梨状窝癌的治疗和生存分析

目的探讨梨状窝癌治疗的疗效和影响预后因素。方法对浙江省肿瘤医院1995年12月至2002年12月收治的62例梨状窝癌手术治疗病例进行回顾性分析。其中T1期13例，1、2期17例，T3期12例，T4期20例。4例行术前放疗，40例行术后放疗，18例行单纯手术治疗。原发灶术式包括：13例梨状窝切除术；20例下咽部分切除及喉部分切除术；21例下咽部分切除及喉全切除术；8例下咽全切除、喉全切除及食管拔脱加胃代食管术。结果采用Kaplan—Meier法行生存分析，生存曲线显示总的3年、5年生存率分别为42．3％和27．8％，保留喉功能组和未保留喉功能组的3年生存率分别为51．9％和29．9％，5年生存率分别为39．5％和11．2％，两组差异有统计学意义（x^2=4．14，P〈0．05）。Cox回归模型分析显示T分期、是否行手术联合放疗的综合治疗是影响患者预后的独立因素。结论早期诊断、早期治疗以及综合治疗可提高梨状窝癌的生存率；早期患者及部分适宜的进展期患者行保留喉功能手术可提高患者牛活质量并取得较为满意的治疗效果。     

The submandibular triangle in squamous cell carcinoma of the larynx and hypopharynx

A 15-year retrospective analysis was carried out at the University of Illinois College of Medicine, Chicago, reviewing the tumor staging and pathology data of 239 patients treated for carcinoma of the larynx and hypopharynx requiring laryngectomy alone, laryngectomy with neck dissection, or laryngopharyngectomy and neck dissection. Surgery was the primary treatment modality in 205 of the 239 cases, with the remaining 34 having surgery to treat radiation therapy failure. Primary tumors were located within the supraglottic region, the glottic region and, less commonly, the pyriform sinus. Ninety-five of the 239 patients either presented with or developed nodal metastases following initial treatment. Of these, only two had tumors within the lymph nodes of the submandibular triangle. This data corroborates impressions that tumors of the larynx and hypopharynx rarely metastasize to the submandibular triangle and that sparing this area during neck dissection for lesions of the larynx would seem justified.     

Voice preservation in treatment of carcinoma of the pyriform sinus.

A retrospective analysis of 175 patients having a histopathologic diagnosis of epidermoid carcinoma of the pyriform sinus presenting between January 1, 1964 and December 31, 1973 was undertaken to establish the effectiveness of conservation surgery in preserving voice. Patients were treated by three separate methods: 1. preoperative radiation therapy, partial laryngopharyngectomy and radical neck dissection (PLP and RND) (N = 85); 2. preoperative radiation therapy, total laryngopharyngectomy and radical neck dissection (TLP and RND), (N = 57); and 3. palliation, which consisted of palliative radiation therapy alone or combinations of radiation therapy and chemotherapy or palliative surgery (N = 33). Of the 85 patients treated with the expectation of cancer cure and voice preservation (PLP and RND), 44 or 52% actually had their voice preserved. Of course, in none of the patients treated by TLP and RND was voice preserved, but 2 of the 33 patients treated palliatively retained ability to speak. Overall, 46 of 175 patients (26%) with carcinoma of the pyriform sinus were afforded voice preservation. The ability to preserve voice is correlated with stage and an analysis of operative complications is presented.     

喉外侵犯对声门上型喉癌部分喉切除术的影响

本文回顾分析了中国医学科学院肿瘤医院1979年至1990年168例声门上型喉癌行部分喉切除术患者的临床资料,研究了喉外侵犯对声门上型喉癌水平部分喉切除术的影响,发现舌根受侵切除部分舌根使水平部分喉切除术的拔管率由92.10％降为58.82％,梨状窝受侵者切除部分梨状窝使3/4部分喉切除术的拔管率由67.39％降为33.33％(P<0.05)。梨状窝内壁受侵组的生存率低于舌根受侵组(P<0.01)。因此,将声门上型喉癌梨状窝内壁受侵定为T_4病变更合适。结论:声门上型喉癌侵及舌根及梨状窝内壁时部分喉切除术后的拔管率降低,梨状窝内壁受侵时生存率也明显降低。     

