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Total Laryngectomy and Voice Restoration

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  • 高齢者の喉頭全摘・音声再建

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Abstract

Total laryngectomy is popular in the treatment of advanced (T3/T4) laryngeal squamous cell carcinoma (SCC) in Japan. In this study we compared the survival rates between young patients (under 64 years old) and elderly patients (over 65 years old) with advanced laryngeal SCC. Fifty-five patients with advanced laryngeal cancer were treated between 1984 and 1999 at the Department of Otorhinolaryngology, Fukui Medical University. All of the 55 cases were involved in the follow up. Although 85.7% of the young patients with advanced laryngeal cancer reached an overall survival rate of 5 years, 70.3% of older patients survived for that same length of time. All of patients with advanced laryngeal cancer underwent total laryngectomy with the exception of four extremely old patients (over 80 years old). Three patients were treated with only radiation therapy and one patient (92-year-old) was not treated. Three patients experienced a highly compromised quality of life until their death. No complications for total laryngectomy with the older patients were found. <BR>Tracheoesophageal shunt (T-E shunt) for the restoration of voice were utilized in 40 patients treated with total laryngectomy. Twenty-one young patients (81%) made good use of it, while 8 old patients (57%) used a shunt. We recently recommended elderly patients treated with total laryngectomy to use an electric artificial larynx. Only 4 patients (21%) used the electric larynx every day. These results suggest that the use of restored voice is dependent upon the individual character of the patient.

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