Donor Aortic Graft Improves Reconstruction

The researchers describe how this approach – which uses cryopreserved aortas from deceased donors to replace removed larynx tissue – allowed patients to avoid a permanent tracheotomy and maintain voice and swallowing function with no need for immunosuppressive medications.

"Without this new reconstructive technique, most of these patients would have required a total laryngectomy," says Doctor Steven Zeitels. "I do not believe anything like this has been achieved before – especially for larynx cancer reconstruction in patients whose tumours recurred after radiotherapy."

Although small laryngeal tumours can be successfully removed through minimally invasive laser surgery or treated with radiation, advanced tumours require more invasive procedures to remove the affected area, especially when chemotherapy and radiation have failed as initial treatment. In these situations, problems with the healing of tissues previously exposed to radiation and the lack of reliable reconstructive techniques have meant that a majority of patients having partial laryngectomy still needed a permanent tracheotomy – an opening through the neck and into the trachea – resulting in substantial voice and swallowing dysfunction. Since the quality of life would probably be better with removal of the entire larynx, patients and their surgeons often chose a total laryngectomy.

To address the reconstructive limitations of partial laryngectomy, Zeitels and Doctor John Wain developed an approach using the body's largest blood vessel, the aorta, to reconstruct the larynx. The surgeons first used a previously frozen aortic graft for reconstruction after partial laryngectomy for recurrent cancer in 2009. Over the next two years, they performed the procedure on 15 patients, 8 of whom had previously received radiation therapy. All of these procedures were performed in one operation, combining both the tumour removal and reconstruction at the same time, and no immunosuppressive medications were needed.

Of that initial group of patients, all were able to have their postoperative tracheotomy tubes removed and resume breathing normally. All resumed speaking without the need for assistive devices, although their vocal quality depended on how much tissue had been removed, and all but one recovered and maintained swallowing function. Two patients had recurrence of their advanced tumours that required subsequent total laryngectomy. No stents were needed to keep patients' airways open, unlike in pilot trials using similar aortic grafts to reconstruct the trachea, which have had limited success.; Source: Massachusetts General Hospital (MGH)