Salvage Subtotal Supracricoid Laryngectomy with Cricohyoidoepiglottopexy for Late Recurrence of Irradiated T1a Glottic Carcinoma Eighteen Years After Radiotherapy: A Case Report and Literature Review
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Abstract
Early glottic carcinoma treated with radiotherapy has excellent local control, but a minority of patients develop recurrence, which classically occurs within the first three years. Late recurrences are uncommon and pose specific diagnostic and therapeutic challenges in a previously irradiated larynx. We report the case of a 72-year-old man with a history of T1aN0M0 glottic squamous cell carcinoma treated with 32 fractions of radiotherapy (completed in 2008) and endoscopic resection of a local lesion in 2014, who presented after a 12-year disease-free interval with progressive dysphonia. Endoscopy revealed a 15-mm polypoid, hypervascular lesion on the anterior and middle thirds of the left vocal fold, sparing the anterior commissure, posterior third, ventricle and subglottis. Biopsy showed a high-grade intraepithelial lesion with post-radiation changes, and computed tomography and neck ultrasound showed no deep invasion or cervical disease. The patient underwent salvage subtotal supracricoid laryngectomy with cricohyoidoepiglottopexy (SSC-CHEP) with 20 mL of blood loss, no intraoperative complications and grossly negative margins. The postoperative course was favorable, and he was discharged with the drain in place for outpatient follow-up, with good postoperative evolution; definitive histopathology is pending. This case, together with a brief review of the literature, supports SSC-CHEP as an oncologically sound, larynx-preserving alternative to total laryngectomy for carefully selected radiorecurrent glottic tumors, even after very long disease-free intervals and in older patients with good functional status.
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