. Partial laryngectomy can preserve larynx functions, though postoperative period is difficult for recovery of both speech and swallowing functions. Reconstructive Anterior Frontal Laryngectomy (RAFL), maintaining physiological height of the laryngo-pharyngeal axe, could be an alternative partial laryngectomy for selected elderly patients.
METHODS: Twenty-four patients were treated by the same equipe with RAFL between January 2018 and March 2020, with a follow-up period greater than 7 months. Patients underwent a dynamic examination of swallowing using F.E.E.S. and they completed three questionnaires about dysphagia and quality of life: the M.D. Anderson Dysphagia Inventory (MDADI), The EORTC (H&N) 35 and the EORTC-C30.
RESULTS: Overall survival was 93.33%, while disease free survival was 94.11%. Functional evaluation with F.E.E.S. reported only minimal dysphagia, while laryngeal sensitivity was preserved in all patients. MDADI reported good functional ed emotional status, and EORTC-C30 and EORTC-H&N-35 showed high global health status and functional scales with low symptoms.
CONCLUSIONS: The global health status of the patient with laryngeal cancer plays a fundamental role in choosing the most suitable treatment, especially when dealing with an elderly patient. Pignat’s partial laryngectomy allows to obtain good functional outcomes even in elderly patients when the surgical indications are respected by referring not only to tumor staging but also to the functional and cognitive status of patient.

KEY WORDS: Laryngectomy; Aged; Frailty

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