Partial Laryngectomy for pT4a Laryngeal Cancer: Outcomes and Limits in Selected Cases

Abstract

A large multi-institutional case series of laryngeal cancer (LC) T4a was carried out, including 134 cases treated with open partial horizontal laryngectomies (OPHL) +/- post-operative radiation therapy (PORT). The goal was to understand better whether OPHL can be included among the viable options in selected pT4a LC patients who refuse a standard approach, represented by total laryngectomy (TL) + PORT. All 134 patients underwent OPHL type I (supraglottic), II (supracricoid), or III (supratracheal), according to the European Laryngological Society Classification. Comparing clinical and pathological stages showed pT up-staging in 105 cases (78.4%) and pN up-staging in 19 patients (11.4%). Five-year data on overall survival, disease-specific survival, disease-free survival, freedom from laryngectomy, and laryngo-esophageal dysfunction-free survival (rate of patients surviving without a local recurrence or requiring total laryngectomy and without a feeding tube or a tracheostomy) were, respectively, 82.1%, 89.8%, 75.7%, 89.7%, and 78.3%. Overall, complications were observed in 22 cases (16.4%). Sequelae were observed in 28 patients (20.9%). No patients died during the postoperative period. This large series highlights the good onco-functional results of low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction, treated with OPHLs. The level of standardization of the indication for OPHL should allow consideration of OPHL as a valid therapeutic option in cases where the patient refuses total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy.

Keywords: OPHL; T4 laryngeal cancer; laryngeal cancer; laryngeal preservation; partial laryngectomy; radiotherapy.

Figure 1

Glottic squamous cell carcinoma cT3 (left vocal cord): endoscopic and radiological (MRI) picture: the tumor was likely to be sub-staged with endoscopic evaluation alone.

Figure 2

The radiological finding of suspected extra laryngeal extension through the cricothyroid membrane is evidenced (yellow arrow). Intraoperative evaluation (yellow arrow) confirmed the extra laryngeal spread through a vascular foramen of the cricothyroid membrane.

Figure 3

Overall Survival: Forrest Plot and Kaplan–Meier Estimator. Kaplan–Meier: * = p < 0.05 (LR); # = p < 0.05 (GBW).

Figure 4

Disease Specific Survival: Forrest Plot and Kaplan–Meier Estimator. Kaplan–Meier: ** = p < 0.01 (LR); ## = p < 0.01 (GBW). Forrest Plot: * = <0.05.

Figure 5

Disease-free Survival: Forrest Plot and Kaplan–Meier Estimator. Kaplan–Meier: * = p < 0.05, *** = p < 0.001 (LR); # = p < 0.05, ### = p < 0.001 (GBW). Forrest Plot: ** = <0.01.

Figure 6

Freedom From Laryngectomy: Forrest Plot and Kaplan–Meier Estimator. Kaplan–Meier: *** = p < 0.001 (LR); ### = p < 0.001 (GBW). Forrest Plot: *** = <0.001.

Figure 7

Laryngoesophageal Dysfunction Free Survival: Forrest Plot and Kaplan–Meier Estimator. Kaplan–Meier: * = p < 0.05, ** = p < 0.01 (LR); ## = p < 0.01 (GBW). Forrest Plot: * = <0.05.