全喉切除术后早期经口进食的临床观察

目的 :对喉癌、梨状窝癌行全喉切除术后早期经口进食进行可行性研究。方法 :42例行全喉切除术的患者 (其中喉癌 34例 ,梨状窝癌 8例 )随机分为两组 :观察组 2 1例 ,术后 48～ 72h经口进食 ;对照组 2 1例 ,按常规 10～ 12d经口进食。结果 :观察组咽瘘发生率为 4.8%(1/ 2 1) ,对照组为 9.5 %(2 / 2 1) ,两者差异无显著性意义(P >0 .0 5 ) ;观察组术后平均住院天数较对照组明显缩短。结论 :术前未行放疗的喉癌、梨状窝癌患者行全喉切除术后 48～ 72h经口进食是安全可行的。     

Squamous cell carcinoma of the pyriform sinus: A nonrandomized comparison of therapeutic modalities and long-term results

From January 1964 through December 1991, 408 patients with squamous cell carcinomas involving the pyriform sinus were treated at Washington University Medical Center. Their ages ranged from 29 to 83 years (mean, 62.3; median 59) and the male to female ratio was 5:1. The mean duration of symptoms prior to diagnosis was 3.9 months (range 1 to 32 months) and 89% had a smoking or ethanol history. Sixty-seven percent had T3 or T4 lesions and 87% were stage III or IV at presentation. Sixty-nine percent had neck metastases. The treatment strategy varied with respect to radiation and reconstruction. Prior to 1978, preoperative radiation (3.5 to 5000 cGy) was used. Postoperative radiation was given thereafter (600+ Gy). Since 1982, flap reconstruction (usually pectoralis major myocutaneous) has been used to close the partial laryngopharyngectomy (PLP) defect. Almost all N0 necks were treated by radiation or surgery and all N1-N3 lesions were treated by combined therapy. Pyriform tumors were subdivided into three groups: 1. one-wall lesions (n = 48), 2. medial-wall lesions which involved the aryepiglottic fold or supraglottis (N = 267), and 3. two- or three-wall lesions which extended to the pyriform apex or post-cricoid region (N = 93). Ninety-five patients had single-modality therapy and 302 had combined treatment. Two hundred seven patients had conservation surgery (PLP) and 157 had total laryngopharyngectomy alone or in combination with radiation. Thirty-three patients were treated by radiation alone. Eleven patients were excluded from the study because of distant metastases (TxNxM1) at presentation. The cumulative survival (NED) at 5, 10, 15, and 20 years was 56%, 35%, 31%, and 20%, respectively. The cumulative locoregional control rate was 71%. At 5 years (NED), the cure rates for one-wall lesions (73%) were better than for medial-wall lesions (63%) or 2- and 3-wall lesions (49%). One-wall lesions were smaller, medial-wall lesions behaved similar to supraglottic tumors, and two- or three-wall tumors behaved as hypopharyngeal tumors. The cure rates were related to T stage with T1 + T2 > T3 + T4 (28%). Neck metastases reduced the cure rate by 26% and N1 > N2-N3 by an additional 12%. Other factors contributing to therapeutic failure were distant metastases (17.7%), second primary tumors (6.2%; oropharynx and lung were most common), and intercurrent disease fatalities (9.5%). The secondary therapeutic salvage rate was 44% for surgery and 32% for radiation therapy. The therapeutic complication rate was 19% with 3.6% leading to fatality. On a selected basis, radiation combined with conservation surgery (71%) was more curative than with total laryngectomy (53%) or radiation alone (27%). There was no statistical difference between preoperative or postoperative radiation in either the conservation surgery or total laryngopharyngectomy groups. Postoperative radiation with flap reconstruction decreased the incidence of all complications, especially perioperative or delayed fatal complications (from 20% to 5.7%) in conservation surgery patients.     

Complications of combined radiation therapy and surgery for carcinoma of the larynx and inferior hypopharynx

