Abstract
Simple SummaryComplete removal of the larynx (total laryngectomy) offers a curative approach for advanced laryngeal and pharyngeal cancer. If the operation is performed after radiotherapy wound healing problems have to be taken into account which can be managed by adapted reconstructive techniques. Laryngectomy results in the loss of voice which can be managed e.g., by using a voice prosthesis with a significant increase in quality of life. Total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology.Surgical removal of the larynx (total laryngectomy) offers a curative approach to patients with advanced laryngeal and hypopharyngeal (squamous cell) cancer without distant metastases. Particularly in T4a carcinoma, laryngectomy seems prognostically superior to primary radio(chemo)therapy. Further relevant indications for laryngectomy include massive laryngeal dysfunction associated with aspiration and recurrence after radio(chemo)therapy, resulting in salvage surgery. The surgical procedure including neck dissection is highly standardised and safe. The resulting aphonia can be compensated by functional rehabilitation (e.g., voice prosthesis) associated with a significant quality of life improvement. This article presents an overview of indications, preoperative diagnostics, surgical procedures, including new developments (robotics), possible complications, the choice of adjuvant treatment, alternative therapeutic approaches, rehabilitation and prognosis. In summary, total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology.
Highlights
Total laryngectomy is the surgical removal of the larynx
The human papillomavirus (HPV) status has a subordinate role in laryngeal cancer; the prevalence is about 6% [6]
Patients with unilateral subglottic or advanced glottic squamous cell carcinoma and cN0 status should have at least a unilateral elective neck dissection as part of the primary laryngectomy, while patients with supraglottic, hypopharyngeal or approximately midline tumours should have a bilateral elective neck dissection, in order to minimise the risk of recurrence from clinically occult metastases, especially if there is no plan for adjuvant radio(chemo)therapy to cover the lymphatic drainage territory [28,29,45]
Summary
Total laryngectomy is the surgical removal of the larynx. It was first performed on a patient with laryngeal cancer by Christian Albert Theodor Billroth in Vienna on. 2. Diagnostic Work-Up upper aero-digestive tract is easy to perform in practice [13], but by consensus is not Potential symptoms of a patient cancer are hoarseness, and recommended at the present time aswith therelaryngeal is no evidence to suggest that dyspnoea it lowers the dysphagia [14]. Precancerous conditions such as persistent vocal cord leucoplakia should beDiagnostic completelyWork-Up excised if possible (excision biopsy), as some 20% of patients develop laryngeal cancer symptoms within five of years [15]. A hoarse voice lasting more than four history weeks should examined examination, a biopsy of the primary tumour as part of a panendoscopy under anaesendoscopically [8] Precancerous conditions such as persistent vocal cord leucoplakia thetic, be contrast-enhanced computed tomography After diagnostic work-up, laryngeal and hypopharyngeal cancers are categorised by the current 8th TNM classification, and staged according to the UICC (Union internationale contre le cancer) criteria [25]
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