17 Other studies have reported better survival in surgically treated patients; however, it is impossible to exclude bias in many of these studies. Another possibility is the increased long-term toxicity from concurrent chemoradiation protocols, and an apparent trend toward increased death rates due to non-primary cancer-related causes.34 Further research will be required
in the coming years to elucidate the causes of this apparent decrease in larynx cancer survival, and/or better select patients for surgical versus non-surgical treatment. CONCLUSIONS The management Inhibitors,research,lifescience,medical of advanced laryngeal cancer has evolved toward a predominance of non-surgical strategies, in an endeavor to avoid the sequelae of total laryngectomy. This has been facilitated
by the development of modern chemoradiotherapy protocols with improved local control compared to radiotherapy alone. Ongoing challenges include development Inhibitors,research,lifescience,medical of strategies to reduce toxicity and adverse functional outcomes. Most very advanced (T4) laryngeal cancers are best treated with up-front total laryngectomy, due to the lower likelihood of response with non-surgical treatment. The role of total laryngectomy is increasingly as a salvage procedure for cases failing radiotherapy or chemoradiotherapy. Of increasing concern Inhibitors,research,lifescience,medical are reports of reduced survival among patients with laryngeal cancer, and speculation that this may be linked to recent changes Inhibitors,research,lifescience,medical in treatment paradigms. Abbreviations: RTOG Radiation Therapy Oncology
Group SCC squamous cell carcinoma VA Veterans Administration.
Since the nineteenth century, when Kocher implemented the classical cervical thyroidectomy, little has changed in this procedure.1 When performed by experienced surgeons, the cervical approach is relatively short but unfortunately leaves a noticeable scar. Further advances in surgical instrumentation have introduced the minimally invasive thyroid Inhibitors,research,lifescience,medical surgery. The endoscopic thyroid surgery resulted in less morbidity and smaller surgical scars and developed into several different techniques.2 Nevertheless, Brefeldin_A the endoscopic cervical approach is surgically challenging since the neck is a very confined space and can be applied today to a small group of patients. The non-cervical, remote access choose size approaches originally developed unfortunately primarily due to cosmetic considerations—poor wound healing of certain ethnic groups and the aversion in the Asian culture to neck scars.3 Ikeda et al. in 2000 were the first to develop the transaxillary endoscopic approach to the thyroid.4 With the introduction of the Da Vinci robot (Intuitive Surgical, Sunnyvale, CA, USA), some surgeons have recognized its potential advantages. The South Korean team from Seoul, led by Chung, pioneered the transaxillary approach to the thyroid gland in late 2007.