A group of 554 patients was studied to determine and compare the complications of combined preoperative radiation therapy with surgery and combined surgery with postoperative radiation therapy when used for treatment of carcinoma of the larynx and inferior hypopharynx. The complications recorded were infection, slough, carotid blowout, glottic insufficiency, pharyngeal stricture, operative death, chondritis, fistula, and margins of resection involved with tumor. The highest complication rates were in the partial laryngopharyngectopy-postoperative radiation group (63.6%) and in the supraglottic laryngectomy-postoperative radiation group (52.9%). Most of the increase in total complication rate was attributable to higher rates of glottic insufficiency and margins involved with tumor categories. The lowest complication rates were in the hemilaryngectomy with no radiation group (4.5%) and the total laryngectomy-postoperative radiation group (12.8%). The complication rate for the supraglottic laryngectomy-postoperative radiation group (52.9%) was significantly higher than for the preoperative radiation-supraglottic laryngectomy group (26.4%). Within the partial laryngopharyngectomy group, there was no significant difference in total complication rate between the use of preoperative (47.2%) or postoperative radiation (63.6%). Within the total laryngectomy group there was no significant difference between complication rates when either preoperative or postoperative radiation was employed. There was no significant difference in the rate of carotid blowout, chondritis, operative death, slough, or fistula, between preoperative or postoperative radiation in any of the surgical groups. In general, patients with conservation surgery seem to tolerate postoperative radiation without a prohibitive increase in complications.     

Outcome of locally advanced stage III and IV head and neck cancer treated by surgery and postoperative external beam radiotherapy

An uncontrolled retrospective analysis of 76 patients with locally advanced Stage III and Stage IV squamous cell carcinoma of the oral cavity, oropharynx, pyriform sinus, supraglottic larynx, glottic larynx, and hypopharynx, who were treated in a uniform manner by surgical resection and 6,600 rad postoperative external beam radiotherapy, revealed relatively high 2-year and 4-year adjusted survival rates of 76% and 68%, respectively. Complication rates were acceptable (8%). The advantages of this treatment approach for locally advanced head and neck cancers compared to treatment by surgery alone are discussed.     

Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx

The treatment of choice for supraglottic carcinomas of intermediate size (stages T2 and T3) remains controversial. Between 1974 and 1983 in our institution, 139 patients with supraglottic carcinoma of intermediate size were judged retrospectively to have been technically amenable to conservation surgery. Primary disease control at three years was achieved in 100% of the patients treated by supraglottic laryngectomy, 91% (34 patients) of those treated by total laryngectomy, and 69% (81 patients) of those treated by radiotherapy. Of the latter group, 62% were salvaged by total laryngectomy yielding a net three-year local control of 85%. Determinate five-year survival rates were 89% for supraglottic laryngectomy, 78% for total laryngectomy, and 70% for radiotherapy. Significant problems with aspiration occurred in four patients (16%) who were treated by conservation surgery, and two patients (8%) required a permanent tracheostomy. The results of this study show that supraglottic laryngectomy with postoperative radiotherapy as indicated is a highly effective method for the local control of supraglottic carcinoma of intermediate size that is amenable to conservation surgery.     

梨状窝内侧壁癌切除与喉功能保留

目的 探讨梨状窝内侧壁癌切除喉功能保留犬的技术方法和临床疗效。方法 回顾分析手术治疗的梨状窝内侧壁癌71例。其中49例行喉功能保留术;22例未保存喉功能。喉功能保留手术方法：①切除范围：声带活动正常者行患侧水平上半喉＋梨状窝内侧壁切除;声带活动受限者行同侧水平半喉＋声门旁间隙＋梨状窝内侧壁切除;声带固定者行患侧垂直半喉＋梨状窝内侧壁和部分梨状窝外侧壁切除,梨状窝尖受累者切除范围扩大到环状软骨环和颈段食管;②修复:喉修复对利用会厌、甲状软骨膜、带状肌肌筋膜、颈前皮瓣修复喉缺损;梨状窝修复对缺损范围小者用下咽粘膜瓣或残缘粘膜后直接讨合,对缺损范围大者用胸大肌肌皮瓣转移及胸三角皮瓣修复;③颈淋巴结处理：71例中65例（91．5％）行颈清扫术,其中同侧颈清扫术39例,双侧颈清扫术26例;④术后全部病例予以辅助放射性治疗,剂量60－75Gy。结果 寿命表法统计3年、5年生存率：喉功能保留组分别为63．4％和49．6％;喉功能不保留组分别为52．4％和42．4％。喉功能保留组喉功能全部恢复者占71．4％（35／49）,部分恢复者占28．6％（14／49）。结论 梨状窝内侧壁癌易侵入喉部,但多数病例在彻底切除肿瘤病灶的前提下保留喉功能是可行的。     

