The zyxwvutsrqponmlkjih Laryngoscope zyxwvutsrqponm Lippincott-Raven Publishers, Philadelphia zyxwvutsrq 0 1998 The American Laryngological, Rhinological and Otological Society, Inc. Supracricoid Partial Laryngectomies in the Elderly: Mortality, Complications, and Functional Outcome Ollivier Laccourreye, MD; Daniel Brasnu, MD; Sophie PBriB, MD; Luca Muscatello, MD; Madeleine MBnard, MD; Gregory Weinstein, MD A review of the postoperative course, complica- tions, and functional outcome of zyxwvut 69 elderly patients (older than zyxwvuts 65 years of age) consecutively managed with a supracricoid partial laryngectomybetween 1977 and 1993 is presented. The tumors were glottic and supraglottic in origin in 53 and 16 patients, re- spectively. A zyxwvutsr cricohyoidoepiglottopexy, a tracheo-crico- hyoidoepiglottopexy, and a cricohyoidopexy were per- formed in 48, five, and 16 patients, respectively. Immediate laryngeal, cervical, and medical complica- tions were noted in 5.8%, 10.2%, and 10.2% of patients, respectively. Supracricoid partial laryngectomies never resulted in perioperative or postoperative death. The 5-year actuarial survival and local control esti- mates were 68%, and 93.9%, respectively. Late surgical complications included laryngocele, laryngeal steno- sis, and pneumonia from aspiration-related death in 4.3%, 4.3%, and 1.4% of patients, respectively. Comple- tion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 1.4%,1.4%, and 2.Wo of patients, respectively. Overall a 92.8% la- ryngeal preservation rate was achieved. Univariate analysis of the potential correlation of different factors with the mortality incidence and causes, the incidence and type of the various complications, and the inci- dence for postoperative aspiration is presented. Laryngoscope, 108:237-242,1998 Presented at the Fourth International Congress on New Perspec- tives in Otolaryngology--Head and Neck Surgery, Cascais, Portugal, July 6,1996. From the Departments of Otorhinolaryngology-Head and Neck Surgery (O.L., D.B., M.M.), Laennec Hospital, Assistance Publique des HBpi- tam de Paris, University Paris V, Pans, France; and the University of Pennsylvania Medical Center (L.M., G.w.), Philadelphia, Pennsylvania. Dr. PBri4 is currently working at Tenon Hospital, Pans, France. Editor’sNote: This Manuscript was accepted for publication May 16, 1997. Send Reprint Requests to Ollivier Laccourreye, MD, Department of Otorhinolaryngology-Head and Neck Surgery, Laennec Hospital, zyxwvuts 42 rue de SBvres, 75007, Paris, France. INTRODUCTION Supracricoid partial laryngectomies (SCPLs) are con- servation techniques that were introduced in the early 1990s in the English-language medical literature.l.2 Since then, various reports in the North American medical lit- erature documented and analyzed the indications, con- traindications, and oncological results achieved with SCPLs for selected invasive endolaryngeal squamous cell carcinoma.1-11 Analysis of the reported data suggested that the use of SCPLs reduced the indications for total la- ryngectomy in selected advanced endolaryngeal carci- noma and resulted in higher local control and long-term laryngeal preservation rates when compared with the con- ventional treatment modalities of vertical and horizontal partial laryngectomy and radiation therapy for selected “early” invasive endolaryngeal squamous cell carci- noma.l-11 Recently Myers and Alvi,l2 in a review article fo- cusing on the management of carcinoma of the supraglot- tic larynx, stated that “SCPLs provided new hope for patients that would have otherwise lost their larynx.” In Western countries, elderly patients represent the fastest-growing section of the population.13-15 In 1990 in France, elderly patients (older than 65 years) represented 14.8% of the population, and this percentage was esti- mated to be doubled by the year 2040.14 Similarly, in 1993, elderly patients in the United States constituted 12.1% of the population with an estimated 19.6% increase by the year 2000.13The incidence of cancer is reported to increase with advancing age, and the predominant cancers encoun- tered in the elderly patient are of the skin and aerodiges- tive tract.16.17 Therefore an increase in cases of endolaryn- geal carcinoma should be anticipated in the future. Such data led us to examine the postoperative course, mortality, morbidity, and functional outcome after SCPLs in the elderly patient. This report examines the functional results after SCPLs in patients older than 65 years of age. The authors attempted to determine the fac- tors that may contribute to increased surgical risk and poor outcome in patients older than 65 years of age man- aged with SCPLs. The oncological results and the cancer Laryngoscope 108: February 1998 Laccourreye et al.: Partial Laryngectomy 237