Current Status of Partial Laryngeal Surgery for Advanced Laryngeal Cancer: When and Why?

Abstract

Purpose of review: This paper aims to evaluate the evolution and current status of partial laryngeal surgery in the treatment of advanced laryngeal cancer (LC). Specifically, recent progress in the selection of both patients and tumors, together with surgical and rehabilitation innovations, have contributed to balancing oncological control with the maintenance of quality of life in naïve and radiorecurrent patients. The main aspect is represented by the recognized role of open partial horizontal laryngectomies (OPHLs) in this new era of laryngeal cancer treatment.

Recent findings: Recent advancements highlight OPHLs' efficacy for conservative management of intermediate to advanced stages of LC. Innovations such as supratracheal partial laryngectomy have expanded surgical options, offering a modular approach to complex cases. Improved understanding of tumor biology, enhanced imaging techniques, and more precise preoperative planning have led to better patient outcomes, emphasizing the importance of a conservative function-preserving surgical treatment. These advancements reflect a broader trend towards individualized treatment plans that prioritize both survival and quality of life. OPHLs play an important role in current management of intermediate/advanced LC, effectively balancing oncological control with the preservation of laryngeal functions. Critical factors include meticulous patient and tumor selection, the impact of surgical and technological refinements on functional outcomes, and the necessity of a multidisciplinary approach in treatment planning. Current evidence justifies the use of these interventions in many intermediate T-stage laryngeal tumors, even at risk of upstaging on pathological examination. The oncological results, the preservation of laryngeal function and the laryngectomy-free survival achieved with OPHLs appear to be highly competitive with those of non surgical organ-preservation protocols, aiming to introduce a new standard in the LC treatment.

Keywords: Laryngeal cancer; OPHL; Partial laryngeal surgery; Partial laryngectomy.

Fig. 1

Endoscopic work-up in narcosis: A glottic cancer involving the left vocal cord and determining impairment of the vocal cord motility (O^ 5 mm telescope). B Same patient: a slight submucosal swelling with evident tributary vessel in the left anterior subglottic area is noticeable. Tumor highly suspected for spreading through the cricothyroid membrane (70° 5 mm telescope)

Fig. 2

Subglottic level on axial FSE T2-weighted (a), FSE fat sat T2-weighted (b), FSE T1-weighted (c) and 3D gradient echo fat sat T1 post contrast (d); FSE T2-weighted on sagittal plane (e). A neoplastic submucosal thickening (white dashed arrows) with enhancement (d) in the anterior and left side of subglottic level. At the same level similar soft tissue representing extralaryngeal spread (white arrows) through the cricothyroid membrane (e) (curved arrow) is present. The cricoid cartilage (C) does not show abnormal alterations indicative of invasion. FSE, fast spin echo