cancer de laringe precoce
TRANSCRIPT
![Page 1: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/1.jpg)
Leonardo Rangel
Tratamento Cirúrgico do Câncer Inicial de Laringe
Dr. Leonardo Rangel
![Page 2: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/2.jpg)
Leonardo Rangel
! 6% dos tumores malignos
! Sexo masculino
!Quarta a sexta décadas de vida
!Relação com etilismo e tabagismo
!Tipo histológico
!CEC (95%)
![Page 3: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/3.jpg)
Leonardo Rangel
Supraglote
!T1 - Tumor limitado a uma sub-localização anatômica da supraglote, com mobilidade normal da corda vocal
!T2 - Tumor que invade a mucosa de mais de uma sub-localização anatômica adjacente da supraglote ou a glote ou região externa à supraglote (p. ex., a mucosa da base da língua, a valécula, a parede medial do seio piriforme), sem fixação da laringe
![Page 4: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/4.jpg)
Leonardo Rangel
Glote
! T1 - Tumor limitado à(s) corda(s) vocal(ais) (pode envolver a comissura anterior ou posterior), com mobilidade normal da(s) corda(s) T1a Tumor limitado a uma corda vocalT1b Tumor que envolve ambas as cordas vocais
! T2 - Tumor que se estende à supraglote e/ou subglote, e/ou com mobilidade diminuída da corda vocal
! T3 - Tumor limitado à laringe, com fixação da corda vocal e/ou que invade o espaço para-glótico, e/ou com erosão mínima da cartilagem tireóide (p. ex., córtex interna)
![Page 5: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/5.jpg)
Leonardo Rangel
OBJETIVOS:
!Ressecção do tumor preservando máximo da função sem comprometer %cura
!Deglutição
!Respiração
!Fonação
!Proteção da Via aérea
![Page 6: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/6.jpg)
Leonardo Rangel
!Cirurgia endoscópica
!Laringectomias parciais
!Laringectomias sub-totais
!Laringectomia total
![Page 7: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/7.jpg)
Leonardo Rangel
Cirurgia Endoscópica da Laringe
![Page 8: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/8.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Avanços técnicos Laringoscópios Óticas 0º/30º/70º Material microcirúrgico Laser/CO2
Ferris RL, Simental A. Operat Tech Otolaryngol – Head Neck Surg 2003;14(1):3-11.
![Page 9: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/9.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
![Page 10: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/10.jpg)
Ressec. End. Laser
![Page 11: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/11.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Indicações
Tumores Glóticos ou supraglóticos
Estágios I ou II
Leve/moderada diminuição da mobilidade
Ø fixação na comissura anterior
Pequena extensão supra e/ou subglótica
Ferris RL, Simental A. Operat Tech Otolaryngol – Head Neck Surg 2003;14(1):3-11.
![Page 12: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/12.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Tumores Glóticos
Tis, T1 e T2
Tto pescoço quando
extensão supraglótica
ou subglótica
Traqueostomia é raro
Média: 2 ressecçõesMyers EM et al. Ann Otol Rhinol Laryngol 1994;103:28-30.
![Page 13: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/13.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Contra-indicações
Extensão subglótica >5mm
Fixação de CV
Extensão para aritenóide
Envolvimento do seio piriforme
Extensão pós-cricóide
Invasão de cartilagem
Invasão grosseira da comissura anterior (TC)Ferris RL, Simental A. Operat Tech Otolaryngol – Head Neck Surg 2003;14(1):3-11.
![Page 14: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/14.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
" Subepitelial (I)" Subligamentar (II)" Transmuscular (III)" Total (IV)" Estendida (V)
Va - Prega contralateralVb - aritenóideVc- Falsa PregaVd - Subglote
Comissura Anterior (VI)
![Page 15: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/15.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Cordectomia Tipo I
Dx e Terapêutico
Laringite Crônica Tumor “in situ”
![Page 16: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/16.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Cordectomia Tipo II
Dx e Terapêutico
Ceratose recorrente T1
![Page 17: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/17.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Cordectomia Tipo III
Terapêutico
T1 T2 com diminuição
moderada de mobilidade Comissura anterior
(Cordectomia III)
![Page 18: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/18.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Autor Ano Npacientes Classificação SobrevidaAj
ustadaRecorrência
LocalRESGATE L.TOTAL
Eckel 1992 67 T1-T2 100% 6 (9%) 6 (9%)
Steiner 1993 130 T1-T2 100% 10 (8%) 1 (1%)
Rudert 1995 106 T1-T2 100% 10 (9%) 3 (3%)
Moreau 1996 97 T1-T2 97% 0 (0%) 0 (0%)
Moreau PR. Laryngoscope 2000;110(6):1000-6.
