Open Partial Horizontal Laryngectomies for T3–T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization

Abstract

Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate–advanced laryngeal cancers (LC). T–N categories are well-known prognosticators: herein we tested if “anterior” vs. “posterior” tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor. We analyzed a retrospective cohort of 85 T3–4a glottic LCs, treated by Type II or III OPHL (according to the European Laryngological Society classification) from 2005 to 2017 at two academic institutions. Five-year overall survival (OS), disease-specific survivals (DSS), and recurrence-free survivals (RFS) were compared according to tumor location and pT category. Anterior and posterior tumors were 43.5% and 56.5%, respectively, 78.8% of lesions were T3 and 21.2% were T4a. Five-year OS, DSS, and RFS for T3 were 74.1%, 80.5%, and 63.4%, respectively, and for T4a 71.8%, 71.8%, and 43%, respectively (p not significant). In relation to tumor location, the survival outcomes were 91%, 94.1%, and 72.6%, respectively, for anterior tumors, and 60.3%, 66.3%, and 49.1%, respectively, for posterior lesions (statistically significant differences). These data provide evidence that laryngeal compartmentalization is a valid prognosticator, even more powerful than the pT category.

Laryngeal Compartmentalization Does Not Affect the Prognosis of T3-T4 Laryngeal Cancer Treated by Upfront Total Laryngectomy

“…As a contribution to this topic, two recent studies have been published claiming that T-topography (distinguished in anterior vs. posterior involvement of the PGS) could represent a significant prognosticator in patients to be treated by OPHLs for T3–T4 LCs [ 11 , 12 ]. By contrast, in the present retrospective study focused on patients treated by upfront TL, we did not find a similar significant difference in survival outcomes comparing tumors with anterior vs. posterior laryngeal compartmentalization.…”

“…PGS involvement was retrospectively re-assessed according to previously published criteria, considering a frontal plane passing through the arytenoid vocal process and perpendicular to the ipsilateral thyroid lamina as the boundary between anterior vs. posterior PGS [ 10 , 11 , 12 ]. Laryngeal motility and involvement of the medial wall of the piriform sinus were also considered as ancillary signs for the definition of anterior vs. posterior topography of each tumor (T-topography).…”

“…For example, regarding open partial horizontal laryngectomies (OPHLs) applied to T3-T4 LCs, some authors have recently shown that tumor extension (distinguished in anterior vs. posterior PGS involvement, based on a virtual coronal plane passing through the arytenoid vocal process and perpendicular to the ipsilateral thyroid lamina) is a major prognosticator [ 11 , 12 ]. They therefore concluded that anterior cT3 tumors, without arytenoid fixation, can be successfully managed by OPHLs, and this approach could also be proposed for treatment of anterior cT4aN0, whereas it should be considered less safe in posterior cT3 tumors with crico-arytenoid joint fixation, since these lesions have clinical and biological behaviors that are quite similar to cT4a tumors.…”

Learning Modern Laryngeal Surgery in a Dissection Laboratory

“…As emphasized in recent work, surgical ability (as a matter of fact, the success of a procedure requires millimetric accuracy) and strict patient selection are mandatory for good results 7,8,9 . In good hands, and if applied to the proper patients and diseases, TLM and OPHL exhibit solid surgical and survival outcomes.…”

A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases

“…In the latest version of the 8th Edition of the Union for International Cancer Control—American Joint Committee on Cancer (UICC-AJCC) TNM staging system, cT3 is defined as a tumor determining vocal fold and arytenoid fixation, invading the pre-epiglottic (PES) and/or paraglottic space (PGS) or minimally infiltrating the laryngeal framework [3]. Arytenoid fixation is considered the best predictive factor for posterior PGS involvement and cricoarytenoid unit (CAU) infiltration [4,5,6,7]. It is worth noting that, when the tumor involves the cricoarytenoid joint and adjacent intrinsic muscles, the recurrent nerve, branches of the inferior laryngeal artery, vein, and related lymphatic vessels may all represent possible pathways for extra-laryngeal tumor spread, causing a high rate of local recurrence and making surgical organ preservation a risky therapeutic option.…”