Cordectomy
Cordectomy, also referred to as vertical hemilaryngectomy or partial laryngectomy, is a surgical procedure primarily used to treat laryngeal cancer, specifically glottic carcinoma. This operation involves the removal of an entire vocal cord, surrounding soft tissue, and part of the thyroid cartilage. It is particularly effective for early-stage glottic cancers due to the prompt nature of their symptoms, such as hoarseness and sore throat. The procedure can achieve local control rates ranging from 80 to 95 percent for T1 lesions and 70 to 85 percent for T2 lesions.
Preparation for cordectomy involves a comprehensive preoperative assessment, including imaging studies to determine tumor characteristics and airway status. Traditionally performed under general anesthesia via a neck incision, cordectomy can also utilize advanced techniques like carbon dioxide laser cordectomy or Transoral Robotic Surgery (TORS), which offer minimally invasive alternatives and may reduce recovery time. Postoperative care varies; traditional procedures may require a few days of hospitalization, while laser procedures typically allow for outpatient observation.
Like any surgical intervention, cordectomy carries risks, including speech difficulties and airway complications, but successful outcomes often hinge on individual patient factors and access to follow-up care, such as speech therapy.
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Subject Terms
Cordectomy
ALSO KNOWN AS: Vertical hemilaryngectomy, partial laryngectomy
DEFINITION: A cordectomy is a surgical procedure for treating laryngeal cancer. It entails resectioning an entire vocal cord, the surrounding soft tissue, and the inner lining of the thyroid cartilage.
Cancers treated: Laryngeal (glottic) carcinoma
Why performed: In defining treatment protocols, the larynx is divided into three anatomical regions: supraglottis, glottis, and subglottis. The distribution of carcinoma among these regions is estimated at 35:60:5. Glottic carcinomas are the most common and readily detected because of the prompt development of symptoms (hoarseness, sore throat, and dysphagia). Early-stage glottic carcinoma can be treated effectively by a single modality, utilizing surgery or radiation. Radiation therapy will provide 85 to 94 percent local control for T1 (Stage 1) glottic cancer and local control in 70 to 80 percent of T2 (Stage 2) lesions. Vertical (cordectomy) can achieve local control rates of 80 to 95 percent for T1 lesions and 70 to 85 percent for T2 lesions. Overall, surgery provides better local control, but the potential benefit of radiation therapy has been voice preservation.
Patient preparation: A routine preoperative workup and assessment of anesthetic risks are required. Before any surgery for laryngeal cancer, the larynx is physically examined with indirect mirror visualization or direct laryngoscopy. Magnetic resonance imaging (MRI) scans evaluate tumor size, location, airway patency, and cartilage involvement.
Steps of the procedure: With the patient under general anesthesia, surgical exposure is performed through a traditional transcervical incision. Exposure of the vocal cords is achieved through a laryngofissure approach (a midline through the thyroid cartilage).
Carbon dioxide (CO2) laser cordectomy is now an alternative surgical option. It is performed as an endoscopic procedure and can be performed on an outpatient basis. The single disadvantage of this procedure is the problem of evaluating free (healthy) tissue margins, especially on frozen sections. Transoral Robotic Surgery (TORS) has emerged as a minimally invasive option for removing tumors. The use of robotic instruments ensures accuracy, minimizes damage to surrounding tissue, and can reduce patient recovery time. TORS is most effective in early-stage cancers. The right course of treatment should be tailored to the patient and their specific needs.
After the procedure: With traditional cordectomy, the patient stays in the hospital for a few days so that vital signs, incision site, and respiratory status can be monitored. Patients undergoing laser cordectomy are required to stay only for observation (three to four hours) to detect any signs of airway obstruction. Postoperatively, an adult companion should remain with the patient for the first twenty-four hours.
Risks: The specific risks of cordectomy involve speech problems, airway obstruction, and aspiration. General surgery risks include postoperative infection, scarring, and potential neurologic-vascular compromise to the operative area.
Results: The success of postoperative rehabilitation depends on anatomic and patient factors. The extent of the surgery, the type of reconstruction, and the utilization of radiation are important anatomical factors. Patient factors include motivation, dexterity, and access to speech therapy.
Bibliography
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