Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know?

Abstract

Supracricoid laryngectomies (SCLs) are conservative organ-sparing surgical techniques for the treatment of selected T2-T4 laryngeal carcinomas. Although these procedures allow preserving the larynx and its functions, in several countries SCLs are not adopted in oncological protocols. One of the possible reasons to account for this choice is the complexity of post-surgical in-hospital management and the variability in functional results. The aim of this review is to analyse the literature on functional results after SCLs as knowledge on functional results will help in focusing on what is needed in the future to reach more standardized post-surgical procedures and homogeneous outcomes. The analysis of the length of hospital stay, feeding-tube removal time and time to eventual tracheotomy decannulation showed a marked variability across authors and centres. Several factors may come into play, including health-system organizations in different countries. In most studies in-depth description of the criteria applied for discharge, tracheotomy tube removal and commencement of oral feeding were not reported. Moreover, the review on swallowing functional outcomes showed marked variability, as well as a lack of consensus on how to assess swallowing after SCLs. The analysis of voice functional outcomes also revealed a marked variability; surprisingly, the tools applied in the assessments were very often not adequate for substitution voice. Literature review showed that voice- and swallowing-related quality of life are often satisfactory but the variability among centres is still too large. Therefore, there is a need for clearer clinical recommendations on early post-surgical management, tracheal-cannula and feeding-tube removal criteria, voice- and swallowing-assessment protocol, rehabilitation need and timing.

Overview of surgery for laryngeal and hypopharyngeal cancer in Ontario, 2003‐2010

“…With the popularization of nonsurgical organ preservation protocols, this is also partly because of the limited indications for these approaches. However, the low number of partial laryngeal resections could also be related to the study period during which there was increased recognition of the role and value of transoral laser surgery . There has been and there will likely continue to be an increase in the utilization of this technique to treat early select laryngeal and hypopharyngeal cancers in Ontario.…”

Transoral laser microsurgery for managing laryngeal stenosis after reconstructive partial laryngectomies

“…OPHL outcomes, and ways to improve them, are beyond the scope of this study (our research group has already described OPHL techniques and their oncological outcomes elsewhere). Functional outcomes, in terms of length of hospital stay, feeding‐tube removal time, time to tracheostomy decannulation, swallowing, and voice features have also recently been addressed . Further studies with a randomized and perspective design would be needed to investigate whether different surgical techniques would result in lower POLO rates after open partial laryngectomy.…”

“…The main aims of conservative surgery for laryngeal carcinoma are to control the disease and enable a good functional recovery of breathing, swallowing, and speech, avoiding the need for a permanent tracheostomy. However, organ preservation is not just a matter of sparing anatomical structures; it also involves the reconstruction of a functional neolarynx . We recently proposed a new classification of open partial horizontal laryngectomies (OPHLs): supraglottic laryngectomy (type 1), supracricoid laryngectomy with cricohyoidoepiglottopexy (type 2a), or cricohyoidopexy (type 2b); and supratracheal laryngectomy with tracheohyoidoepiglottopexy (type 3a) or tracheohyoidopexy (3b) .…”

“…However, organ preservation is not just a matter of sparing anatomical structures; it also involves the reconstruction of a functional neolarynx. 1 We recently proposed a new classification of open partial horizontal laryngectomies (OPHLs): supraglottic laryngectomy (type 1), supracricoid laryngectomy with cricohyoidoepiglottopexy (type 2a), or cricohyoidopexy (type 2b); and supratracheal laryngectomy with tracheohyoidoepiglottopexy (type 3a) or tracheohyoidopexy (3b). 2 Functional complications of OPHL have been reported, particularly concerning swallowing and respiratory functions.…”

Open partial horizontal laryngectomy using CO2 fiber laser

“…Open partial horizontal laryngectomies (OPHLs) represent a group of surgical procedures that have been recently classified with a systematic nomenclature by Succo et al OPHLs could greatly benefit from the application of CO 2 fiber laser during the surgical procedure, as the quality of margins, the resection accuracy, and the possibility to “tailor” the resection based on the real tumor extent are crucial for the oncologic and functional outcomes …”