The Comparison of Functional Outcomes between Supraglottic Horizontal Laryngectomy and Supracricoid Partial Laryngectomy

Objectives The aim of this study was to compare the functional outcomes (including swallowing, respiration and phonation) of supraglottic horizontal laryngectomy (SGHL) and supracricoid partial laryngectomy (SCPL). Methods The clinical and pathological data were evaluated for 36 previously untreated patients who were diagnosed with laryngeal carcinoma and underwent SGHL or SCPL at the Department of Otorhinolaryngology-Istanbul Training and Research Hospital from 2010 to 2016. Removal of the nasogastric tube, decannulation and hospitalisation times were recorded in both groups and postoperative complications were noted. Results The SGHL group contained 15 patients and the SCPL group contained 21 patients (14 cases of cricohyoidoepiglottopexy (CHEP) and 7 cases of cricohyoidopexy (CHP)). The mean age of the subjects was 57.4 years in the SGHL group, and 59.7 in the SCPL group. Patients in the SGHL group were decannulated after 65.2 days, whereas the average decannulation time was 72.6 days in the SCPL group. This difference in decannulation time between the groups was not statistically significant (p>0.05). The mean hospitalisation time was 23 days, with no statistically significant difference between the groups (>0.05). The nasogastric tube was removed from the patients after 37.9 days in the SGHL group and after 35.8 days in the SCPL group. No statistically significant difference was determined in the time to start feeding between the groups (p>0.05). Surgical wound infection, the occurrence of pharyngo-cutaneous fistulas and rupture of the pexy sutures were complications. Conclusion Functional outcomes of SCPL were similar to those of patients who underwent SGHL. The preservation of the hyoid bone is the most important consideration for preserving the swallowing function. DOI : 10.14302/issn.2379-8572.joa-16-1364 Corresponding author: Suat Bilici, Istanbul Training and Research Hospital, Otorhinolaryngology Department/Istanbul/Turkey 34500, suatbilici@yahoo.com, Phone: 090532 2334600090212 6691893, Fax: 090212 6320060


Introduction
Providing patients with an ideal quality of life is a desired outcome after laryngeal cancer surgery. Therefore, organ preservation is an important surgical consideration, in addition to elimination of the disease [1].
Supraglottic horizontal laryngectomy (SGHL) is a technique which removes en-bloc the upper 1/3 part of thyroid cartilage, epiglottis, false cords, aryepiglottic folds, a large portion of the ventricle and the preepiglottic field. Reconstruction is done by hanging the hyoid and tongue root of the remaining thyroid cartilage with sutures [2] .
Supracricoid partial laryngectomy (SCPL) is a technique consisting of an en-bloc resection of the thyroid cartilage, along with the paraglottic and preepiglottic space starting at the cricoid cartilage and continuing to base of the epiglottis [3][4][5][6] . SCPL has two subtypes in terms of reconstruction type: cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP) [6] . are considered to be true organ preservation techniques, and they allow the physiological rehabilitation of speech, swallowing and respiration [6] .
The decannulation, which occurs on different days depending on arytenoid oedema, is especially important for beginning nutrition. Decannulation and swallowing problems in SCPL and SGHL patients are the main causes of prolonged hospitalisation and increased treatment costs [1] . The literature describes different parameters of the functional consequences of single partial laryngectomy techniques, but no accepted guidelines are available to evaluate these consequences.
The aim of this study was to compare the postoperative functional outcomes, such as swallowing, respiration and phonation, in patients who underwent SGHL or SCPL and to share our experiences.

Materials and methods
The clinical and pathological data were evaluated   [7] . The  Protection of the hyoid bone varies depending on tumour prevalence and infiltration [7] . We preserved the hyoid bone in all patients, since none of the tumours involved the bone. In addition, we preserved the intactness of the hypoglossal nerve and the superior and inferior laryngeal nerves to allow functional swallowing after surgery. The swallowing function was evaluated by the nasogastric tube removal time and no significant difference was observed in the time to start feeding between the groups.

Statistical analysis
Alicandri-Ciufelli et al have reported that the type of partial laryngectomy does not seem to affect the deglutition results, whereas radiotherapy significantly and negatively affected the dysphagia score [8] . To our knowledge, the present study is the second in the literature to evaluate postoperative functions between SGHL and SCPL. We found no significant difference in swallowing outcomes between the SGHL and SCPL groups. Laccourreye et al demonstrated that the dosage of RT negatively affected the swallowing function [9] .
However, we excluded patients who were to undergo RT; therefore, we did not evaluate whether RT had an effect on the swallowing function.  start of oral feeding [1] . Ozturk et al. showed that resection of an arytenoid had a negative outcome on swallowing [10] . We believed that the arytenoids have a secondary importance in swallowing. However, our data suggest that the number of arytenoids has a greater effect on the decannulation time.   The respiration function was interpreted based on the decannulation time. Different authors, including Ulusan et al. (11) and Bron et al., [12] have reported a mean decannulation time of 17 days for patients who undergo SGHL. This time for patients in the present study was consistent with the literature. According to the literature, the mean decannulation time for patients who undergo SCPL ranges between 9 and 30 days [11] . Kılıç et al reported that this time was 7 to 12 days for patients with SCPL [1] . The decannulation time in the present study was longer than that reported in the literature.
The number of patients with one arytenoid was greater than the number of SCPL patients with two arytenoids in our series, so the decannulation time may have been longer than that of previous reports due to the remaining mucosal membrane after one arytenoid is removed.
Hospitalisation time was shorter than the NGT

Conclusions
Although SCPL is a more extensive surgery, functional outcomes were similar to those of patients who underwent SGHL. In both operations, the preservation of the hyoid bone is of prime importance for preservation of the swallowing function.