Butlin has performed total laryngectomy upon seven patients, only one of whom died from the operation. He says: ‘I first removed a large mass of glands on both sides, and later took out the larynx, which was so diseased, that the surrounding parts were infiltrated for a considerable distance. He lived six weeks after the second operation, and then died of double pneumonia, which was attributed to an attack of influenza when he was up and about his room. I do not know whether the pneumonia was due to that cause or to sepsis of the lungs, for we had on several occasions some difficulty in feeding him, and in getting a tube properly down his œsophagus.’
The following is a table showing Butlin’s operations since the year 1890, from a paper which was read at the Second Congress of the International Surgical Society at Brussels in 1908:—
| Operations. | |||||
| Number and type of operation | Type of operation | Number of patients | |||
| 23 | Thyrotomy 1 | 21 | patients | ||
| 1 | Hemi-laryngectomy | 1 | patient | ||
| 7 | Laryngectomy 2 | 6 | patients | ||
| — | — | ||||
| 31 | operations on | 28 | " | ||
| Died of the operation (1 thyrotomy, 1 laryngectomy) | 2 |
| Died of recurrence | 4 |
| Died of intrathoracic disease, probably cancerous glands, within 2 years | 1 |
| Died of cancer of tongue 3 | 1 |
| Lost sight of after operation | 1 |
| Alive after operation for recurrence | 2 |
| Well within 3 years | 3 |
| Died of other disease after 3 years | 1 |
| Well after 3 years 4 | 13 |
| — | |
| 28 |
1 In two patients the operation was repeated.
2 In one patient thyrotomy was followed by laryngectomy, but the patient was included amongst the thyrotomies only.
3 This was regarded as a second attack of cancer, for the disease of the tongue was some distance from the larynx, and there was no sign of cancer of the intervening parts. Also more than a year elapsed before he began to suffer from cancer of the tongue.
4 Periods during which patients remained well lasted from 3 to 15 years.
Recurrence after laryngectomy is, therefore, more frequent than after thyrotomy, and it is difficult to estimate the proportion of cases that are cured by this operation. Butlin writes: ‘Of the six patients who survived the operation, one died of probable cancerous glands in the mediastinum, one had inoperable recurrence in the cervical glands, three were alive within three years, and one was well three years after the operation.’ He says: ‘I began to perform laryngectomy three years ago on account of Gluck’s success, and of the excellent modification due to Solis Cohen. I wish I had begun to perform it earlier. I am sure that several of the cases on which I performed thyrotomy were much better fitted for laryngectomy, and I cannot help thinking I might have saved one or two patients in whom recurrence took place if I had then removed the larynx. I think the glands ought to be removed in every case in which there is extensive carcinoma of the larynx, even if it be intrinsic, unless the disease is limited to the middle zone of the interior of the larynx. Even in these cases it would probably be a wise precaution to remove the glands. I have never removed the glands and the larynx at one sitting.’ Von Bruns,[22] from statistics of all total operations since 1890, gives the following proportions:—
| Cure, over 3 years | 8.6% |
| Cure, 1 to 3 years | 17.4% |
| Cure, under 1 year | 32.0% |
| Recurrence | 23.4% |
| Death due to operation | 18.5% |