![Page 19: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/19.jpg)
Leonardo Rangel
CIRURGIA ENDOSCÓPICA
Cirurgia
Repouso VocalAntibiótico
DexametasonaProtetor gástrico
Video Laringoscopia40 dias após Cirurgia
Sem Evidência de Doença
Com Evidência de DoençaControle por Video Laringoscopia
Micro Cirurgia ResgateRxT/Cirurgia
3 m 6 m 12 m
semestral / 5 anos
![Page 20: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/20.jpg)
Leonardo Rangel
Laringectomias Parciais
![Page 21: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/21.jpg)
Leonardo Rangel
Objetivos :
# Ressecção de parte do órgão
# Preservação da respiração normal
# Preservação da deglutição
# Preservação da voz
LARINGECTOMIAS PARCIAIS
![Page 22: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/22.jpg)
Leonardo Rangel
!Verticais (tumores glóticos)
!Horizontal (tumores supraglóticos)
LARINGECTOMIAS PARCIAIS
![Page 23: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/23.jpg)
Leonardo Rangel
TIPOS: !Cordectomia (laringo-fissura) !Fronto-lateral !Fronto-anterior !Hemilaringectomia
L. Parciais Verticais
![Page 24: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/24.jpg)
Leonardo Rangel
" T1 1/3 médio de CV
" Traqueostomia
" ~ RxT/Endoscopia
Cordectomia por Laringofissura
![Page 25: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/25.jpg)
Leonardo Rangel
Cordectomia por Laringofissura
![Page 26: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/26.jpg)
Leonardo Rangel
!T1b glótico (comissura) !CV oposta de 1-2 mm
! Ressecção de : ! CV, ! falsa corda ! ventrículo ! cartilagem
Freitas EQ. Cirurgia conservadora para câncer glótico. In: Dias FL, Noronha MJ. Câncer de
Laringe: uma abordagem multidisciplinar. 1997 p. 160-4.
Fronto - Lateral
![Page 27: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/27.jpg)
Leonardo Rangel
Fronto - Lateral
![Page 28: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/28.jpg)
Leonardo Rangel
Fronto - Lateral
![Page 29: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/29.jpg)
Leonardo Rangel
Fronto - Lateral
![Page 30: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/30.jpg)
Leonardo Rangel
Fronto - Lateral
![Page 31: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/31.jpg)
Leonardo Rangel
! T1/T2 glótico anterior
! Quilha sintética
Fronto - Anterior
![Page 32: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/32.jpg)
Leonardo Rangel
" T1/T2 glótico
" Extensão a aritenóidesem fixação
" Reconstrução
Hemilaringectomia
![Page 33: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/33.jpg)
Leonardo Rangel
Hemilaringectomia
![Page 34: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/34.jpg)
Leonardo Rangel
Hemilaringectomia
![Page 35: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/35.jpg)
Leonardo Rangel
Hemilaringectomia
![Page 36: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/36.jpg)
Leonardo Rangel
Extensão Sub-glótica
![Page 37: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/37.jpg)
Leonardo Rangel
RECONSTRUÇÃO:
!Falsa corda vocal
!Músculo (esterno-hióideo)
!Retalho mio-cutâneo (platisma)
!Epiglote
Laringectomias Verticais
![Page 38: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/38.jpg)
Leonardo Rangel
Hemilaringectomia
![Page 39: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/39.jpg)
Leonardo Rangel
Reconstrução com falsa corda
Fronto-lateral
![Page 40: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/40.jpg)
Leonardo Rangel
TARDIAS: !Dificuldades de decanulização !Aspiração !Disfonia acentuada
ComplicaçõesIMEDIATAS:
!Hemorragia
!Infecção
![Page 41: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/41.jpg)
Leonardo Rangel
Sobrevida Global - 161 pacientes (1976-1986)
3 anos 91% 5 anos 85% 7 anos 78%
Depts. of Otorhinolaryngology, Mayo Clinic Rochester, Mayo Clinica Scottsdale, and Mayo Foundation, Rochester
Jon V. Thomas, Kerry D. Olsen, Lawrence W. Desanto, H.Bram Neel, Vera Suman
Resultados
LARINGECTOMIAS PARCIAIS VERTICAIS
![Page 42: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/42.jpg)
Leonardo Rangel
!Microcirurgia Endoscópica à Laser
!Laringectomia Parcial Supracricóidea (CHEP)
Alternativas de Tratamento
![Page 43: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/43.jpg)
Leonardo Rangel
CONCLUSÃO
!Casos bem selecionados de tumores glóticos T1 e T2 com mobilidade preservada
Indicações:
![Page 44: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/44.jpg)
