Conservation Surgery for Early Laryngeal Carcinoma

Background: Squamous cell carcinoma is the commonest malignant tumour of the larynx. The traditional treatment options have included radiotherapy and total laryngectomy. Due to the pivotal role of the larynx in respiration, speech and deglutition, conservative approaches to the management of malignant lesions were suggested. These organ-preserving policies aim at preserving most of the laryngeal functions without compromising the oncological outcomes. Such approaches include organ-preserving radio/chemotherapy protocols, endoscopic laser surgery, photodynamic therapy and open conservative surgery. Each of these has their indications, advantages and disadvantages. The modern trend towards organ preservation protocols and endoscopic laser techniques seems to have supplanted open conservative surgery. However, these techniques still have an important role in the management of laryngeal malignancies. Methods: This is retrospective study on 216 patients followed for a minimum of 2 years and a maximum of 16. All patients underwent partial surgery as first-line treatment: 135 underwent partial vertical laryngectomy, 76 underwent supraglottic hemilaryngectomy and 5 underwent supracricoid subtotal laryngectomy. Results: Our overall disease-free survival was 92.1%, which compares favourably with most series. Total laryngectomy was performed in 11 patients (in 10 as salvage and in 1 for intractable aspiration) resulting in a laryngeal preservation rate of 94.4%. The decanulation rate was 95% (11 patients in the three types of surgery). There were no major morbidities or surgery-related mortalities. The most significant complication was aspiration (18.9% of patients), but it could be managed conservatively in all but one case. Conclusion: In this era of organ preservation policies, open conservative surgery offers a viable option with comparable functional and oncological results. It should be considered when logistic, economical or patient factors make other protocols impractical.