梨状窝粘膜修复喉部分切除术后的粘膜缺损

目的 :探讨应用梨状窝粘膜修复喉部分切除术后粘膜缺损及恢复喉功能的效果。方法 :对 198例患者施行此术式 ,其中喉水平部分切除术 87例、喉垂直部分或扩大喉垂直部分切除术 6 5例、喉水平加垂直部分切除术 4 6例。同时进行随访观察。结果 :喉水平部分切除术者拔管率为 10 0 % ;术后发音、呼吸、吞咽功能恢复好 ;5年生存率为 84 .7%。喉垂直部分或扩大喉垂直部分切除术拔管率为 87.7% ;5年生存率 86 .2 % ;术后吞咽、呼吸功能恢复好 ,但有声音嘶哑。喉水平加垂直部分切除术后初期进食呛咳较重 ,训练适应时间较长 ,拔管率为82 .6 % ;5年生存率为 78.3% ;术后声音嘶哑 ,部分患者喉狭窄导致拔管困难。结论 :本方法操作简单 ,取材方便 ,手术时间较短 ,成活率高 ,术后喉功能保留好 ,患者的 5年生存率高。     

CO2激光手术治疗声门上型喉癌

目的 总结CO2激光手术治疗声门上型喉癌的临床治疗效果.方法 回顾性分析1995年2月至2005年6月CO2激光手术治疗的32例声门上型喉癌患者临床资料.32例患者中T1N0M0 20例,T1N1M0 2例,T2N0M0 8例,T2N1M0 2例,全部病例术后随诊3年以上.喉部肿瘤均经口行激光手术,同期行择区性(Ⅱ-Ⅳ区)颈清扫术12例,改良全颈清扫术4例.结果 KaplanMeier法统计5年生存率为90.6%,其中T1病变5年生存率为95.6%,T2病变为78.2%.喉的局部控制率为96.8%;喉局部和颈部区域5年控制率为90.3%,其中T1病变5年局部区域控制率为90.9%,T2病变为89.0%.喉部局部复发2例,1例再治疗行喉水平垂直部分切除术,1例行喉全切除术.颈部区域复发2例,其中1例喉部复发伴颈淋巴转移,再治疗后存活;1例颈部复发,治疗后再次颈部复发并伴肺转移死亡.4例患者出现较轻并发症,保守治疗后好转.除1例患者因局部复发行喉全切除外,其余存活患者喉功能良好.结论 激光治疗早期声门上型喉癌创伤小、疗效可靠,是一种理想的治疗方式.     

Near-total laryngectomy in advanced cancers of the larynx and pyriform sinus: a comparative study of morbidity and functional and oncological outcomes.

This prospective study, performed from 1991 to 1996, analyzes the differences in oncological safety, functional utility, and surgical morbidity in 14 advanced lesions of the larynx (10 T3 and 4 T4; 7 N+) and 40 pyriform sinus lesions (1 T2, 20T3, and 19 T4; 29 N+) subjected to Pearson near-total laryngectomy. The laryngeal cancer patients healed much faster, with a minimal wound complication rate of 28%, in comparison to the 68% rate encountered in the pyriform sinus cases (p < .05). The 3-year disease-free survival rate for the laryngeal cancers was 74%, while the 5-year survival rates for pyriform sinus cases were 66% for medial wall lesions and 54% for lateral wall lesions. Lung-powered shunt speech deemed qualitatively superior by acoustic analysis was obtained in 81% of the individuals (93% in laryngeal cases and 76% in pyriform sinus cases). Aspiration-free deglutition was achieved by 90% over periods ranging from 15 to 30 days. This study conclusively attests to the therapeutic efficacy of near-total laryngectomy for advanced lesions of the larynx and pyriform sinus that are unsuitable for radiotherapy, that are deemed too large or risky (because of aspiration) for partial laryngectomy, and that in the past would have merited total laryngectomy.     

The management of laryngeal cancer.

