Open Partial Laryngectomies: History of Laryngeal Cancer Surgery

Abstract

Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved in recent decades and was influenced by many historic events and the development of new technologies. Partial laryngectomies may be performed by open, endoscopic or transoral robotic approaches. In this historic paper, we describe the evolution of open partial laryngectomy techniques, indications and surgical outcomes. Since the first partial laryngectomy in 1788, many U.S., U.K. and European surgeons, including Henry Sands, Jacob da Silva Solis-Cohen and Theodor Billroth, performed this surgical procedure under local anesthesia for tuberculosis, cancer or syphilis. Partial laryngectomy gained reputation in the medical community in 1888 due to the laryngeal cancer and death of the prince of Prussia, Frederick III. Frederick III’s death represented the turning point in the history of partial laryngectomies, calling attention to the importance of semiotics, biopsy and early diagnosis in laryngeal cancers. Hemi-laryngectomy was indicated/proposed for lateral laryngeal tumors, while thyrotomy was indicated for cancers of the middle part of the vocal fold. The second landmark in the history of partial laryngectomies was the discovery of cocaine, novocaine and adrenaline and the related development of local anesthetic techniques, which, together with the epidemiological and hygienic advances of the 19th century, allowed for better perioperative outcomes. General anesthesia was introduced in the second part of the 20th century and further improved the surgical outcomes. The diagnosis of laryngeal cancer was improved with the development of X-rays and direct laryngoscopies. The 20th century was characterized by the development and improvement of vertical partial laryngectomy procedures and the development of horizontal partial laryngectomies for both supraglottic and glottic regions. The history and the evolution of these techniques are discussed in the present historical paper.

Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study

“…The survival status of laryngeal cancer patients has been significantly improved. Early laryngeal cancer 23 , 24 can be treated with hemilaryngectomy, preserving some of the laryngeal organs. Lee et al 25 A retrospective analysis of 119 patients with organ preservation (OP) compared stage I total laryngectomy and OP in patients with locally advanced T3/T4a laryngeal cancer The overall survival rates of total laryngectomy and OP patients were similar, with most patients able to maintain a normal diet after total laryngectomy and a higher local recurrence rate in OP patients.…”

Survival Benefit from Cancer‐Directed Surgery for Metastatic Head and Neck Cancer

“…From a therapeutic standpoint, a number of studies have clearly demonstrated the survival benefit of salvage surgical resection in advanced HNC, because it helps to achieve maximum tumor control and functional preservation. [18][19][20][21][22] Unfortunately, only a few studies have demonstrated the potential survival benefit of CDS in patients with M1 HNC, 7,23 and there is a lack of relevant research identifying which patients may benefit most from CDS treatment. In recent years, several studies have supported the survival benefit of CDS in metastatic pancreatic cancer and metastatic breast cancer.…”

Transoral robotic vertical partial laryngectomy (hemilaryngectomy) extended to the hypopharynx

“…To overcome these concerns, several partial laryngectomy techniques have been developed over the years, the first of which dates back to 1788 4 . Vertical laryngectomy, also called hemilaryngectomy, is a partial laryngectomy technique known since the 1800s that was proposed for lateral laryngeal tumors 3–5 . This surgical technique is used for cancers involving the true vocal cord, false cord, subglottic region, and sometimes epiglottis, through a surgical access obtained with a laryngofissure 2,6–8 …”

“…Therefore, the objective of laryngeal oncologic surgery is not only to remove the tumor, but also, as far as possible, to preserve the organ and its functions 2,3 . To overcome these concerns, several partial laryngectomy techniques have been developed over the years, the first of which dates back to 1788 4 . Vertical laryngectomy, also called hemilaryngectomy, is a partial laryngectomy technique known since the 1800s that was proposed for lateral laryngeal tumors 3–5 .…”

“…4 Vertical laryngectomy, also called hemilaryngectomy, is a partial laryngectomy technique known since the 1800s that was proposed for lateral laryngeal tumors. [3][4][5] This surgical technique is used for cancers involving the true vocal cord, false cord, subglottic region, and sometimes epiglottis, through a surgical access obtained with a laryngofissure. 2,[6][7][8] Thanks to the advent of transoral robotic surgery (TORS) and transoral laser microsurgery, laryngeal tumors removal can be performed in a less invasive way than traditional techniques providing excellent oncological and functional results.…”