Abstract
The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.
Highlights
In recent years, the introduction of chemoradiation-based organ-sparing protocols [1,2,3] has demonstrated that larynx preservation is feasible even when this organ is affected by intermediatelocally advanced cancer
Even considering the good results obtained by transoral approaches [transoral laser microsurgery (TLM) and transoral robotic surgery (TORS)] [43, 44], type I and type IIb open partial horizontal laryngectomy (OPHL) allow good outcomes in function preservation management of early-intermediate supraglottic cancer (95% at 5 years) [45]
In patients affected by intermediate cancer, the locoregional control (LRC) and disease-free survival (DFS) at 5 years reach 88.7 and 86.4%, respectively, while in patients with an early extra-laryngeal extension, LRC drops to 64.8% and DFS to 52.7% [22, 23]
Summary
The introduction of chemoradiation-based organ-sparing protocols [1,2,3] has demonstrated that larynx preservation is feasible even when this organ is affected by intermediatelocally advanced cancer This approach, together with associated surgical procedures, has led to a considerable change in the therapeutic approach to laryngeal cancer, characterized by anatomical sparing of the larynx or preservation of its functions [4, 5]. The excellent reliability of the technique is demonstrated by robust and repeatable oncological outcomes at a similar level to function sparing results [8, 9] as long as strict eligibility criteria are applied Thanks to this rigorous approach, with a further comparative balance between pre- and post-treatment staging, OPHLs provide excellent oncological and functional results as rescue procedures in radio-recurrent [10] and laser-recurrent [11] laryngeal cancer [12]. A mini-review of recent literature, focusing on OPHLs, is reported in order to assess the changes which are occurring in open laryngeal organ preservation surgery, based on selection of patients, indications, functional outcomes, strategies, and technique refinements
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