Carcinoma of the larynx is best managed in an interdisciplinary centre with wide therapeutic and rehabilitative services. Current management is confused, but may be simplified by consideration of three groups: 1) no fixation of laryngeal structures, 2) fixation of laryngeal structures and extension beyond the larynx, 3) all others including carcinoma in situ, verrucous carcinoma, transglottic tumor, and squamous carcinoma with marked airway obstruction. The rational treatment of Group 1 glottic tumors is primary radiation, which produces 75% crude and 92% corrected five year tumor free survival. If surgery is undertaken as primary treatment or for salvage, a vertical hemilaryngectomy may preserve the voice. Group 1 supraglottic carcinomas may be divided into supraglottic and marginal. Thirty per cent have palpable nodes at diagnosis and a further 20% occult disease in the cervical chain. Irradiation of neck nodes or block dissection is an integral part of treatment. The indications for a supraglottic horizontal partial laryngectomy are outlined. Where indicated this has five year survival figures of 70%. Recurrence is usually in the neck. Marginal tumors have a 50% five year survival rate when treated by conservation surgery combined with pre-operative radiation. Recent radiotherapeutic advances have improved treatment of these lesions. Thirty to 40% of patients with Group 2 tumors have regional metastases at presentation. There are no fixed protocols for treatment of these patients, less than 50% of whom will survive five years tumor free. The difficulty in carrying out a protocol based on pre-operative radiation with planned surgery is outlined. Under optimum conditions treatment should be primary radiation with salvage surgery for failures or recurrence, for the results are almost as good as primary surgery but 30% of larynges are saved. The difficulties of diagnosing recurrent tumor in irradiated tissue are discussed. Care must be taken to recognize that group of patients in whom tissue edema is the result of perichondritis rather than tumor recurrence, because in these patients surgery is extremely hazardous. Problems of diagnosis and methods of treatment of carcinoma in situ, and verrucous carcinoma are described. Transglottic carcinomas are defined and treatment is primary total laryngectomy with appropriate neck dissection. Similarly if tumors are causing major airway obstruction, treatment is by primary laryngectomy.     

喉功能保留的梨状窝癌外科治疗

目的　评价喉功能保留梨状窝癌的手术治疗效果。方法　回顾性分析了 1974～ 1994年 6月我院初治的 44例经保留喉功能手术治疗的梨状窝癌病例。其中T110例 ,T2 14例 ,T3 18例 ,T42例。 2例术后放射治疗 ,42例术前放射治疗。原发灶术式包括 :36例梨状窝切除术 ;8例喉及下咽部分切除术。结果　 44例 5年生存率为 5 0 % ,I期为 80 % ,II期为 71 43% ,III期为 5 2 9% ,IV期为2 6 7%。总的局部控制率为 81 8%。T3 加T4 的 5年生存率为 45 %。T3 加T4 的 5年局部控制率为75 % (15 /2 0 )。结论　综合治疗过程中选择适宜患者 ,行保留喉功能的梨状窝癌手术 ,可取得满意的治疗效果。术前放射治疗有助于梨状窝癌尤其是T3 梨状窝癌患者喉功能的保留。     

Five hundred cancers of the larynx and pyriform sinus: Results of treatment by radiation and surgery

Three hundred eighty cancers of the larynx and 120 of the pyriform sinus were treated in the 15 years from 1958-1973 at Yale-New Haven Hospital. They were studied for response to treatment by surgery, radiation or a combination of the two. Overall control rates in the entire group of 500 were 51% for radiotherapy, 51% for surgery. Further analysis showed significant differences in the results obtained by stage and by location for surgery and radiotherapy. The total number of cases treated by combined therapy was relatively small, except for pyriform sinus. Radiotherapy success showed a steep gradient from 82% in Tl lesions to 5% in T4. The gradient for surgery was less steep with 64% success for Tl and 40% for T4. Both radiotherapy and surgery were most successful in glottic cancer and least successful in the pyriform sinus. However, the success range varied more with radiation than with surgery (83% success in glottic cancer, 5% in pyriform sinus cancer for radiotherapy; 81% in glottic cancer and 24% in pyriform sinus for surgery). Late primary recurrences (3 years or more after radiation therapy) developed only in the glottic group. Recurrent cancer at the primary site in non-glottic lesions appeared within 2 years after radiotherapy in 65 of the 66 local recurrences. Similarly, 77 of the 82 local recurrences of non-glottic cancer after surgery appeared within 2 years. With only 1 exception in 34 cases, surgical salvage of radiation failures succeeded only in glottic cancer. Of the 136 T1 glottic lesions there were no discernible regional metas-tases. In the remaining 73 glottic T2 and T3 lesions, cervical node me-tastases developed in 8 lesions. Supraglottic cancer was the most likely to produce cervical node metastasis from an early primary lesion (5 Tl lesions among 10 supraglottic lesions with unrecognized positive nodes). Eight of the 65 patients with fixed cervical node metastasis were controlled with no evidence of disease after 3 years. Among the treatment failures, most of those in the radiotherapy group were due to uncontrolled primary disease (72%). The failures among the surgical group were due mainly to metastasis (72%). Final controls obtained by surgery, radiotherapy, combined treatment and secondary salvage of radiation or surgical failures were as follows: glottic 82%; supraglottic 58%; transglottic 58%; subglottic 60%; pyriform sinus 17%.     

