Laryngeal Cancer: Recent Paradigm Shift in Larynx Preservation

Abstract

Background: The evolution of laryngology over the past 200 years has transformed laryngeal cancer from the most feared to the most curable head and neck cancer. The delicate balance with laryngeal cancer management revolves around improving survival while preserving function. Chemoradiotherapy (CRT) has become the standard of care for larynx preservation in advanced laryngeal cancers. Recent works have shown faltering survival trends for patients with laryngeal cancer, and we are challenged to improve and innovate. Methods: A literature review. Results: Overall survival of laryngeal cancer in the US was 70% in 1977 and, after 40 years, 61% in 2016. As CRT prevailed over the past 2 decades, the incidence of open laryngeal surgery as initial treatment declined. Congruent with contemporary minimally invasive surgery (MIS) trends, it is imperative that the head and neck surgeons refine partial laryngectomy (PL) procedures using modern equipment and techniques. Since 2016, our international collaboration team has conducted multiple preclinical trials focused on blending transoral surgeries with conventional open laryngectomies. An innovative hybrid approach by blending transoral robotic surgery or endoscopic transoral surgery with limited open (6-cm skin incision) supracricoid PL may facilitate postoperative and functional recoveries, in turn making larynx preservation procedure more accessible to surgeons and patients. Conclusions: Head and neck surgeons are in an important position to potentially avoid total laryngectomy in some patients through PL procedures that may offer survival benefits with improvements in function. Earnest endeavor in pursuing MIS may bring once fading open larynx preservation surgeries to the forefront of the patient care.