Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures

Abstract

Long-term oncological and functional results from a retrospective study on 469 patients over a 10-year period of subtotal laryngectomies (SL), 399 supracricoid partial laryngectomies (SCL) and 70 supratracheal partial laryngectomies (STL) are presented. The mean follow-up time was 97 months (range 60–165 months). Acute complications, types and rates of late sequelae, functional results, 2-year post-operative scores of laryngeal function and quality of life are reported. The observed long-term results were: SCL, 5-year overall and disease-free survival: 95.6, and 90.9%, respectively; 2-year post-operative laryngeal function preservation: 95.7%; STL, 5-year overall and disease-free survival: 80 and 72.9%, respectively; 2-year post-operative laryngeal function preservation: 80%. The performance status scale for laryngeal function preservation showed very high 2-year scores, with no significant differences depending on the type and extent of surgery. The adopted type of function-sparing surgery provided overall and disease-free survival rates that were somewhat better than those reported in studies based on organ-sparing protocols with chemoradiotherapy. The rate of total laryngectomy of completion in this series was 4.4%. A new classification of the current horizontal partial laryngectomies is also proposed, namely “Horizontal Laryngectomy System” (HOLS), based on the extent of surgical removal of laryngeal structures.

Quality of Life After Conservation Surgery for Laryngeal Cancer

“…40 Other efforts such as a European proposal for a new partial laryngectomy nomenclature may contribute to foster more uniform and reproducible review of outcomes and coherent presentation of findings. 41 Regrettably, the study of the outcomes of transcervical partial laryngectomy, by virtue of the fact that it remains a rare option used only in a small number of centers, is certain to produce results with limited statistical power. This fact does not mean that the existing plethora of small series reports with valuable expert opinion should be discounted, particularly if the findings are consistent between various investigators.…”

Swallowing, voice, and quality of life after supratracheal laryngectomy: Preliminary long‐term results

“…Overall survival has been shown to be good for patients treated with STL and, at 5 years, SCL and STL were demonstrated to provide similar rates of local control . Moreover, it was found that STL can be used as salvage surgery, even after organ‐sparing protocols .…”

Acta Otorhinolaryngologica Italica

“…They must accept the possibility that the procedure may become more extended, implying that the rate of complications may become higher and the time of rehabilitation may become longer. For example, if frozen sections reveal positive margins on the subglottic mucosa during an OPHL Type II, the procedure will be converted to an OPHL Type III, which still provides the same excellent oncological and functional outcomes, but will have a longer hospital stay and rehabilitation time, and a higher rate of immediate and late complications 2 10 27 . In this CF, the surgeon has the possibility to highlight the most plausible extensions for each patient, if unexpected infiltration of surrounding tissues is discovered during surgery.…”