Laryngeal conservation surgery

Abstract

T he management of laryngeal carcinoma by conservation surgery is one of the most challenging aspects of head and neck surgical oncology, because both surgical expertise and a thorough understanding of the disease process are required for a successful outcome. Improper patient selection or an error in surgical judgment can result in lifethreatening complications or tumor recurrence in a patient with potentially curable disease. In the United States, laryngeal cancer (including pyriform fossa) afflicts 12,300 patients per year, representing 1.2% of all cancers and 50% of head and neck malignancies.’ Less than half of these patients develop early-stage lesions (Tl or T2), which are amenable to conservation surgery. Therefore, only 4,000 to 5,000 patients a year are candidates for conservation treatment. Many patients with earlystage lesions can be successfully treated with radiotherapy, leaving only a limited number of patients who require surgical therapy. However, this low number of candidates for surgical therapy results in fewer opportunities for training surgeons in these techniques and for maintaining the skills of established head and neck surgeons. Although the most important treatment goal is to cure the patient, quality-of-life issues are more than ever assuming an even greater role in the treatment decision-making process. Critical factors in evaluating treatment outcome are voice quality, deglutition, and complications of treatment such as aspiration, dysphagia, and radiation necrosis. Many times the decision to operate or irradiate depends on the treating physician’s personal philosophy. The purpose of this article is not to extol the virtue of any one modality over the other, but rather to help the treating physician identify the patient who may best be treated with conservation surgery with or without postoperative radiotherapy.