1 case died 5 years after operation from pulmonary embolism.
1 case died 4 years after operation from pneumonia.
In both the last cases recurrence was excluded.
The condition of the patient after thyrotomy. The voice results are often surprisingly good even when a free excision of soft parts, including one or both vocal cords, has been required. In from 40 to 60% of cases that are cured, the voice is practically normal, though rough and reduced in volume and range. Of the remainder, the majority recover sufficiently to produce a considerable whisper, and only a few suffer complete loss of voice. The causes of a complete loss of voice, when it occurs, are chronic inflammation, cicatricial contractions, or improper union of the cartilage. Further, a loss of voice is probable in the event of a recurrence of the growth.
The breathing is not affected unless the operation is followed by stenosis. The power of swallowing is soon regained, and the general condition of those who are cured is one of complete happiness and general excellence of health.
These results may now be briefly compared with those obtained by laryngectomy, whether partial or complete.
Hemi-laryngectomy. The immediate mortality of this operation also has been greatly reduced. Sendziak collected 108 cases, up to 1894, showing a mortality of 26.3%; von Bruns 106 cases, between 1890 and 1898, with a mortality of 17%; Gluck has performed thirty-five such operations with only three deaths—8.1%. The number of cases reported in England is too small to be of value, chiefly because thyrotomy or total extirpation has been considered better. Taking, therefore, the best published results, it appears that the mortality is at least twice as great as with thyrotomy.
The danger of recurrence is also greater, partly because the glands are affected. Statistics show that recurrence occurs in at least one-fourth of the cases, possibly more, and is generally fatal. It is impossible to give a prognosis as to cure in the early stages after operation, but there are instances of life being prolonged for many years; a case of Gluck’s lived for eleven years.
The after-condition is not unsatisfactory. The permanent wearing of a tracheotomy tube is rarely necessary. Swallowing is soon recovered, and the voice is often good.
Total laryngectomy. Although the mortality of this operation has been greatly reduced by many improvements in recent years, it still remains higher than that of thyrotomy. As far as can be judged from the small number of cases that have been reported by English surgeons, there seems to be a direct mortality of at least 20% from these operations. C. Jackson[21] has, however, performed eight consecutive total laryngectomies without a death in the first thirty days. He writes: ‘Of eight total laryngectomies done by me, three were hemi-laryngectomies followed by recurrence and the total operation. Of the eight laryngectomies, one lived seven years. I felt justified in claiming a cure, but upon inquiry a few weeks ago I was informed by relatives that he died of cancer of the stomach. One case lived three years without recurrence, dying of cerebral hæmorrhage, and one eight months, dying of alcoholism. Of the remaining five, three recurred within a year, one apparent cure was lost to observation after a year, and one is too recent to record: one of the three prompt recurrences had metastases in the lungs, liver, and pancreas. Thus, of eight laryngectomies, no absolute ultimate cures can be claimed, though three were apparent cures at the end of one year.’