Total Laryngectomy: A Review of Surgical Techniques.

Adit Chotipanich

doi:10.7759/cureus.18181

Abstract

Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end.Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.

Highlights

BackgroundThe total laryngectomy procedure involves the removal of all laryngeal structures and a section of the upper trachea, which leads to disconnection of the airway and a permanent breathing hole in the neck
A reduction in the utilization of total laryngectomy has been observed [2,3] since landmark trials in organ preservation for laryngeal squamous cell carcinoma by the Veterans Affairs Laryngeal Cancer Study Group in 1991 [4], followed by the Groupe d’Etude des Tumeurs de la Tête et du Cou group in 1998 [5] and the Radiation Therapy Oncology Group 91-11 in 2001 [6]
This review aims to broadly summarize the variation and improvement in surgical technique for total laryngectomy

Summary

Introduction

The total laryngectomy procedure involves the removal of all laryngeal structures and a section of the upper trachea, which leads to disconnection of the airway and a permanent breathing hole in the neck (tracheostoma). Routine thyroidectomy is still recommended for tumors that involve the subglottic, post-cricoid, and pyriform sinus because of the high risk of occult thyroid gland involvement and lymphatic metastasis in these tumors Apart from these concerns, thyroid-preserving laryngectomy in selected patients does not increase local recurrence rates, nor does it negatively affect disease-free survival [26]. The pharyngeal constrictors are stitched to the tongue base muscles These additional or modified techniques have shown more success in voice restoration than the traditional three-layer closure, and are associated with lower rates of voice restoration failure (between 0% and 10%) [77,79,80,81,82,83,84].

Conclusions

Disclosures