Paraglottic space in supracricoid laryngectomy.

Background: Paraglottic space (PGS) is a connective tissue compartment of the larynx and is important in the extension of laryngeal cancer. It communicates with the preepiglottic space superiorly and with the extralaryngeal region inferiorly through the gap within the cricothyroid membrane. Transglottic cancer of the larynx, which spreads within PGS, is characterized by a high incidence of laryngeal skeleton invasion and of cervical metastasis. Determining the correct stage of transglottic cancer of the larynx is difficult, leading to therapeutic failure of partial laryngectomy in some cases.

Objective: To clinically confirm a pathologically complete resection of PGS from the piriform sinus mucosa by supracricoid partial laryngectomy in laryngeal cancers involving PGS.

Materials And Methods: Eight patients with transglottic cancer whose cancer was confirmed clinically and pathologically at stages T2b or higher underwent supracricoid partial laryngectomy. During supracricoid partial laryngectomy, we performed a sharp dissection of PGS from the piriform sinus mucosa to obtain a complete resection margin while preserving the piriform sinus mucosa. Microscopic evaluation of the specimens was made for the invasion of PGS and the safe margin distance from the piriform sinus mucosa.

Results: Pathological cancer invasion of PGS was confirmed in 7 of 8 patients and a sufficient pathological margin from tumor invasion to the piriform sinus mucosa was obtained. The average safety margin was 10.3 mm.

Conclusion: Supracricoid partial laryngectomy could be considered a safe surgical modality for cancers not extending to PGS.