Salvage Laryngectomy in Patients with Recurrent Laryngeal Cancer in the Setting of Nonoperative Treatment Failure

Abstract

Tumor staging, methods of initial and salvage treatment, and nodal disease were not significant predictors of survival. Both salvage partial and total laryngectomy were effective methods in the treatment of recurrent laryngeal cancer in carefully selected patients.

Management of the N0 neck in recurrent laryngeal squamous cell carcinoma

“…Van der Putten et al (12) also reported higher rates of complications following bilateral neck dissection in patients with neck dissection. In the study by Li et al (11), of the 72 early-stage patients, 15 (21%) patients without neck dissection had an improved survival compared to the 57 (79%) patients with neck dissection (P=0.042). By contrast, Wax and Touma (25) and Yao et al (26) recommended neck dissection in recurrent supraglottic carcinoma and advanced (rT3-T4) disease.…”

“…The optional management strategies for the primary tumor in recurrent laryngeal SCC are salvage surgery, including salvage total laryngectomy (STL), salvage partial laryngectomy (SPL) or endoscopic resection with a CO 2 laser (ERL), followed by re-irradiation with or without chemotherapy; supportive treatment and palliative chemotherapy are less effective options. Surgery is predominantly used for salvage in patients with recurrent laryngeal cancer following the failure of non-surgical treatments (radiation or chemoradiation) (10)(11)(12). ERL is only suitable for a small group of patients with early-stage disease.…”

“…As it has equivalent outcomes and lower rates of treatment-associated morbidity, ERL is currently used more frequently than open SPL for the treatment of recurrent early-stage disease (10). As conservative surgical techniques, SPL and ERL should only be considered for selected groups of patients without advanced loco-regional disease (10,11). For patients who have previously undergone surgery, a second or third surgery is usually the first choice for radical treatment over radiotherapy and chemotherapy (13,14).…”

Salvage surgery for head and neck squamous cell carcinoma

“…While preserving function, partial laryngectomy affords no survival advantage. In a retrospective analysis of 56 patients with recurrent laryngeal cancer comparing total to partial laryngectomies, patient survival was not affected by the primary treatment or by salvage surgical approach, but was improved by obtaining negative margins [35]. Patients with an early disease relapse appear to have a worse prognosis compared with patients with a delayed relapse [36].…”

Analiza 191 pacjentów z rakiem krtani w oparciu o nową klasyfikację otwartych poziomych laryngektomii częściowych według Europejskiego Towarzystwa Laryngologicznego z 2014 roku

“…Laryngektomie pionowe, ze względu na szerokie stosowanie technik laserowych i gorsze wyniki funkcjonalne, są obecnie stosowane rzadziej [6,7]. Natomiast wiele technik resekcji poziomych, o różnym zakresie i miejscach zespolenia zyskało znaczenie zarówno jako leczenie pierwotne, jak i postępowanie ratujące [8][9][10][11][12][13][14].…”