Organ preservation surgery for laryngeal cancer

Abstract

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the locoregional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.

Difficulties in the surgical management of head and neck cancer patient

“…Early supraglottic tumours (T1, T2) are amendable by transoral laser microsurgery, supraglottic laryngectomy or supracricoid laryngectomy with cricohyoidopexy. One of the most important principles of open organ sparing surgery is preserving at least one cricoarytenoid unit as the functional unit of the larynx in order to keep the respiratory and digestive paths separated 64 . Transoral laser microsurgery is currently expanding its indications for progressively more advanced laryngeal cancer rivalling the most extensive function preserving open approaches like the supracricoid partial laryngectomy.…”

Extended Open Partial Laryngectomy with Titanium-Based Laryngeal Framework Reconstruction: Surgical Technique and Treatment Outcomes

“…In early tumors, clinical efficacy of surgery is comparable to the one of radiotherapy. However, radiotherapy cannot be repeated, so the surgery, which can be used as monotherapy or as a part of combined treatment, for instance followed by subsequent radiation therapy, appears a reasonable alternative [1][2][3]11].…”

“…Such approach can be safely assumed when planning endoscopic laser, open partial laryngectomy or radiotherapy [1,4,[7][8][9][10][11][12][13][14][15]. Treatment choices depend on the presence of local and regional tumor spread and its distant metastases [1,11].…”

“…In Poland, it accounts for approximately 2.7% of overall cancer morbidity in males and 0.4% in females [6]. Most cases originate in the glottis and the risk in males is eight times as high as in females [1][2][3][4].…”

“…Squamous cell carcinoma of the larynx constitutes 48% of all malignant head and neck cancers, excluding skin cancer [1][2][3][4][5]. In Poland, it accounts for approximately 2.7% of overall cancer morbidity in males and 0.4% in females [6].…”