Understanding Supracricoid Partial Laryngectomy for Laryngeal Cancer

Introduction and Terminology

Supracricoid Partial Laryngectomy (SCPL) is a specialized surgical procedure often used in treating laryngeal cancer, specifically for tumors that are localized to the larynx. The larynx, commonly known as the voice box, is a vital part of our respiratory system, located in our throat. Cancer affecting this area can be life-threatening and may also impact speech and swallowing functions.

The term ‘Supracricoid’ refers to the part of the larynx located above the cricoid cartilage, and ‘Partial Laryngectomy’ means partial removal of the larynx. In an SCPL, the surgeon removes the cancerous part of the larynx, preserving the cricoid cartilage and at least one of the vocal cords. This can help maintain speech and swallowing abilities post-surgery. According to the American Society of Clinical Oncology, about 13,150 new cases of laryngeal cancer were diagnosed in the United States in 2021, and SCPL is one of the preferred treatments for early-stage tumors.

Indications for Supracricoid Partial Laryngectomy

Supracricoid Partial Laryngectomy is typically recommended in specific scenarios, primarily concerning early to moderately advanced laryngeal cancer. The following indications often suggest that SCPL may be an appropriate treatment:

• Early to Mid-Stage Laryngeal Cancer: SCPL is usually considered for patients with T1, T2, or selected T3 tumors, according to the TNM staging system, which considers tumor size, lymph node involvement, and distant metastasis.
• Localized Tumors: If the cancer is primarily located in the supraglottis or glottis regions of the larynx, SCPL can be a beneficial option. It’s also preferred when the tumor is present above the cricoid cartilage.
• No Cartilage Invasion: If the cancer has not spread to the cartilage structure of the larynx, SCPL can be highly effective.
• Preservation of Laryngeal Function: For patients where maintaining the ability to speak naturally and swallow is a priority, SCPL is often recommended.

It’s essential to understand that these indications are general and the final decision is always individualized based on a comprehensive assessment of your overall health, tumor characteristics, and personal preferences. Always consult with your healthcare provider to ensure the best treatment plan for your unique circumstances.

Pre-Op Preparation

Once you and your healthcare provider decide on an SCPL, there are specific steps you’ll need to take before surgery. Here are some general guidelines:

• Fasting: You’ll likely need to fast (not eat or drink) for a certain period before the surgery.
• Medication Adjustments: Some medications might need to be adjusted or stopped before surgery. This includes over-the-counter drugs, prescription medications, and dietary supplements.
• Pre-Op Labs and Imaging: Specific lab tests or imaging studies may be required to ensure you’re healthy enough for the procedure and to provide your surgeon with crucial information about the tumor.
• Pre-clearance Authorization: Your insurance company may require pre-clearance authorization for the surgery.
• Logistical Considerations: Plan for transportation to and from the hospital and arrange for time off from work or school.

Remember, these are just general guidelines. Your doctor will provide you with specific instructions based on your particular circumstances. It’s essential to follow your doctor’s advice, and don’t hesitate to ask any questions you might have. For convenience, consider scheduling your pre-operative clearance, labs, and imaging through our primary care telemedicine practice.

Procedure Technique for Supracricoid Partial Laryngectomy

It’s important to know that the Supracricoid Partial Laryngectomy (SCPL) is a complex procedure. However, here we’ll break down the key steps to help you understand what happens during the surgery.

1. Anesthesia and Positioning

Firstly, you’ll be placed under general anesthesia, meaning you’ll be unconscious and won’t feel any pain during the surgery. Once the anesthesia takes effect, you’ll be positioned carefully on the operating table to provide the surgeon with optimal access to your neck area.

2. Surgical Incision

The surgeon will make a horizontal incision across your neck, generally in a skin crease to minimize visible scarring. This approach provides the surgeon with the best access to your larynx while protecting the surrounding structures.

3. Exposing the Larynx

After the incision, the surgeon will gently move the muscles and tissues aside to expose the larynx. This is done carefully to prevent any damage to the important nerves and vessels in your neck.

4. Removal of the Laryngeal Structures

The surgeon will then remove the necessary parts of your larynx based on the location and extent of the cancer. This might include the supraglottis, the upper part of the larynx, and part or all of the vocal cords. The thyroid cartilage, which is the “Adam’s apple,” may also be removed. However, the cricoid cartilage and at least one vocal cord are preserved to maintain swallowing and speech functions after the procedure.

5. Checking for Complete Tumor Removal

After removing the diseased portion of the larynx, the surgeon will carefully inspect the area to ensure that all visible signs of the tumor have been removed. This is a crucial step to reduce the risk of cancer recurrence.

6. Reconstruction

Once the cancerous tissue is removed, the surgeon will start the reconstruction process. They will connect the remaining part of the larynx to the trachea, establishing a pathway for air to enter and exit the lungs. Then, the swallowing passage will be reconstructed by suturing the tongue base to the remaining larynx and esophagus.