The use of pyriform sinus mucosa for reconstruction after vertical partial laryngectomy.

This prospective study included 30 patients with glottic carcinoma of the larynx who were treated primarily by vertical partial laryngectomy. The pyriform sinus mucosa was used to reconstruct the new laryngeal wall and to form a pseudo-vocal fold at the side of resection. Our results showed that 90 per cent of patients were decannulated, 80 per cent were able to eat a normal diet, 70 per cent developed excellent voice quality after surgery and a 97 per cent three-year survival was achieved. The pyriform sinus mucosa proved to be a reliable material for reconstruction after vertical partial laryngectomy.     

1115例喉癌患者的生存分析

目的 了解20世纪80～90年代外科治疗喉癌的远期效果，并且探讨影响预后的因素。方法 应用回顾性调查的方法，对1983～1996年间中国医科大学第一附属医院耳鼻咽喉科1115例喉癌患者进行分析，统计患者的生存率和死亡原因。结果 生存5年以上者780例，死亡260例，失访75例，累积生存率曲线统计5年生存率为77％，其中Ⅰ期为94％、Ⅱ期为89％、Ⅲ期为82％、Ⅳ期为66％。不同分型的5年生存率由高到低的顺序是声门型、声门上型、声门下型、跨声门型。喉部分切除术患者的5年生存率为85％，而喉全切除术患者的5年生存率为68％。患者5年内死亡的主要原因是局部复发和转移(70％)，另有14％的死亡者没有弄清他们的死亡原因。结论 近20年我国喉癌治疗水平得到明显提高，早期诊断是提高喉功能保留手术比例和提高生存率的关键，患者5年内死亡的原因主要是局部复发和转移。     

Evolution of the epidemiology and clinical characteristics of larynx and hypopharynx carcinoma in Poland from 1991 to 2001

A retrospective analysis was performed of 12,888 cases of larynx and hypopharynx carcinoma diagnosed in 19 ENT Departments in Poland during an 11-year period from 1991 to 2001. An assessment of basic epidemiological data, including also tumor site and disease stage at the time of diagnosis, was conducted. Epidemiological trends over the 11-year period of the analysis were examined. The average M:F proportion was 8:1, with a significant increase in the number of female patients during the analyzed period. The predominant localization of carcinoma was in the glottis (47.2%), followed by the supraglottis (40.3%) and pyriform sinus (7.8%). A significant increase in pyriform sinus tumors was observed in the analyzed period. Majority of cases (57.4%) presented with local advanced stage (T3 + T4) carcinoma of the larynx and hypopharynx, with the highest rate (81.0%) for the pyriform sinus carcinomas, and with the lowest rate for glottic tumors (41.8%). Regional lymph node metastases were diagnosed in 47.7% of the analyzed cases, with the highest rate (82.2%) in cases of pyriform sinus carcinomas, and the lowest (31.7%) in glottic carcinomas. In the 11-year period, a significant drop in N0 cases and a tendency toward increased rates of N2 and N3 lymph nodes metastases cases of supraglottic carcinoma were observed. Distant metastases at the time of diagnosis were registered in 2.2% of the analyzed cases, with the highest percentage in the posterior pharyngeal wall (7.6%) and pyriform sinus (7.4%) carcinomas.     

Extended supraglottic laryngectomy. Review of 84 cases

Extended supraglottic laryngectomy is a surgical procedure by which the boundaries of standard supraglottic laryngectomy are extended to include the base of the tongue and/or pyriform sinus and/or one of the arytenoids, according to the extent of epilaryngeal or extralaryngeal invasion by vestibular cancer. We report the results of 84 extended supraglottic laryngectomies performed by our group from 1970 to 1980. Besides the highly favorable 5-year cure rate (75%), full functional rehabilitation followed in all but three patients, who were therefore submitted to secondary total laryngectomy. Rehabilitation time is often somewhat longer than in standard supraglottic laryngectomy, especially when an ample resection of the base of the tongue is required. Combined resection of the base of the tongue, aryepiglottic fold, and one of the arytenoids may further lengthen the rehabilitation period. We believe that extended supraglottic laryngectomy should be performed more often, not only for actual invasion, but also for suspected invasion of extralaryngeal structures.