Leonardo Rangel
Laringectomia Horizontal Supraglótica
![Page 45: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/45.jpg)
Leonardo Rangel
!Conceito
!Histórico
!Alonzo, 1947
!Ogura, 1958
!Som, 1959
Laringectomia Supra-glótica
![Page 46: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/46.jpg)
" Indicações
" T1-T2 supraglótico
" T3 selecionados:
Espaço pré-epiglóticoP. medial s. piriformeMucosa da valécula
Laringectomia Supra-glótica
![Page 47: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/47.jpg)
Leonardo Rangel
!Contra-indicações
- Invasão do ventrículo de Morgani - Comprometimento da comissura anterior - Fixação de cordas vocais - Invasão de cartilagem tireóide - Comprometimento do ápice do seio piriforme - Invasão do espaço interaritenóideo ou pós-cricóide - Diminuição da mobilidade da língua - Comprometimento de ambas aritenóides
Laringectomia Supra-glótica
![Page 48: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/48.jpg)
Leonardo Rangel
! 25 – 50% - metástases linfáticas ao diagnóstico
! Taxas de metástases ;T2 - 39% ,T3 e T4 até 65%
! EC bilateral reduz falha regional de 21 p/ 7%
! Conduta no INCa :
- ECL bilateral em N0
- ECRM em N+ s/ extravasamento capsular
- ECR em N+ c/ extravasamento capsular
- RxT adjuvante
Tratamento do pescoço
![Page 49: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/49.jpg)
Laringectomia Supra-glótica
![Page 50: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/50.jpg)
Leonardo Rangel
Técnica
Laringectomia Horizontal Supraglótica
![Page 51: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/51.jpg)
Leonardo Rangel
L. Supra-glótica / técnica cirúrgica
![Page 52: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/52.jpg)
Leonardo Rangel
L. Supra-glótica / técnica cirúrgica
![Page 53: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/53.jpg)
Leonardo Rangel
L. Supra-glótica / técnica cirúrgica
![Page 54: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/54.jpg)
Leonardo Rangel
![Page 55: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/55.jpg)
Leonardo Rangel
!Ampliações
!Ressecção de uma aritenóide
!Seio piriforme
!Base de língua (até 1 cm das papilas circunvaladas)
L. Supra-glótica
![Page 56: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/56.jpg)
Leonardo Rangel
!Cuidados pós-operatórios
!Proteção da sutura
!Decanulização
!Reabilitação vocal
!Reintrodução da ingesta oral
L. Supra-glótica
![Page 57: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/57.jpg)
Leonardo Rangel
Autor Ano Nº de casos 3 anos 5 anos
!Alajamo 1991 361 88,1%
!Bocca 1983 403 75,0%
!Ogura 1975 177 76,0%
!Piquet 1984 105 64,0% 47,5%
! Shah 1988 78 85,0% 72,0%
! Suarez 1995 193 74,3%
L. Supra-glótica
![Page 58: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/58.jpg)
Leonardo Rangel
!Laringectomia Supra-Cricóidea !Laringectomia Quase Total ( Near-Total Laryngectomy )
Laringectomias Sub-totais
![Page 59: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/59.jpg)
Leonardo Rangel
Laringectomia Supracricóidea
! Majer E., Rieder W.: Technique de laryngectomie permettant de conserver la permeabilité respiratoire. Ann Otolaryngol
76:677-681, 1959. ! Labayle J., Bismuth R.: La laryngectomie totale avec
reconstruction. Ann Otolaryngol 88:219-228, 1971. ! Piquet J.J.,Desaulty A , Decroix G: La crico-hyoido-epiglotto-
pexie. Technique opératoire et résultats fonctionnels. Ann Otolaryngol 91:681-686, 1974.
! Laccourreye H, Laccourreye O, Weinstein G, et al: Supracricoid laryngectomy with cricohyoidoepiglottopexy; A partial
procedure for glottic carcinoma. Ann Otol Rhinol Laryngol 99:421-426,1990.
Histórico:
![Page 60: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/60.jpg)
Leonardo Rangel
!CHEP – Tumores glóticos !CHP - Tumores supraglóticos ou tumores
glóticos com extensão para supraglote
Indicações :
! T1b glote (comissura)! T1-T2 glote com área de displasia grave! T2 glote uni ou bilateral! T3 glote! Tumores supraglóticos ! glóticos
LPSC
![Page 61: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/61.jpg)
Leonardo Rangel
Emprego: procedimento funcional adequado para tratar
câncer glótico moderadamente avançado. Preservação de Funções: !Fonação !Respiração nasal !Deglutição (evita traqueostomia definitiva)
LPSC
![Page 62: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/62.jpg)
Leonardo Rangel
! Quais as estruturas laríngeas removidas?