7. Tracheostomy

A temporary tracheostomy (a hole in the front of your neck and into your trachea) will be created to allow you to breathe while your surgical wound heals. This is usually closed a few weeks after the surgery, once it’s confirmed that the reconstructed larynx is functioning properly.

8. Closure

Finally, the surgeon will carefully close the incision using sutures. A drain may be placed to remove any fluids that may accumulate at the surgical site.

This is a simplified overview of what happens during an SCPL. It’s important to note that each procedure is tailored to the individual patient’s needs, and specific details may vary. Don’t hesitate to discuss any concerns or questions you might have with your healthcare provider.

Duration of Supracricoid Partial Laryngectomy

The duration of a Supracricoid Partial Laryngectomy procedure can vary, but on average it takes approximately 3 to 4 hours. This duration could extend depending on the patient’s individual circumstances.

Post-Op Recovery from Supracricoid Partial Laryngectomy

Recovery after a Supracricoid Partial Laryngectomy is a process. You’ll likely stay in the hospital for about a week following the procedure. During this period, the medical team will monitor your recovery and manage any immediate post-operative symptoms.

Once you’re discharged, your surgeon will schedule follow-up appointments to track your progress, typically within two weeks and then regularly thereafter. In the beginning, you may require physical therapy to regain swallowing and voice functions. Additionally, you’ll need to adapt to lifestyle changes such as dietary modifications and possibly temporary voice changes.

The time off work varies among patients and depends on your specific job demands. On average, patients may need four to six weeks off work. It can take several weeks to a few months before you feel fully recovered, but this varies greatly among individuals.

Our practice is here to assist with any needed paperwork for work or school. We’re available for same-day appointments until 9pm on weekdays and 5pm on weekends.

Effectiveness of Supracricoid Partial Laryngectomy

The Supracricoid Partial Laryngectomy is an effective procedure in treating laryngeal cancer, especially when the cancer is localized and has not spread extensively. Studies show that this procedure has good long-term survival rates, often comparable to total laryngectomy but with the added benefit of preserving voice and swallowing function.

The effectiveness of SCPL can be influenced by several factors. Patient characteristics, such as overall health and the ability to tolerate surgery, play a crucial role. Moreover, the extent, stage, and location of the tumor also significantly impact the procedure’s effectiveness.

Early detection of laryngeal cancer significantly improves the effectiveness of SCPL. In cases where the cancer is detected early and is limited to one part of the larynx, SCPL can remove the tumor while preserving much of the larynx’s function. In contrast, if the cancer has spread widely or invaded deeper tissues, total laryngectomy might be needed, which involves removing the entire larynx.

It’s essential to understand that while SCPL is an effective treatment option for many patients, it’s not the best choice for everyone. Each patient’s situation is unique, and the decision for treatment should be made in consultation with a team of experts, considering all the available treatment options, the potential benefits and risks, and the patient’s preferences.

Adverse Events with Supracricoid Partial Laryngectomy

Like all surgical procedures, Supracricoid Partial Laryngectomy (SCPL) carries certain risks. Understanding potential complications can help you in making an informed decision about your treatment.

• Aspiration pneumonia (5-15%): This occurs when food, saliva, liquids, or vomit is inhaled into the lungs, leading to infection. It happens due to temporary dysfunction in swallowing mechanism after SCPL.
• Temporary tracheostomy (30-40%): Sometimes, a temporary tracheostomy (a hole made in your neck to aid breathing) may be required after the procedure. It is usually removed once swallowing function is sufficiently recovered.
• Voice changes: While every effort is made to preserve vocal function, changes in the voice can occur. However, most patients recover satisfactory voice function after a period of voice therapy.
• Pharyngocutaneous fistula (5-10%): This is an abnormal passageway between the pharynx and skin that may occur after surgery. This can delay recovery and may require additional treatment.

The mortality rate from the procedure is low, usually less than 2%.

Alternatives to Supracricoid Partial Laryngectomy

SCPL is one of several treatment options for laryngeal cancer. Alternatives include radiation therapy, chemotherapy, other types of surgery like total laryngectomy or transoral laser microsurgery, or a combination of these. The choice of treatment depends on the stage and location of the cancer, as well as the patient’s overall health and personal preferences. Some patients may also benefit from lifestyle modifications like quitting smoking and limiting alcohol consumption, which can lower the risk of recurrence.

Experimental or Emerging Technologies

In the realm of laryngeal cancer treatment, several emerging technologies are being investigated. These include targeted therapies, which work by targeting specific characteristics of cancer cells, and immunotherapy, which uses the body’s immune system to fight the cancer. Robotic surgery is also being explored as a less invasive option for laryngeal cancer surgery. However, these treatments are still under investigation and are not yet standard treatments.

Conclusion

Supracricoid Partial Laryngectomy is an effective procedure in treating laryngeal cancer. However, like all surgeries, it carries some risks. It’s crucial to discuss these potential complications, along with other treatment options, with your healthcare provider to make an informed decision. Emerging technologies also present new potential treatments, but they are still under research. Being well-informed about your treatment options allows for active participation in your healthcare decisions.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.