Aktueller Stellenwert der offenen Larynxteilresektion unter besonderer Berücksichtigung der suprakrikoidalen Teilresektionen

Zusammenfassung

Die offene organerhltende Chirurgie des Larynx beinhaltet ein weites Spektrum von den klassischen konservativen bis hin zu den suprakrikoidalen Teilresektionen. In Deutschland sind die Indikationen des offenen Zugangs bei Karzinomen im Stadium T1 - 2 von der aufgrund ihrer entscheidend geringeren perioperativen Morbidität weitverbreiteten transoralen Laserchirurgie weitestgehend verdrängt worden. Bei Patienten mit teilresezierbaren Larynxkarzinomen im Stadium T3 wäre eine Prüfung des Stellenwertes der offenen organerhaltenden Chirurgie im Vergleich zur transoralen Laserchirurgie und zu den Organerhaltungsprotokollen mit kombinierter oder sequentieller Radio-Chemotherapie von hohem Interesse. Unter Berücksichtigung der aktuellen Literatur werden zeitgemäße Indikationen und zukünftige Möglichkeiten der offenen Teilresektion unter besonderer Berücksichtigung der suprakrikoidalen Teilresektion diskutiert.

Abstract

Open partial laryngectomies include a broad variety of vertical or horizontal partial or supracricoid laryngectomies. Especially in Germany the excellent results of the transoral approach in combination with the CO₂ laser surgery radically have diminished the indications of the open surgical techniques for laryngeal cancer staged cT1 - 2. In patients with laryngeal cancer staged cT3 the role of open organ-preservation surgery remains to be defined in the context of extended treatment options for endolaryngeal CO₂ laser surgery and conservative larynx-preservation approaches with concurrent chemoradiation or induction chemotherapy followed by radiation therapy. With regard to the reviewed literature this manuscript will discuss current indications and future roles of open partial laryngectomies with special emphasis given to the supracricoid laryngectomies.

offene konservative Kehlkopfteilresektion - suprakrikoidale Larynxteilresektion - chirurgischer Organerhalt - Larynxkarzinom - Rettungs-Chirurgie

conservation laryngeal surgery - supracricoid partial laryngectomy - organ-preservation surgery - glottic cancer - squamous cell carcinoma of the larynx - salvage surgery

Literatur

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1 Alle nicht besonders gekennzeichneten Tumorstadien entsprechen der AJCC 2002. Um eine Übersichtlichkeit zu gewährleisten, wurde auf die Indikationen zur Therapie der ableitenden Lymphwege nicht eingegangen.