LPSC
![Page 63: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/63.jpg)
Leonardo Rangel
LPSC Estruturas cartilaginosas
![Page 64: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/64.jpg)
Leonardo Rangel
LPSC Espaços para-glóticos
![Page 65: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/65.jpg)
Leonardo Rangel
!Vídeo-laringoscopia !Tomografia computadorizada !Ressonância magnética
LPSC
avaliação da extensão tumoral
![Page 66: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/66.jpg)
Leonardo Rangel
!TÉCNICA
LPSC
![Page 67: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/67.jpg)
Leonardo Rangel
![Page 68: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/68.jpg)
Leonardo Rangel
![Page 69: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/69.jpg)
Leonardo Rangel
![Page 70: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/70.jpg)
Leonardo Rangel
![Page 71: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/71.jpg)
Leonardo Rangel
metástase cervical oculta - 30%
# unilateral 17/44 38% # bilateral 06/32 18%
Revista Bras. de Cirurgia de Cab. e Pesc. Vol.19 nº 2, MAI./AGO. 1995
Câncer de Laringe T3 e T4 / N0
INCA – RJ ( 1981-1989 ) Análise de 76 casos
![Page 72: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/72.jpg)
Leonardo Rangel
![Page 73: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/73.jpg)
Leonardo Rangel
![Page 74: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/74.jpg)
Leonardo Rangel
![Page 75: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/75.jpg)
Leonardo Rangel
![Page 76: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/76.jpg)
Leonardo Rangel
![Page 77: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/77.jpg)
Leonardo Rangel
![Page 78: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/78.jpg)
Leonardo Rangel
![Page 79: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/79.jpg)
Leonardo Rangel
![Page 80: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/80.jpg)
Leonardo Rangel
![Page 81: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/81.jpg)
Leonardo Rangel
LPSC Articulação crico-tireóidea
![Page 82: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/82.jpg)
Leonardo Rangel
![Page 83: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/83.jpg)
Leonardo Rangel
![Page 84: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/84.jpg)
Leonardo Rangel
![Page 85: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/85.jpg)
Leonardo Rangel
![Page 86: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/86.jpg)
Leonardo Rangel
![Page 87: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/87.jpg)
Leonardo Rangel
![Page 88: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/88.jpg)
Leonardo Rangel
![Page 89: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/89.jpg)
Leonardo Rangel
LPSC
![Page 90: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/90.jpg)
Leonardo Rangel
![Page 91: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/91.jpg)
Leonardo Rangel
LPSC
![Page 92: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/92.jpg)
Leonardo Rangel
!A incisão de abertura superior da laringe deve ser exatamente ao nível do pecíolo.
!No lado do tumor, a mucosa subglótica ao nível da cricóide, deve ser descolada juntamente com o pericôndrio interno.
!É necessário a preservação do nervo laríngeo (recorrente) e de uma aritenóide no lado normal.
!A aproximação da cartilagem cricóide ao osso hióide deve ser efetuada num mesmo nível.
LPSC sumário dos pontos chaves
![Page 93: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/93.jpg)
Leonardo Rangel
!Fixação da aritenóide
! Invasão profunda da comissura
!Extensão subglótica anterior maior do que 7mm
!Extensão subglótica posterior maior do que 5mm
!Extensão ao teto do ventrículo
Contra-indicações
![Page 94: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/94.jpg)
Leonardo Rangel
!Pneumonia ( por aspiração )
!Mucosa redundante ( seio piriforme )
!Ptose da epiglote
!Encurvamento da epiglote (em forma de U)
!Rotura da pexia
!Estenose laríngea
COMPLICAÇÕES
![Page 95: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/95.jpg)
Leonardo Rangel
![Page 96: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/96.jpg)
Leonardo Rangel
![Page 97: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/97.jpg)
Leonardo Rangel
!decanulização, !respiração !fonação idade avançada edema de aritenóide
LPSC morbidade
![Page 98: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/98.jpg)
Leonardo Rangel
dec. degl. fonação !Piquet et al. 28d 23d 28d !Laccourreye et al. 09d 16d 28d !Lefebvre et al. 19d 15d 21d Advances in Otolaryngology-Head and Neck Surgery 1998; 12:1-15.
LPSC – CHEP resultados funcionais
![Page 99: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/99.jpg)
Leonardo Rangel
AUTOR N estágioRec. local
%Sobrevida
%Seg. mín.
%
Laccourreye et al,1990(18)
68
T1-T4 0,0
71,4 3 anos
18 mêses
Laccourreye et al,1993(25) 19
T3
5,6 84,2 5 anos
Chevalier e Piquet,1994
(22) 61 T1-T4 3,3 79,0 5 anos
de Vicenttis et al,1996 (20) 70 T1-T4 7,1 91,0 3 anos
LPSC – CHEP
![Page 100: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/100.jpg)
Leonardo Rangel
# RESULTADOS FUNCIONAIS E
TERAPÊUTICOS
LPSC – CHEP INCA – RJ (1995 – 1999)
Análise de 50 casos
![Page 101: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/101.jpg)
Leonardo Rangel
! decanulização 33d (08 – 120d) ! deglutição 38d (07 – 120d) ! fonação 33d (08 – 120d)
LPSC – CHEP INCA – RJ (1995 – 1999)
Análise de 50 casos
![Page 102: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/102.jpg)
Leonardo Rangel
! pneumonia por aspiração 02 casos 04% !mucosa redundante 05 casos 10% ! rotura da pexia 01 caso 02% ! fístula 01 caso 02% ! estenose laríngea 02casos 04%
LPSC – CHEP INCA – RJ (1995 – 1999)
Análise de 50 casos
![Page 103: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/103.jpg)
Leonardo Rangel
!T2 88% 3 anos
!T3 72% 3 anos
LPSC – CHEP INCA – RJ (1995 – 1999)
Análise de 50 casos
![Page 104: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/104.jpg)
Leonardo Rangel
!O procedimento é exequivel em casos selecionados de tumores glóticos T2 e T3
!A sobrevida global é comparável à das cirurgias mais alargadas quando indicadas em situações idênticas
!A recuperação da respiração, deglutição e da fonação é obtida na maioria dos pacientes (96% - 48 pacientes)
LPSC – CHEP INCA – RJ (1995 – 1999)
Análise de 50 casos
![Page 105: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/105.jpg)
Leonardo Rangel
204 Casos LPV 85 CHEP 119
Controle Local (10 anos) 69,3% (p< .0001) 94,6%
Annals Oct 2000 Ollivier Laccourreye,MD,Laurent Laccourreye,MD, Dominique Garcia,MD, Raimundo Gutierrez-Fonseca,MD, Daniel Brasnu,MD,
Gregory Weinstein,MD.
Vertical Partial Laryngectomy Versus Supracricoid Partial Laryngectomy
For Selected Carcinomas Of The Vocal Cord Classified As T2N0
![Page 106: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/106.jpg)
Laringectomia quase total (near-total laryngectomy)
Mayo Clinic – 1974 Bruce Pearson
![Page 107: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/107.jpg)
Remoção quase total do órgão
Preservação da voz e da deglutição
Traqueostomia definitiva
Laringectomia quase total
![Page 108: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/108.jpg)
Indicações
Tumor T3 ou T4 restrito a um lado da laringe
#glote# supraglote# sub-glote# seio piriforme
![Page 109: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/109.jpg)
contra-indicações
# tumor com extensão bilateral # comprometimento do espaço inter-aritenóideo # extensão circunferencial da subglote
![Page 110: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/110.jpg)
Complicações
# aritenóide imóvel # estenose do “shunt” # deiscência do “shunt” # estenose do traqueostoma # fístula
![Page 111: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/111.jpg)
! Bronco-aspiração
! Dificuldades para a retirada da SNG
Complicações Tardias
![Page 112: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/112.jpg)
vantagens
# possibilidade de preservação da voz
# dispensa o uso de prótese
# baixo custo
![Page 113: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/113.jpg)
Desvantagens
# permanência do traqueostoma (difícil manuseio)
# dificuldade de coordenação motora (mão-respiração-voz)
![Page 114: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/114.jpg)
Técnica
Leonardo Rangel
![Page 115: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/115.jpg)
Leonardo Rangel
![Page 116: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/116.jpg)
Leonardo Rangel
![Page 117: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/117.jpg)
Leonardo Rangel
![Page 118: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/118.jpg)
Leonardo Rangel
![Page 119: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/119.jpg)
Leonardo Rangel
![Page 120: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/120.jpg)
Leonardo Rangel
![Page 121: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/121.jpg)
Leonardo Rangel
![Page 122: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/122.jpg)
Leonardo Rangel
![Page 123: Cancer de Laringe Precoce](https://reader037.vdocuments.pub/reader037/viewer/2022102516/55d0beedbb61ebac5c8b45e5/html5/thumbnails/123.jpg)
Leonardo Rangel